Blijleven Esther E, Willemsen Koen, Bleys Ronald L A W, Stokroos Robert J, Wegner Inge, Thomeer Henricus G X M
Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
Brain Center, University Medical Center Utrecht, Utrecht, Netherlands.
Front Surg. 2022 Nov 23;9:1054342. doi: 10.3389/fsurg.2022.1054342. eCollection 2022.
To investigate the feasibility of the endoscopic approach vs. microscopic approach during stapes surgery, focusing on the visualization of the important anatomical structures of the middle ear, the volume of the resected scutum and chorda tympani (CT) injury.
Fresh frozen human cadaveric heads underwent two stapes surgeries using an operating microscope on one ear and an endoscope on the other ear. The surgeon documented the visualization of critical landmarks, as well as exposure and injury of the CT. The volume of resected scutum was evaluated using cone beam computed tomography scanning and three-dimensional imaging.
We performed endoscopic stapes surgery in 10 ears and microscopic stapes surgery in 11 ears. A stapes prosthesis was placed in all ears. The volume of bony scutum resection was significantly lower in the endoscopic group (median = 2.20 mm, IQR = 4.17) than in the microscopic group (median 13.25 mm, IQR = 8.71). No scutum was removed in two endoscopic ears, while scutum was removed in all microscopic ears. The endoscopic and microscopic group had similar CT injury.
This study showed that the endoscopic stapes surgery procedure is feasible and might be less invasive than microscopic stapes surgery. Future clinical prospective and functional studies will be needed to support our findings.
探讨镫骨手术中内镜入路与显微镜入路的可行性，重点关注中耳重要解剖结构的可视化、切除的盾板体积以及鼓索神经（CT）损伤情况。
对新鲜冷冻的人类尸体头部，一只耳朵使用手术显微镜进行镫骨手术，另一只耳朵使用内镜进行镫骨手术。手术医生记录关键标志的可视化情况以及鼓索神经的暴露和损伤情况。使用锥形束计算机断层扫描和三维成像评估切除的盾板体积。
我们对10只耳朵进行了内镜镫骨手术，对11只耳朵进行了显微镜镫骨手术。所有耳朵均植入了镫骨假体。内镜组切除的骨质盾板体积（中位数 = 2.20 mm，四分位间距 = 4.17）显著低于显微镜组（中位数13.25 mm，四分位间距 = 8.71）。在内镜手术的两只耳朵中未切除盾板，而在所有显微镜手术的耳朵中均切除了盾板。内镜组和显微镜组的鼓索神经损伤情况相似。
本研究表明内镜镫骨手术操作是可行的，并且可能比显微镜镫骨手术的侵入性更小。未来需要进行临床前瞻性和功能研究来支持我们的发现。
