Abolfotoh Mohammad, Bi Wenya Linda, Hong Chang-Ki, Almefty Kaith K, Boskovitz Abraham, Dunn Ian F, Al-Mefty Ossama
Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts;
Department of Neurosurgery, Ain Shams University, Cairo, Egypt;
J Neurosurg. 2015 Nov;123(5):1301-11. doi: 10.3171/2014.10.JNS141465. Epub 2015 Apr 24.
The combined microscopic and endoscopic technique has shown significant advantages in the management of various lesions through different approaches. Endoscopic-assisted techniques have frequently been applied to cerebellopontine angle (CPA) surgery in the context of minimally invasive craniotomies. In this paper the authors report on the use of the endoscope in the CPA as a tool to increase the extent of resection, minimize complications, and preserve the function of the delicate CPA structures. They also describe a technique of the simultaneous use of the microscope and endoscope in the CPA and dissection of CPA tumors under tandem endoscopic and microscopic vision to overcome the shortcomings of introducing the endoscope alone in the CPA. The reliability of using the microscope alone in dissecting CPA tumors is evaluated, as is the effectiveness of the combined technique in increasing the resectability of various types of CPA tumors.
The authors conducted a retrospective analysis of 50 patients who underwent combined microscopic-endoscopic resection of CPA tumors by the senior author over a period of 3 years (February 2011 to February 2014) at Brigham and Women's Hospital, Harvard Medical School. The reliability of the extent of microscopic removal was evaluated with endoscopic exploration. Additional resection was performed with both microscopic and the combined microscopic-endoscopic technique. Endoscopically verified total resection was validated by intraoperative or postoperative MRI. The function of the cranial nerves was evaluated to assess the impact of the combined technique on their function.
A tumor remnant was endoscopically identified in 69% of the 26 patients who were believed to have microscopic total resection. The utilization of the endoscopic visualization and dissection increased endoscopically verified total removal to 38 patients, and 82% of these patients had no sign of residual tumor on postoperative imaging. The technique was most effective with epidermoid tumors. There were a total of 17 new cranial nerve deficits in 10 patients. Preoperative fifth cranial nerve deficits improved in 52% and hearing improved in 29% of patients after surgery.
This method provides simultaneous microscopic and endoscopic visualization and dissection techniques through skull-base approaches to CPA tumors. It overcomes some of the shortcomings of endoscopic-assisted surgery, further extends the surgical field, and increases the radicality of tumor resection with good functional outcomes.
显微与内镜联合技术在通过不同入路处理各种病变时已显示出显著优势。内镜辅助技术已频繁应用于微创开颅手术背景下的桥小脑角（CPA）手术。在本文中，作者报告了在CPA中使用内镜作为一种工具来扩大切除范围、将并发症降至最低并保留CPA精细结构的功能。他们还描述了一种在CPA中同时使用显微镜和内镜以及在串联内镜和显微镜视野下切除CPA肿瘤的技术，以克服单独在CPA中引入内镜的缺点。评估了单独使用显微镜切除CPA肿瘤的可靠性，以及联合技术在提高各种类型CPA肿瘤可切除性方面的有效性。
作者对哈佛医学院布莱根妇女医院的资深作者在3年时间（2011年2月至2014年2月）内对50例行CPA肿瘤显微 - 内镜联合切除术的患者进行了回顾性分析。通过内镜探查评估显微切除范围的可靠性。使用显微镜和显微 - 内镜联合技术进行额外切除。内镜证实的全切除通过术中或术后MRI验证。评估颅神经功能以评估联合技术对其功能的影响。
在被认为已进行显微全切除的26例患者中，69%经内镜发现有肿瘤残留。内镜可视化和分离的应用使内镜证实的全切除患者增加至38例，其中82%的患者术后影像学检查无残留肿瘤迹象。该技术对表皮样肿瘤最有效。10例患者共有17例新发颅神经功能缺损。术后52%的术前第五颅神经功能缺损患者有所改善，29%的患者听力改善。
该方法通过颅底入路为CPA肿瘤提供了同时的显微和内镜可视化及分离技术。它克服了内镜辅助手术的一些缺点，进一步扩大了手术视野，提高了肿瘤切除的彻底性，并取得了良好的功能结果。
