神经内镜辅助显微直视手术切除桥小脑角胆脂瘤

Endoscope-assisted microneurosurgery for treatment of cholesteatoma in cerebelloponfine angle

目的 总结桥小脑角（CPA）胆脂瘤显微直视手术辅以内镜处理显微死角部位的经验,以期提高CPA胆脂瘤的全切率.方法 回顾性分析自2007年1月至2009年7月手术治疗的34例CPA胆脂瘤,术前均经CT、MRI检查并经手术及病理证实.经乙状窦后入路,先在显微镜直视下分离切除所见肿瘤及其包膜,然后用内镜（0°和30°）观察显微镜死角是否有残余肿瘤,并在内镜下切除.同时以2004年1月至2006年12月收治的未用内镜辅助手术的CAP胆脂瘤36例作为病例对照.结果 内镜辅助手术经术后影像学检查,全切31例（91.18%）,次全切除3例（8.82%）,术后近期出现神经功能损害者2例（5.88%）,无手术死亡.随访半年至一年半,均恢复正常工作和学习.对照组全切25例（69.44%）,大部切除11例（30.56%）,出现神经功能损害者9例（25%）,无手术死亡.结论 在CPA胆脂瘤显微直视手术中,辅以内镜可以观察并切除显微镜死角内的残余肿瘤,从而明显提高手术全切率,有效防止肿瘤复发.

Objective To summarized the experiences of endoscope used to cope with the tumor located at the dead angle during microsurgical treatment to increase the total removal rate of cholesteatoma in cerebellopontine angle （CPA）. Methods We retrospectively analyzed the data of 34 patients with CPA. These patients underwent microsurgery from January 2007 to July 2009. All patients received CT and MRI on the head and brain, and were documented with cholesteatoma by surgery.Retrosigmoid approach was adopted; tumors and their capsules were separated and removed, and then the dead angles were inspected by 0-30 degree rigid neuroendoscopy to dissect the residual tumor. Another 36 patients with CAP, admitted to our hospital and performed surgery without neuroendoscopy from January 2004 to December 2006, were chosen as controls. Results Total removal was achieved in 31 patients （91.18%）, and subtotal removal in 2 （5.88%）. Temporal neurological damage was noted in 2 patients; no death was noted. All patients followed up for half a year to one and half a year returned to work and study. In control group, total removal was achieved in 25 patients （69.44%） and subtotal removal in 11 （30.56%）; neural dysfunctions were present in 9 （25%）; no patient died. Conclusion Endoscope-assisted microsurgery can decrease the tumor recurrence by exposing the remnant tumor in the death angle and increasing the total removal rate.