Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, piazzale Aristide Stefani, 1, 37126, Verona, Italy.
Neurosurgery Department, University Hospital of Verona, piazzale Aristide Stefani, 1, 37126, Verona, Italy.
Eur Arch Otorhinolaryngol. 2019 Aug;276(8):2155-2163. doi: 10.1007/s00405-019-05442-4. Epub 2019 Apr 26.
To analyze how and when the endoscope is used in vestibular schwannoma surgery and identify the benefits of using endoscopy in this type of surgery.
It is currently unclear if there is any benefit from using an endoscope in vestibular schwannoma surgery so this retrospective analysis set out to study this.
All the patients who underwent vestibular schwannoma surgery at our clinic were included for all the vestibular schwannoma approaches taken. We studied when endoscopy was used during surgery and the goal of using endoscopy. Several pre- and postoperative factors were assessed such as complications, facial function, and hearing function in the case of techniques that allow hearing preservation.
From January 2015 to September 2018, 280 patients underwent lateral skull base surgery. Of these, 112 were included in this study. The endoscope was used in all 112 patients, and in eight cases it was possible to identify residual disease using the endoscope to check the surgical field, and then to remove the disease under endoscopic view. Moreover, in two other cases, the endoscope was used to resolve a vasculoneural conflict between the anterior inferior cerebellar artery (AICA) loop and facial nerve in one case, and for deafferentation of the superior and inferior vestibular nerves in the second case. No major intraoperative complications occurred in our series. There was no statistically significant difference in postoperative facial nerve function between patients in whom the endoscope was used as a diagnostic tool and patients in whom it was used as an operative tool (p = 0.3152).
The endoscope may be useful, especially in surgical techniques where there is poor control of the internal auditory canal (IAC). An endoscopic support technique is strongly recommended to avoid residual disease, particularly in retrosigmoid and retrolabyrinthine approaches. Moreover, the recent introduction of the transcanal transpromontorial approach allows the endoscope to be used during all the procedures in patients affected by a vestibular schwannoma limited to the IAC or to support surgical procedures during an enlarged microscopic approach.
分析内窥镜在听神经瘤手术中的使用方式和时间，并确定在这种手术类型中使用内窥镜的益处。
目前尚不清楚在听神经瘤手术中使用内窥镜是否有益，因此本回顾性分析旨在对此进行研究。
我们纳入了在诊所接受听神经瘤手术的所有患者，研究了手术中何时使用内窥镜以及使用内窥镜的目的。评估了几种术前和术后因素，例如并发症、面神经功能和听力功能（适用于允许保留听力的技术）。
2015 年 1 月至 2018 年 9 月，280 例患者接受了侧颅底手术。其中，112 例患者纳入本研究。所有 112 例患者均使用了内窥镜，在 8 例中，使用内窥镜检查手术视野，然后在内窥镜下切除残余病变，可以识别出残余病变。此外，在另外 2 例中，内窥镜用于解决前下小脑动脉（AICA）环和面神经之间的血管神经冲突，以及第二例中的上、下前庭神经去传入。我们的系列手术中没有发生重大术中并发症。在将内窥镜用作诊断工具的患者和将内窥镜用作手术工具的患者之间，术后面神经功能没有统计学上的显著差异（p=0.3152）。
内窥镜可能有用，特别是在对内耳道口（IAC）控制不佳的手术技术中。强烈建议采用内窥镜支持技术以避免残余病变，尤其是在乙状窦后和迷路后入路中。此外，最近引入的经耳道经岩骨前入路允许内窥镜在受限于 IAC 的听神经瘤患者的所有手术中使用，或在扩大的显微镜入路中支持手术程序。
