Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery, Ohio State University Medical Center, Columbus, OH 43210, USA.
Neurosurgery. 2009 Dec;65(6):1147-52; discussion 1152-3. doi: 10.1227/01.NEU.0000359328.90826.97.
Surgical treatment of aneurysms of the anterior communicating artery complex is challenging, owing to its intricate vascular anatomy. Endoscopy is a recently rediscovered neurosurgical technique that could lend itself well to overcoming some of the vascular visualization challenges associated with this procedure. The purpose of this study was to quantify and compare the working area afforded by the microscope and the endoscope to the anterior communicating artery complex in different surgical approaches and using image guidance.
We performed a total of 9 dissections, including mini-supraorbital, pterional, and orbitozygomatic approaches bilaterally in 5 whole, fresh cadaver heads. We used computed tomography-based image guidance for intraoperative navigation as well as for quantitative measurements. We estimated the working area of the anterior communicating artery complex region, using both a rigid endoscope (4.0 mm in diameter and 18 cm long with 0- and 30-degree lenses) and an operating microscope. Operability was qualitatively assessed by the senior authors.
In microscopic exposure, the orbitozygomatic approach provided the greatest working area (204.5 +/- 33.9 mm2), as compared with the mini-supraorbital approach (114.8 +/- 26.9 mm2) and pterional approach (170 +/- 20.4 mm2; P < 0.05). Evaluation of the endoscopic working area showed that the supraorbital approach, using both 0- and 30-degree endoscopes, provided a working area greater than that of a conventional pterional approach (P < 0.05) and comparable to that of an orbitozygomatic approach (P > 0.05).
In our model, use of the endoscope, in an assistive manner to microscopic surgery, provided a working area advantage without loss of microneurosurgical techniques of dissection or of depth perception in the surgical field. This advantage was most prominent when smaller craniotomies were used.
由于前交通动脉复合体的血管解剖结构复杂，因此对其进行手术治疗具有挑战性。内窥镜是一种最近重新发现的神经外科技术，可以很好地克服该手术过程中与血管可视化相关的一些挑战。本研究的目的是量化和比较显微镜和内窥镜在前交通动脉复合体不同手术入路和使用图像引导下提供的工作区域。
我们总共进行了 9 次解剖，包括在 5 个完整的新鲜尸头双侧进行的迷你眶上、翼点和眶颧入路。我们使用基于计算机断层扫描的图像引导进行术中导航和定量测量。我们使用刚性内窥镜（直径 4.0 毫米，长 18 厘米，带有 0 和 30 度镜头）和手术显微镜来估计前交通动脉复合体区域的工作区域。资深作者对可操作性进行了定性评估。
在显微镜暴露下，眶颧入路提供的工作区域最大（204.5 +/- 33.9 mm2），其次是迷你眶上入路（114.8 +/- 26.9 mm2）和翼点入路（170 +/- 20.4 mm2；P < 0.05）。内窥镜工作区域的评估表明，使用 0 和 30 度内窥镜的眶上入路提供的工作区域大于传统的翼点入路（P < 0.05），与眶颧入路相当（P > 0.05）。
在我们的模型中，使用内窥镜以辅助显微镜手术的方式提供了工作区域优势，而不会丢失显微神经外科手术的解剖技术或手术视野的深度感知。当使用较小的骨窗时，这种优势最为明显。
