神经内镜治疗小脑脑桥角区表皮样囊肿

Neuroendoscopic treatment for epidermoid cyst at the cerebellopontine angle

目的探讨在神经内镜下切除小脑脑桥角区表皮样囊肿的手术技巧及并发症。方法单纯应用神经内镜采用乙状窦后入路切除11例小脑脑桥角区表皮样囊肿。结果本组11例小脑脑桥角区表皮样囊肿均在内镜直视下被切除，术后MRI复查未见肿瘤残余。术后发热1例，经腰穿及对症治疗1周后体温恢复正常。无颅内出血和死亡病例。随访期间肿瘤无复发。1例术后1个月出现交通性脑积水，再行脑室一腹腔分流术。结论表皮样囊肿缺乏血管、内容物质地松软、包膜完整，适合神经内镜手术；术中利用自然和病理性解剖间隙，以及内镜和吸引器的成角特点，避免脑板牵拉，提高肿瘤全切率，降低并发症；手术疗效与术者掌握神经内镜技术的熟练程度密切相关。

Objective To study techniques and complications of pure neuronendoscopic treatment of epidermoid cyst at the cerebellopontine angle. Methods 11 cases of epidermoid cyst at the cerebellopontine angle were resected with pure neuroendoscopy by retrosigmoid approach. Results All cases of epidermoid cyst were completely resected. There was no remanent tumor which was found through the intraoperative observation and MRI scan. One patient had a fever after the operation, the body temperature returned to the normal level with lumber puncture and symptomatic treatment after one week. There were no death and intracranial hemorrhage in all cases. In the period of follow - up there was no recurred tumor. One case of communicating hydrocephalus was performed with V - P shunt after the operation. Conclusions The biological character of epidermoid cyst is lacking blood vessels, soft texture and intact envdope. The tumor suits for neuroendoscopic treatment . Operaters should sufficiently utilize physical and pathological interspace, and use different angle neuroendoscopy and suction, and decrease the traction for the brain in order to increase the total - resection rate of tumors and decrease the post - operative complications. Operative curative effect related to the proficient level of the surgeon mastering endoscopic techniques.