Tuchman Alexander, Platt Andrew, Winer Jesse, Pham Martin, Giannotta Steven, Zada Gabriel
Department of Neurosurgery, Keck School of Medicine, Los Angeles County-University of Southern California Medical Center, Los Angeles, California, USA.
Department of Neurosurgery, Keck School of Medicine, Los Angeles County-University of Southern California Medical Center, Los Angeles, California, USA.
World Neurosurg. 2014 Sep-Oct;82(3-4):450-4. doi: 10.1016/j.wneu.2013.03.073. Epub 2013 Mar 30.
Intracranial epidermoid tumors are epithelially derived lesions that may present particular challenges to neurosurgeons, often encasing critical neurovascular structures and extending into multiple subarachnoid cisterns. We aimed to evaluate our recent experience with endoscopic assistance to craniotomy with microsurgical resection of these lesions.
A retrospective review of patients undergoing endoscopic-assisted craniotomy for resection of an epidermoid tumor at the Keck School of Medicine of University of Southern California between 2009 and 2012 was conducted. In all patients, the surgical approach and tumor resection were first performed microscopically. This was followed by use of an angled endoscope to facilitate further inspection and additional resection of tumor using a two-surgeon technique.
Twelve patients undergoing 13 consecutive endoscopic-assisted craniotomies were included in the analysis. The mean patient age was 45 years. The mean maximal tumor diameter was 4.0 cm (range, 2.4-5.8 cm). Surgery was for recurrent epidermoid in 6 of 13 cases (46%). Epidermoid tumor location included the cerebellopontine angle (9 patients, 75%), fourth ventricle (2 patients, 17%), and third ventricle (1 patient, 8%). Surgical approaches included retrosigmoid craniotomy (8 patients), suboccipital craniotomy (1 patient), suboccipital craniotomy with supracerebellar approach (1 patient), extradural temporopolar approach (1 patient), and subtemporal approach (1 patient). In 11 of 13 cases (85%), additional tumor was identified upon inspection with an angled endoscope, facilitating additional tumor resection in each case. Gross or deliberate near total resection was achieved in 7 of 13 cases (54%). Four patients (31%) had improvement of cranial nerve function. Postoperative neurological deficits included transient abducens and oculomotor nerve paresis in one patient each.
The endoscope is a safe and effective adjunct to the microscope in facilitating additional inspection and further resection of epidermoid tumors. Endoscopic-assisted surgery is particularly useful for identifying and removing additional tumor located around surgical corners.
颅内表皮样囊肿是上皮来源的病变，可能给神经外科医生带来特殊挑战，常包裹关键神经血管结构并延伸至多个蛛网膜下腔。我们旨在评估近期在内镜辅助下开颅显微手术切除这些病变的经验。
对2009年至2012年在南加州大学凯克医学院接受内镜辅助开颅切除表皮样囊肿的患者进行回顾性研究。所有患者均首先在显微镜下进行手术入路和肿瘤切除。然后使用成角内镜，采用双术者技术辅助进一步检查和额外切除肿瘤。
分析纳入12例患者，共进行了13次连续的内镜辅助开颅手术。患者平均年龄45岁。肿瘤最大平均直径为4.0厘米（范围2.
