全程神经内镜技术在经乙状窦后入路侧颅底肿瘤切除术的应用

Application of fully neuroendoscopic surgery for lateral skull base tumor resection via retrosigmoid approach

目的研究全程神经内镜下经乙状窦后入路侧颅底肿瘤切除术的手术技巧和疗效。方法回顾性分析46例侧颅底肿瘤病例资料,均采用经乙状窦后入路全程在神经内镜操作下完成手术。结果本研究术中采用单人单手内镜技术切除肿瘤15例,以气动臂持镜、单人双手技术切除肿瘤25例,两种技术配合使用完成手术6例。术后肿瘤全切率达91.3%(42/46),病人症状改善率67.4%(31/46)。随访6~42个月、平均(19.6±3.8)个月,无肿瘤复发及死亡病例。结论神经内镜在侧颅底肿瘤切除术中具有多角度、近距离观察,神经血管辨认度高等优势,在气动固定臂配合下,能够全程在内镜下切除肿瘤,疗效类似于显微外科手术。

Objective To investigate surgical techniques and efficacy of fully neuroendoscopic surgery for lateral skull base tumor resection via retrosigmoid approach.Methods The clinical data of 46 patients with lateral skull base tumors,who underwent fully endoscopic removal of lateral skull base tumors via retrosigmoid approach,were analyzed retrospectively.Results Fifteen tumors were removed with single-hand endoscopic technique,25 tumors were removed by pneumatic arm holding endoscope with double-hand technique and 6 tumors were removed by combination of the two techniques.The total tumor resection rate was 91.3%(42/46)and the symptom improvement rate was 67.4%(31/46).All the patients were followed up for 6 to 42 months,with an average of 19.6±3.8 months,without tumor recurrence and patient death.Conclusions Neuroendoscopy has the advantages of multi-angle,near observation and high neurovascular recognition in lateral skull base tumor resection.With the cooperation of the pneumatic fixed arm,the tumor can be removed under the endoscope through the whole process and the effect is similar to that of microsurgery.