Barkhoudarian Garni, Del Carmen Becerra Romero Alicia, Laws Edward R
Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California 90404, USA.
Neurosurgery. 2013 Sep;73(1 Suppl Operative):ons74-8; discussion ons78-9. doi: 10.1227/NEU.0b013e31828ba962.
Three-dimensional (3-D) endoscopy is a recent addition to augment the transsphenoidal surgical approach for anterior skull-base and parasellar lesions. We describe our experience implementing this technology into regular surgical practice.
Retrospective review of clinical factors and outcomes.
All patients were analyzed who had endoscopic endonasal parasellar operations since the introduction of the 3-D endoscope to our practice. Over an 18-month period, 160 operations were performed using solely endoscopic techniques. Sixty-five of these were with the Visionsense VSII 3-D endoscope and 95 utilized 2-dimensional (2-D) high-definition (HD) Storz endoscopes. Intraoperative and postoperative findings were analyzed in a retrospective fashion.
Comparing both groups, there was no significant difference in total or surgical operating room times comparing the 2-D HD and 3-D endoscopes (239 minutes vs 229 minutes, P = .47). Within disease-specific comparison, pituitary adenoma resection was significantly shorter utilizing the 3-D endoscope (surgical time 174 minutes vs 147 minutes, P = .03). These findings were independent of resident or fellow experience. There was no significant difference in the rate of complication, reoperation, tumor resection, or intraoperative cerebrospinal fluid leaks. Subjectively, the 3-D endoscope offered increased agility with 3-D techniques such as exposing the sphenoid rostrum, drilling sphenoidal septations, and identifying bony landmarks and suprasellar structures.
The 3-D endoscope is a useful alternative to the 2-D HD endoscope for transnasal anterior skull-base surgery. Preliminary results suggest it is more efficient surgically and has a shorter learning curve. As 3-D technology and resolution improve, it should serve to be an invaluable tool for neuroendoscopy.
三维（3-D）内镜是最近才应用于经蝶窦手术治疗前颅底和鞍旁病变的一项技术。我们描述了将该技术应用于常规手术实践的经验。
回顾性分析临床因素及手术结果。
对我院引入3-D内镜后所有接受内镜下鼻内鞍旁手术的患者进行分析。在18个月的时间里，仅采用内镜技术进行了160例手术。其中65例使用了Visionsense VSII 3-D内镜，95例使用了二维（2-D）高清（HD）史托斯内镜。采用回顾性方式分析术中及术后情况。
比较两组，2-D高清内镜和3-D内镜在总手术时间或手术室手术时间方面无显著差异（239分钟对229分钟，P = 0.47）。在特定疾病的比较中，使用3-D内镜切除垂体腺瘤的手术时间明显更短（手术时间174分钟对147分钟，P = 0.03）。这些结果与住院医师或进修医师的经验无关。在并发症发生率、再次手术率、肿瘤切除率或术中脑脊液漏方面无显著差异。主观上，3-D内镜在三维技术（如暴露蝶骨嵴、钻除蝶骨间隔以及识别骨性标志和鞍上结构）方面提供了更高的灵活性。
对于经鼻前颅底手术，3-D内镜是2-D高清内镜的一种有用替代方案。初步结果表明，它在手术上更高效，学习曲线更短。随着3-D技术和分辨率的提高，它应成为神经内镜的一项宝贵工具。
