经乙状窦前迷路后入路的内窥镜辅助显微手术的显微镜同步监测：一项初步研究。

Simultaneous supervision by microscope of endoscope-assisted microsurgery via presigmoid retrolabyrinthine approach: A pilot study.

作者信息

Tan H-Y, Yang J, Wang Z-Y, Zhu W-D, Chai Y-C, Jia H, Wu H

机构信息

Department of Otolaryngology Head and Neck Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China.

出版信息

Eur Ann Otorhinolaryngol Head Neck Dis. 2018 Sep;135(5S):S103-S106. doi: 10.1016/j.anorl.2018.08.003. Epub 2018 Aug 20.

DOI:10.1016/j.anorl.2018.08.003

PMID:30139697

Abstract

OBJECTIVE

To examine the impact of integrated hybrid operating rooms for endoscope-assisted microsurgery using the presigmoid retrolabyrinthine (RL) approach, and to determine the value of simultaneous supervision of skull base endoscopic procedures by microscope.

MATERIAL AND METHODS

We retrospectively reviewed endoscope-assisted surgery using the RL approach at our institution between September 2013 and January 2017. The simultaneous supervision of endoscopic procedures by microscope was realized using the integrated hybrid system. Intra- or postoperative complications and surgical outcomes were analyzed. All patients were followed for at least 1 year.

RESULTS

In total, 32 patients were studied: 4 vestibular schwannomas, 5 cholesteatomas, 8 hemifacial spasms, 5 glossopharyngeal neuralgias, and 10 Ménière's disease. In patients with vestibular schwannoma or cholesteatoma, complete removal was performed in all patients. In patients with Ménière's disease, hemifacial spasm or glossopharyngeal neuralgia, satisfactory symptom relief was achieved in all patients. Two (6.3%) patients had hearing loss after surgery which did not recover. One (3.1%) patient with vestibular schwannoma had mild facial palsy (HB III) at 2 weeks after the operation and recovered to near normal facial nerve function (HB II) at 1 year after surgery. No permanent or transient dysfunction of the trigeminal nerve or the lower cranial nerves was observed during follow-up. No complications such as cerebrospinal fluid (CSF) leakage or meningitis were observed.

CONCLUSION

The endoscope provided a clearer and larger view, which solved the limitations of surgery using the RL approach. Endoscopic surgery under simultaneous supervision by microscope was safe and efficient in hearing preservation as well as in preservation of facial nerve function. An integrated operation room provided better support and the ability to switch quickly between these various complex devices.

摘要

目的

探讨集成式杂交手术室在乙状窦前迷路后（RL）入路内镜辅助显微手术中的应用效果，并确定显微镜同步监测颅底内镜手术的价值。

材料与方法

回顾性分析2013年9月至2017年1月在我院采用RL入路的内镜辅助手术。使用集成式杂交系统实现显微镜对内镜手术的同步监测。分析术中或术后并发症及手术效果。所有患者均随访至少1年。

结果

共研究32例患者：4例前庭神经鞘瘤、5例胆脂瘤、8例面肌痉挛、5例舌咽神经痛和10例梅尼埃病。前庭神经鞘瘤或胆脂瘤患者均实现完全切除。梅尼埃病、面肌痉挛或舌咽神经痛患者均获得满意的症状缓解。2例（6.3%）患者术后听力丧失未恢复。1例（3.1%）前庭神经鞘瘤患者术后2周出现轻度面瘫（HB III级），术后1年恢复至面神经功能接近正常（HB II级）。随访期间未观察到三叉神经或下颅神经的永久性或暂时性功能障碍。未观察到脑脊液漏或脑膜炎等并发症。