Arıcıgil Mitat, Arbağ Hamdi, Dündar Mehmet Akif, Aziz Suhayb Kuria, Yılmaz Mehmet Tuğrul
Department of Otorhinolaryngology, Head and Neck Surgery, Necmettin Erbakan University School of Medicine, Konya, Turkey.
Department of Anatomy, Necmettin Erbakan University School of Medicine, Konya, Turkey.
J Int Adv Otol. 2018 Dec;14(3):472-477. doi: 10.5152/iao.2018.4474.
In this study, we aimed to describe how endoscopes show the neural and vascular structures at the cerebellopontine angle (CPA) through a minimal craniotomy in a well-described anatomic point in the retrosigmoid region and at the same time, evaluate the endoscopic anatomic exposure and maneuverability. We planned to use the new surgical instrument (endoscope cannula), which we designed on fresh frozen cadavers to simulate a real surgical procedure.
The surgical procedure was planned to be performed on 20 sides of 10 fresh cadaver heads. The distance between the asterion and mastoid process was determined, and the midpoint was then marked. From this midpoint, a craniotomy 2 cm in size was posteriorly made. The endoscope cannula together with 0° or 30° endoscopes was inserted to capture the panoramic views of the neurovascular structures in CPA. Endoscopic anatomic exposure and maneuverability were evaluated using 0° and 30° endoscopes with/without the endoscope cannula.
The surgeon could easily use both hands during the surgical simulation, and maneuverability was seen to increase in CPA with the use of the endoscope cannula.
The surgeon can work actively with both hands when the endoscopes and the endoscope cannula are used together. We believe that owing to this, the surgeon's maneuverability would increase and a more effective minimally invasive endoscopic retrosigmoid surgery would ensue.
在本研究中，我们旨在描述内窥镜如何通过在乙状窦后区域一个详细描述的解剖点进行的微创开颅手术来显示桥小脑角（CPA）的神经和血管结构，同时评估内窥镜的解剖暴露情况和可操作性。我们计划使用我们在新鲜冷冻尸体上设计的新型手术器械（内窥镜套管）来模拟真实的手术过程。
手术计划在10个新鲜尸体头部的20侧进行。确定星点与乳突之间的距离，然后标记中点。从该中点向后做一个2厘米大小的开颅手术。插入内窥镜套管以及0°或30°内窥镜以获取CPA神经血管结构的全景视图。使用带/不带内窥镜套管的0°和30°内窥镜评估内窥镜的解剖暴露情况和可操作性。
在手术模拟过程中外科医生可以轻松地双手操作，并且使用内窥镜套管时CPA的可操作性有所提高。
当内窥镜和内窥镜套管一起使用时，外科医生可以双手积极操作。我们认为，由此外科医生的可操作性将会提高，进而会产生更有效的微创内窥镜乙状窦后手术。
