内镜辅助显微镜下经乙状窦后入路的解剖学观察及临床应用

Endoscopic Anatomy and Microanatomy of the Retrosigmoid Approach and Clinical Application

目的通过对经乙状窦后入路的内镜解剖与显微解剖学研究,为临床提供解剖学参考。方法 10例成人尸头,取经乙状窦后入路,在显微镜和内镜下对其内部结构进行全程观察。采用经乙状窦后入路切除桥小脑角区肿瘤57例。结果通过显微镜及不同角度内镜,能够清楚观察到桥小脑角区的重要血管、神经结构。听神经瘤全切除27例,大部分切除5例;脑膜瘤全切除15例,大部分切除3例;胆脂瘤7例均全切除。无围手术期死亡。无与神经内镜手术相关的并发症。结论内镜辅助显微镜经乙状窦后入路对桥小脑角区暴露良好,对周围组织损伤小,有效提高手术的安全性,较单纯显微手术有明显优势。

Objective To provide anatomic basis for clinical surgery,via studying the endoscopic anatomy and microanatomy of the retrosigmoid approach.Methods Ten adult cadaveric heads were observed following the retrosigmoid approach under both microscope and endoscope.Meanwhile,57 patients who had received operations via the retrosigmoid approach were also enrolled in this study.Results With endoscope and microscope at different angles,we could observe the major blood vessels and neural structures of the CPA without making any injuries to normal tissues.Of the 57 patients,the total removal of tacoustic neuromas was achieved in 27 cases,and subtotal removal in 5.The total removal of meningioma was completed in 15 cases,and subtotal removal in 3.All the cholesteatomas were totally resected（7 cases）.No perioperative death,nor postoperative endoscope-related complications occurred in our patients.Conclusions The merits of endoscopic-assisted retrosigmoid approach,compared with simple microsurgery,include good exposure of the structures in the CPA and less injury to the surrounding structures,which can effectively improve the safety of the surgery.