Vaz-Guimaraes Francisco, Gardner Paul A, Fernandez-Miranda Juan C
Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-400, UPMC Presbyterian, Pittsburgh, PA, 15213, USA.
Acta Neurochir (Wien). 2015 Apr;157(4):611-5; discussion 615. doi: 10.1007/s00701-014-2332-1. Epub 2015 Jan 18.
Cerebellopontine angle tumor resection and cranial nerve microvascular decompression are usually performed with the aid of the surgical microscope. The endoscope is commonly used as an adjuvant.
A retrosigmoid craniectomy is done. Upon dural opening, the endoscope is inserted into the operative field along the petrotentorial junction. Cerebrospinal fluid drainage provides a wider space for introduction of the endoscope and surgical instruments. Traditional microsurgical techniques are used during the entire procedure.
A fully endoscopic retrosigmoid approach is a safe and effective procedure for cerebellopontine angle tumor resection and cranial nerve microvascular decompression.
• Careful examination of preoperative studies is needed to identify anatomical peculiarities. • Patient positioning: the head must be gently flexed and its vertex gently tilted toward the floor. • Neurophysiologic monitoring and intraoperative navigation. • Craniectomy: partial exposure of the transverse and sigmoid sinuses. • Curvilinear dural incision reflected laterally to minimize the risk of sinus injury. • Opening the cerebellomedullary cistern for CSF drainage and cerebellar relaxation. • Dynamic endoscopy enhances depth perception and must be performed by a team with experience in endoscopic intracranial surgery. • Traditional microsurgical techniques have to be applied during the entire operation. • Multilayer reconstruction, including watertight dural closure. • Meningiomas causing brainstem shift are not suitable for endoscopic resection.
桥小脑角肿瘤切除术和颅神经微血管减压术通常借助手术显微镜进行。内窥镜通常用作辅助工具。
行乙状窦后颅骨切除术。打开硬脑膜后，将内窥镜沿岩骨天幕交界处插入术野。脑脊液引流可为内窥镜和手术器械的置入提供更广阔的空间。整个手术过程中采用传统显微外科技术。
全内窥镜乙状窦后入路是一种安全有效的桥小脑角肿瘤切除术和颅神经微血管减压术。
• 需要仔细检查术前研究以确定解剖学特点。• 患者体位：头部必须轻轻屈曲，头顶轻轻向地面倾斜。• 神经生理监测和术中导航。• 颅骨切除术：部分暴露横窦和乙状窦。• 弧形硬脑膜切口向外侧翻转以降低窦损伤风险。• 打开小脑延髓池进行脑脊液引流和小脑松弛。• 动态内窥镜可增强深度感知，必须由有内窥镜颅内手术经验的团队进行操作。• 整个手术过程中必须应用传统显微外科技术。• 多层重建，包括严密的硬脑膜缝合。• 导致脑干移位的脑膜瘤不适合内窥镜切除。
