Lavergne Pascal, Khoury Tawfiq, Kang KiChang, Sathe Anish, Kelly Patrick, Evans James
Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
Division of Neurosurgery, University of Montreal, Montreal, Quebec, Canada.
J Neurol Surg B Skull Base. 2024 Jan 4;85(Suppl 2):e73-e79. doi: 10.1055/s-0043-1777674. eCollection 2024 Oct.
Traditional open mastoidectomy is performed through a retro-auricular incision to expose the mastoid cortex. Few have addressed the possibility of performing an endoscopic minimally invasive mastoidectomy. Our objective was to test the feasibility of performing an endoscopic mastoidectomy through a 1 cm incision and burr hole. Ten cadaver heads (20 mastoids) were used for this morphometric study. We performed an endoscopic mastoidectomy through a 1 cm burr hole located over the antrum. The goals were to reach predetermined landmarks and maximize the drilling of cancellous mastoid bone. Computed tomography (CT) imaging was acquired at baseline, after endoscopic approach and after traditional open mastoidectomy. The scans were then analyzed with volumetric measurements of each mastoid. Endoscopic mastoidectomy facilitated access to most anatomical landmarks. While open mastoidectomy enabled greater extents of mastoidectomy and tegmen exposure, the endoscopic approach exposed 76% of mastoid and 69.9% of the tegmen achievable by the open approach. Additionally, baseline mastoid volume and tegmen surface area positively correlated with the extent of mastoidectomy and tegmen exposure, respectively. Baseline mastoid volume negatively correlated with the percentage of mastoid drilled and tegmen exposed. We demonstrated the feasibility of an endoscopic mastoidectomy through a standardized postauricular burr hole. This approach reduces the incision size and the need for soft tissue dissection. Burr hole mastoidectomy is facilitated using angled scopes which are not reliant on 0-degree line-of-sight. Although the endoscopic approach afforded slightly less exposure, the location and burr hole size can be adjusted depending on the clinical indications.
传统开放式乳突根治术通过耳后切口进行，以暴露乳突皮质。很少有人探讨过进行内镜微创乳突根治术的可能性。
我们的目的是测试通过1厘米切口和骨孔进行内镜乳突根治术的可行性。
本形态学研究使用了10个尸头（20个乳突）。我们通过位于鼓窦上方的1厘米骨孔进行了内镜乳突根治术。目标是到达预定的标志点并最大限度地钻除松质乳突骨。在基线、内镜入路后和传统开放式乳突根治术后进行计算机断层扫描（CT）成像。然后对扫描图像进行每个乳突的容积测量分析。
内镜乳突根治术便于到达大多数解剖标志点。虽然开放式乳突根治术能够实现更大范围的乳突切除和颅中窝暴露，但内镜入路暴露的乳突范围为开放式入路可达到范围的76%，颅中窝暴露范围为69.9%。此外，基线乳突容积和颅中窝表面积分别与乳突切除范围和颅中窝暴露范围呈正相关。基线乳突容积与钻除的乳突百分比和暴露的颅中窝呈负相关。
我们证明了通过标准化耳后骨孔进行内镜乳突根治术的可行性。这种方法减小了切口大小，减少了软组织分离的需要。使用不依赖0度视线的角度内镜便于进行骨孔乳突根治术。虽然内镜入路的暴露范围略小，但可根据临床指征调整位置和骨孔大小。
