Li J, Zhong D, Lü D, Huang H Y, Du W, Yang J, Wu Y T, Xia H J, Tang W Y, Sun X C
Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
Zhonghua Yi Xue Za Zhi. 2018 May 8;98(17):1311-1316. doi: 10.3760/cma.j.issn.0376-2491.2018.17.006.
To study the value of neuroendoscopy assisted microneurosurgery technique in the treatment of posterior cranial fossa lesion. Clinical data of 36 patients with posterior fossa lesions who accepted neuroendoscopy assisted microneurosurgery (NEAM group) in the department of neurosurgery of the First Affiliated Hospital of Chongqing Medical University, from January 2014 to December 2016, were retrospectively enrolled. A total of 113 cases diagnosed with the same lesions and accepted conventional microneurosurgery (non-NEAM group) in the same period were analyzed as control group. The total tumor resection rate, postoperative leakage of cerebrospinal fluid, intracranial infection, operating time and the recovery of facial nerve function were compared between the two groups. Ninety-three patients with acoustic neuroma were analyzed, which were divided into non-NEAM group 78 cases (removed posterior lip of internal auditory canal in different degrees) and NEAM group 15 cases (not removed posterior lip of internal auditory canal). The total tumor resection rate and postoperative facial nerve function had no significant statistical differences between two groups. The operating time of NEAM group was longer than that of non-NEAM group (=0.048, <0.05), but the rate of leakage of cerebrospinal fluid and intracranial infection did not increase. Twenty-seven cases were diagnosed with cerebellopontine angle cholesteatoma. These cases were divided into two groups, 17 cases in non-NEAM group and 10 cases in NEAM group. NEAM group have higher total tumor resection rate (=0.014, <0.05), better short-term postoperative facial nerve function (=0.039, <0.05), and longer operating time (=0.015, <0.05), compared with non-NEAM group. No significant statistical differences were observed on long-term postoperative facial nerve function and postoperative complications. Of the 16 cases diagnosed tentorial meningioma, 10 cases were in non-NEAM group and 6 cases in NEAM group. Six cases in non-NEAM group and 4 cases in NEAM group were total removal. For the mean operating time, non-NEAM group was (6.6±1.0) hours and NEAM group was (7.1±0.7) hours. Thirteen cases were with fourth ventricular cholesteatoma, which all were totally resected, and 8 cases were in non-NEAM group and 5 cases in NEAM group. For non-NEAM group, 5 cases dissected cerebellar vermis and the mean operating time is (6.0±0.7) hours. However, NEAM group all did not dissect cerebellar vermis and the mean operating time is (6.4±0.4) hours. Neuroendoscopy assisted microneurosurgery for cranial fossa lesions was benefit to totally resect tumor and reduce unnecessary injury. It needed longer operating time, but not increase postoperative intracranial infection.
探讨神经内镜辅助显微神经外科技术在治疗后颅窝病变中的价值。回顾性纳入2014年1月至2016年12月在重庆医科大学附属第一医院神经外科接受神经内镜辅助显微神经外科手术（神经内镜辅助显微神经外科组）的36例后颅窝病变患者的临床资料。同期共分析113例诊断为相同病变并接受传统显微神经外科手术（非神经内镜辅助显微神经外科组）的患者作为对照组。比较两组的肿瘤全切除率、术后脑脊液漏、颅内感染、手术时间及面神经功能恢复情况。分析93例听神经瘤患者，分为非神经内镜辅助显微神经外科组78例（不同程度切除内耳道后壁）和神经内镜辅助显微神经外科组15例（未切除内耳道后壁）。两组肿瘤全切除率和术后面神经功能差异无统计学意义（P=0.048，P<0.05）。神经内镜辅助显微神经外科组手术时间长于非神经内镜辅助显微神经外科组（P=0.048，P<0.05），但脑脊液漏和颅内感染率未增加。27例诊断为桥小脑角胆脂瘤，分为两组，非神经内镜辅助显微神经外科组17例，神经内镜辅助显微神经外科组10例。与非神经内镜辅助显微神经外科组相比，神经内镜辅助显微神经外科组肿瘤全切除率更高（P=0.014，P<0.05），术后短期面神经功能更好（P=0.039，P<0.05），手术时间更长（P=0.015，P<0.05）。术后长期面神经功能和术后并发症差异无统计学意义。16例诊断为天幕脑膜瘤，非神经内镜辅助显微神经外科组10例，神经内镜辅助显微神经外科组6例。非神经内镜辅助显微神经外科组6例、神经内镜辅助显微神经外科组4例全切除。平均手术时间方面，非神经内镜辅助显微神经外科组为（6.6±1.0）小时，神经内镜辅助显微神经外科组为（7.1±0.7）小时。13例为第四脑室胆脂瘤，均全切除，非神经内镜辅助显微神经外科组8例，神经内镜辅助显微神经外科组5例。非神经内镜辅助显微神经外科组5例切开小脑蚓部，平均手术时间为（6.0±0.7）小时。而神经内镜辅助显微神经外科组均未切开小脑蚓部，平均手术时间为（6.4±0.4）小时。神经内镜辅助显微神经外科手术治疗颅窝病变有利于肿瘤全切除并减少不必要的损伤。手术时间较长，但不增加术后颅内感染。
