De Marco Raffaele, Froelich Sébastien, Albera Andrea, Garbossa Diego, Zenga Francesco
Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco, 15, Turin, 10126, Italy.
Pituitary and Skull Base Surgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy.
Eur Arch Otorhinolaryngol. 2025 Apr 30. doi: 10.1007/s00405-025-09427-4.
The use of the endoscope has brought major changes in skull base surgery in the last decades. In the cerebellopontine angle (CPA), it has shown few advantages over microscopic surgery alone, evolving towards a full-endoscopic surgery for neurovascular conflicts and tumors. This review aims to systematically analyze the literature about the use of the endoscope in the cerebellopontine angle tumors.
Pubmed/Medline and Embase databases were investigated applying PRISMA guidelines without time restrictions to find all adult patients affected by an extra-axial cerebellopontine angle tumor (vestibular schwannoma, meningioma, epidermoid tumor, or other extra-axial lesions) treated using only the endoscope (full-endoscopic, FE or endoscopic-controlled, EC) or with endoscopic assistance (EA).
After article selection, a total of 2489 patients have been treated for a CPA lesion using the endoscope: 2054 vestibular schwannomas (VS), 368 epidermoid tumors (ET), 41 meningiomas and 26 among other pathologies. The retrosigmoid approach was the most frequently employed surgical corridor, irrespective of lesion type, for both full-endoscopic and endoscopic-assisted procedures. Although a great heterogeneity should be highlighted among the selected series of VS (1539), a weighted average of 92.5% of gross total resection (GTR) was obtained and 90% out of 1332 showed a good facial nerve outcome when comparable. Advantages in term of recognition of residuals have been described for the CPA meningiomas and multicompartmental epidermoid tumors with origin from CPA cistern, without increasing the risk of complications.
Despite different accepted advantages, the number of tumors in which the endoscope has been included among the surgical armamentarium is still limited compared to the number of the full-microscopic resections. After almost 30 years since its value was recognized, the number of prospective and case-control studies is still scarce to affirm a real benefit leading to its routinary use.
在过去几十年中，内窥镜的使用给颅底外科手术带来了重大变革。在小脑脑桥角（CPA），与单纯显微镜手术相比，其优势并不明显，目前正朝着用于神经血管冲突和肿瘤的全内窥镜手术发展。本综述旨在系统分析有关内窥镜在小脑脑桥角肿瘤中应用的文献。
按照PRISMA指南，对Pubmed/Medline和Embase数据库进行检索，检索无时间限制，以查找所有仅使用内窥镜（全内窥镜，FE或内窥镜控制，EC）或在内窥镜辅助（EA）下治疗的成年轴外小脑脑桥角肿瘤（前庭神经鞘瘤、脑膜瘤、表皮样囊肿或其他轴外病变）患者。
经过文章筛选，共有2489例患者使用内窥镜治疗CPA病变：2054例前庭神经鞘瘤（VS）、368例表皮样囊肿（ET）、41例脑膜瘤以及26例其他病变。无论病变类型如何，乙状窦后入路是全内窥镜和内窥镜辅助手术最常用的手术通道。尽管在所选的VS系列（1539例）中应突出显示很大的异质性，但加权平均全切除率（GTR）为92.5%，在1332例可比较的病例中，90%面神经功能良好。对于CPA脑膜瘤和起源于CPA脑池的多房性表皮样囊肿，在内窥镜识别残余病变方面具有优势，且不增加并发症风险。
尽管有不同公认的优势，但与全显微镜切除术的数量相比，在内窥镜已被纳入手术器械库的肿瘤数量仍然有限。自其价值被认可近30年后，前瞻性和病例对照研究的数量仍然很少，难以证实其常规使用能带来真正益处。
