Department of Otolaryngology-Head and Neck Surgery, Sapporo Medical University School of Medicine, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
Department of Otolaryngology-Head and Neck Surgery, Sapporo Medical University School of Medicine, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
Auris Nasus Larynx. 2024 Oct;51(5):859-865. doi: 10.1016/j.anl.2024.07.004. Epub 2024 Aug 6.
The objective of this study was to assess the utility of narrow-band imaging (NBI) for improving intraneural dissection during gross total resection of head and neck schwannoma. Specifically, we aimed to quantitatively evaluate whether NBI can enhance the identification of pseudocapsule and true capsule within the tumor.
Nine schwannoma surgery cases conducted between February 2018 and October 2022 were retrospectively analyzed. The surgical procedures followed established principles with a specific focus on utilizing NBI to distinguish between the pseudocapsule and true capsule. Intraneural dissection was performed by searching for a tumor surface with a fascicle-free window, followed by longitudinal incision of the pseudocapsule. NBI was used to distinguish between the pseudocapsule and true capsule. Surgical views were captured under both white light (WL) illumination and NBI for further analysis. The brightness and contrast of the pseudocapsule and true capsule were quantitatively measured using ImageJ and were compared.
Under NBI, the pseudocapsule consistently appeared greenish-gray, whereas the true capsule exhibited a white appearance. Quantitative analysis revealed a statistically significant difference (p < 0.0001) in brightness between the pseudocapsule (mean grayscale value 52.1, 95%CI; 46.4-75.3) and true tumor capsule (mean grayscale value 120.8, 95%CI; 155.7-109.0) under NBI. Conversely, there was no statistically significant difference in the brightness of these structures under WL (p = 0.2067). NBI also showed significantly higher contrast between the two structures than did WL (contrast 73.6, 95%CI; 53.1-89.5 vs. 30.9, 95%CI; 1.0-47.5, p = 0.0034). Further spectral analysis revealed that the most substantial difference in brightness between the pseudocapsule and the true tumor capsule was observed in the red spectrum, with a difference in brightness of -0.6 (95%CI; -16.8-14.8) under WL and 83.5 (95%CI; 50.3-100.0) under NBI (p < 0.0001).
NBI proved to be a valuable tool for enhancing the identification of pseudocapsule and true capsule during intraneural dissection in head and neck schwannoma surgery. The improved contrast and membrane visibility offered by NBI might have the potential to reduce postoperative neurological deficits and improve surgical outcomes. Further research is warranted to validate our findings and explore the broader applications of NBI in schwannoma surgery.
本研究旨在评估窄带成像（NBI）在提高头颈部神经鞘瘤大体全切除术中神经内解剖的应用价值。具体而言，我们旨在定量评估 NBI 是否可以增强对肿瘤内假包膜和真包膜的识别。
回顾性分析了 2018 年 2 月至 2022 年 10 月期间进行的 9 例神经鞘瘤手术病例。手术过程遵循既定原则，特别注重利用 NBI 区分假包膜和真包膜。通过寻找具有束间无窗的肿瘤表面进行神经内解剖，然后对假包膜进行纵向切开。使用 NBI 区分假包膜和真包膜。在白光（WL）照明和 NBI 下拍摄手术视野，以备进一步分析。使用 ImageJ 对假包膜和真包膜的亮度和对比度进行定量测量，并进行比较。
在 NBI 下，假包膜始终呈现出绿灰色，而真包膜呈现出白色。定量分析显示，NBI 下假包膜（平均灰度值 52.1，95%CI；46.4-75.3）和真肿瘤包膜（平均灰度值 120.8，95%CI；155.7-109.0）之间的亮度存在统计学显著差异（p<0.0001）。相比之下，在 WL 下，这些结构的亮度没有统计学显著差异（p=0.2067）。NBI 还显示出这两种结构之间的对比度明显高于 WL（对比度 73.6，95%CI；53.1-89.5 vs. 30.9，95%CI；1.0-47.5，p=0.0034）。进一步的光谱分析显示，假包膜和真肿瘤包膜之间亮度的最大差异出现在红色光谱中，WL 下的亮度差异为-0.6（95%CI；-16.8-14.8），NBI 下为 83.5（95%CI；50.3-100.0）（p<0.0001）。
NBI 被证明是一种有价值的工具，可增强头颈部神经鞘瘤手术中神经内解剖时对假包膜和真包膜的识别。NBI 提供的对比度和膜可见度的提高可能有助于减少术后神经功能缺损并改善手术结果。需要进一步的研究来验证我们的发现，并探讨 NBI 在神经鞘瘤手术中的更广泛应用。
