Gallieni Massimo, Del Maestro Mattia, Luzzi Sabino, Trovarelli Donatella, Ricci Alessandro, Galzio Renato
Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy.
Department of Neurosurgery, San Salvatore City Hospital, L'Aquila, Italy.
Acta Neurochir Suppl. 2018;129:19-24. doi: 10.1007/978-3-319-73739-3_3.
Endoscope-assisted microneurosurgery (EAM) combines endoscopic and microsurgical techniques for the treatment of deeply located intracranial lesions. During aneurysm surgery, endoscopic assistance may aid in the visualization of perforating arteries, especially when minimally invasive approaches are used. Between 2002 and 2015, a total of 183 patients with 208 intracranial aneurysms were surgically treated in our department. EAM was performed in 191 procedures. In all, 159 aneurysms were located in the anterior circulation and 49 in the posterior circulation. Of these, 135 aneurysms were ruptured. Lesions were exposed through standard skull base microsurgical approaches. The endoscope was employed during three steps: initial inspection, true operative time, and final inspection. Complications directly related to endoscopic procedures were rare; no surgical mortality was observed in this series. A retrospective analysis of each procedure showed that the usefulness of EAM depended on the anatomical location and size of the lesions. Its advantages were especially evident when dedicated scopes and holders were used.
内镜辅助显微神经外科手术（EAM）结合了内镜和显微外科技术，用于治疗深部颅内病变。在动脉瘤手术中，内镜辅助有助于观察穿支动脉，尤其是在采用微创方法时。2002年至2015年期间，我科共对183例患有208个颅内动脉瘤的患者进行了手术治疗。共进行了191例EAM手术。其中，159个动脉瘤位于前循环，49个位于后循环。这些动脉瘤中，135个为破裂动脉瘤。通过标准的颅底显微外科手术入路暴露病变。在内镜辅助下分三个步骤进行手术：初始检查、实际手术操作以及最终检查。与内镜操作直接相关的并发症很少见；本系列未观察到手术死亡病例。对每例手术的回顾性分析表明，EAM的实用性取决于病变的解剖位置和大小。当使用专用内镜和固定器时，其优势尤为明显。
