Tutino M, Chico F, Ortiz-Monasterio F
Department of Surgical and Anatomical Disciplines, University of Palermo, Italy.
J Craniofac Surg. 1998 Mar;9(2):154-61. doi: 10.1097/00001665-199803000-00014.
The first nine clinical cases using endoscopic dissection of dura and craniotomy with minimal trephines were performed from June to August 1997 after trial dissection of 19 fresh cadavers conducted at the University of Brno's Pathology Institute in the Czech Republic. These procedures involved the refinement of craniofacial and intracranial surgical techniques using the endoscope and prototype instruments. These dissections demonstrated that intracranial structures can be explored using an endoscope without encumbrance, and that major craniofacial surgeries may also be performed with minor incisions and minimal craniotomies. Furthermore, we seek to illustrate that use of the endoscope in craniofacial surgery provides improved visualization and protection of vital structures while simultaneously allowing the surgeon to perform delicate maneuvers. This permits minimal brain retraction with less subsequent morbidity. This minimally invasive craniofacial-intracranial surgical technique using the endoscope is performed with minimal cutaneous incisions, avoiding wide exposure of subcutaneous tissue, cranium, and meningeal structures. The ultimate goal is to perform endoscopic intracranial osteotomies and obtain advancement of craniofacial skeleton with gradual distraction. Potential neurosurgical advantages include improved postoperative recovery, decreased cerebral edema, and decreased risk of hemorrhage and infection.
1997年6月至8月期间，在捷克布尔诺大学病理研究所对19具新鲜尸体进行试验性解剖后，实施了首例9例使用硬脑膜内镜下剥离术和微型环锯开颅术的临床病例。这些手术涉及使用内窥镜和原型器械对颅面及颅内手术技术进行改进。这些解剖表明，使用内窥镜可以无障碍地探查颅内结构，并且主要的颅面手术也可以通过小切口和最小限度的开颅术来进行。此外，我们试图说明，在内窥镜颅面手术中使用内窥镜可改善对重要结构的可视化和保护，同时允许外科医生进行精细操作。这使得脑牵拉最小化，随后的发病率也更低。这种使用内窥镜的微创颅面-颅内手术技术通过最小的皮肤切口进行，避免了皮下组织、颅骨和脑膜结构的广泛暴露。最终目标是进行内窥镜颅内截骨术，并通过逐渐牵引使颅面骨骼前移。潜在的神经外科优势包括术后恢复改善、脑水肿减轻以及出血和感染风险降低。
