Singh Suyash, Das Kuntal Kanti, Kumar Krishna, Rangari Kamlesh, Dikshit Priyadarshi, Bhaisora Kamlesh Singh, Sardhara Jayesh, Mehrotra Anant, Srivastava Arun Kumar, Jaiswal Awadhesh Kumar, Behari Sanjay
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
J Neurol Surg B Skull Base. 2021 Feb 22;83(Suppl 2):e60-e68. doi: 10.1055/s-0040-1722713. eCollection 2022 Jun.
Densely packed neurovascular structures, often times inseparable capsular adhesions and sometimes a multicompartmental tumor extension, make surgical excision of cerebellopontine angle epidermoids (CPEs) a challenging task. A simultaneous or an exclusive endoscopic visualization has added a new dimension to the classical microscopic approaches to these tumors recently. Eighty-six patients (age: 31.6 ± 11.7 years, M:F = 1:1) were included. Nineteen patients (22.1%) had a multicompartmental tumor. Tumor extension was classified into five subtypes. Sixty-two patients underwent a pure microscopic approach (72%) out of which 10 patients (16%) underwent an endoscope-assisted surgery (11.6%) and 24 patients (28%) underwent an endoscope-controlled excision. Surgical outcomes were retrospectively analyzed. Headache (53.4%), hearing loss (46.5%), and trigeminal neuralgia (41.8%) were the leading symptoms. Interestingly, 21% of the patients had at least one preexisting cranial nerve deficit. Endoscopic assistance helped in removing an unseen tumor lobule in 3 of 10 patients (30%). Pure endoscopic approach significantly reduced the hospital stay from 9.2 to 7.3 days ( = 0.012), and had a statistically insignificant yet a clearly noticeable lesser incidence of subtotal tumor excision (0 vs. 10%, = 0.18) with comparable cranial nerve deficits but with a higher postoperative cerebrospinal fluid (CSF) leak rate (29% vs. 4.8%, = 0.004). Endoscope assistance in CPE surgery is a useful addition to conventional microscopic retromastoid approach. Pure endoscopic excision in CPE is feasible, associated with a lesser duration of hospital stay, better extent of excision in selected cases, and it has a comparable cranial nerve morbidity profile albeit with a higher rate of CSF leak.
紧密排列的神经血管结构、常常难以分离的包膜粘连以及有时出现的多房性肿瘤扩展，使得小脑脑桥角表皮样囊肿（CPEs）的手术切除成为一项具有挑战性的任务。近来，同步或单纯的内镜可视化技术为这些肿瘤的经典显微手术方法增添了新的维度。
纳入了86例患者（年龄：31.6±11.7岁，男∶女 = 1∶1）。19例患者（22.1%）存在多房性肿瘤。肿瘤扩展分为五种亚型。62例患者采用单纯显微手术方法（72%），其中10例患者（16%）接受了内镜辅助手术（11.6%），24例患者（28%）接受了内镜控制下切除。对手术结果进行了回顾性分析。
头痛（53.4%）、听力丧失（46.5%）和三叉神经痛（41.8%）是主要症状。有趣的是，21%的患者至少存在一种既往颅神经功能缺损。内镜辅助在10例患者中的3例（30%）帮助切除了一个不可见的肿瘤小叶。单纯内镜手术方法显著缩短了住院时间，从9.2天降至7.3天（P = 0.012），肿瘤次全切除的发生率虽无统计学意义但明显较低（0%对10%，P = 0.18），颅神经缺损情况相当，但术后脑脊液（CSF）漏率较高（29%对4.8%，P = 0.004）。
内镜辅助在CPE手术中是对传统乳突后显微手术方法的有益补充。CPE的单纯内镜切除是可行的，住院时间较短，在某些病例中切除范围更好，并且颅神经发病率情况相当，尽管脑脊液漏率较高。
