目的比较神经内镜下经眶上锁孔入路与显微镜下经侧裂岛叶入路治疗高血压性基底节区脑出血的临床效果。方法选取52例进行手术治疗的高血压性基底节区脑出血患者进行回顾性分析,根据手术方式不同分为内镜组(28例,采用神经内镜下经眶上锁...目的比较神经内镜下经眶上锁孔入路与显微镜下经侧裂岛叶入路治疗高血压性基底节区脑出血的临床效果。方法选取52例进行手术治疗的高血压性基底节区脑出血患者进行回顾性分析,根据手术方式不同分为内镜组(28例,采用神经内镜下经眶上锁孔入路治疗)和显微镜组(24例,采用显微镜下经侧裂岛叶入路治疗)。比较两组患者手术时间、术中出血量、血肿清除率、住院时间、术后7 d格拉斯哥昏迷评分法(GCS)评分、神经功能缺损程度、术后并发症发生情况、颅内再出血情况及预后情况。结果内镜组手术时间(82.35±15.26)min、住院时间(11.58±2.09)d短于显微镜组的(162.47±20.43)min、(14.67±2.11)d,术中出血量(109.58±20.45)ml少于显微镜组的(161.67±38.78)ml,血肿清除率(88.24±8.68)%、术后7 d GCS评分(12.88±1.56)分高于显微镜组的(83.07±7.81)%、(11.16±1.24)分,差异有统计学意义(P<0.05)。两组术前美国国立卫生研究院卒中量表(NIHSS)评分比较差异无统计学意义(P>0.05);内镜组术后1周NIHSS评分(7.86±1.56)分低于显微镜组的(11.12±1.83)分,差异有统计学意义(P<0.05)。两组颅内感染、脑脊液漏、继发性脑梗发生率及颅内再出血发生率比较,差异均无统计学意义(P>0.05)。两组格拉斯哥预后评分法(GOS)评分比较,差异无统计学意义(P>0.05)。结论神经内镜下经眶上锁孔入路可以有效治疗高血压性基底节区脑出血,能明显减少术中出血量,提高血肿清除率、术后GCS评分,缩短手术时间和住院时间,且安全性和预后与显微镜下经侧裂岛叶入路手术无明显差异。展开更多
Background Image-guided neurosurgery, endoscopic-assisted neurosurgery and the keyhole approach are three important parts of minimally invasive neurosurgery and have played a significant role in treating skull base le...Background Image-guided neurosurgery, endoscopic-assisted neurosurgery and the keyhole approach are three important parts of minimally invasive neurosurgery and have played a significant role in treating skull base lesions. This study aimed to investigate the potential usefulness of coupling of the endoscope with the far lateral keyhole approach and image guidance at the ventral craniocervical junction in a cadaver model. Methods We simulated far lateral keyhole approach bilaterally in five cadaveric head specimens （10 cranial hemispheres）. Computed tomography-based image guidance was used for intraoperative navigation and for quantitative measurements. Skull base structures were observed using both an operating microscope and a rigid endoscope. The jugular tubercle and one-third of the occipital condyle were then drilled, and all specimens were observed under the microscope again. We measured and compared the exposure of the petroclivus area provided by the endoscope and by the operating microscope. Statistical analysis was performed by analysis of variance followed by the Student-Newman-Keuls test. Results With endoscope assistance and image guidance, it was possible to observe the deep ventral craniocervical junction structures through three nerve gaps （among facial-acoustical nerves and the lower cranial nerves） and structures normally obstructed by the jugular tubercle and occipital condyle in the far lateral keyhole approach. The surgical area exposed in the petroclival region was significantly improved using the 0° endoscope （1147.80 mm2） compared with the operating microscope （（756.28±50.73） mm2）. The far lateral retrocondylar keyhole approach, using both 0° and 30° endoscopes, provided an exposure area （（1147.80±159.57） mm2 and （1409.94±155.18） mm2, respectively） greater than that of the far lateral transcondylar transtubercular keyhole approach （（1066.26±165.06） mm2） （P 〈0.05）. Conclusions With the aid of the endoscope and image guidance, it is possible to approach the ventral craniocervical junction with the far lateral keyhole approach. The use of an angled-lens endoscope can significantly improve the exposure of the petroclival region without drilling the jugular tubercle and occipital condyle.展开更多
目的探讨经侧裂-岛叶人路显微手术对基底节区高血压脑出血的疗效。方法回顾性分析2010年1月-2013年6月64例基底节高血压脑出血患者临床资料。其中41例行经侧裂-岛叶入路显微手术(A组);另23例行常规骨瓣开颅手术(B组),比较2组治疗效果及...目的探讨经侧裂-岛叶人路显微手术对基底节区高血压脑出血的疗效。方法回顾性分析2010年1月-2013年6月64例基底节高血压脑出血患者临床资料。其中41例行经侧裂-岛叶入路显微手术(A组);另23例行常规骨瓣开颅手术(B组),比较2组治疗效果及近远期预后。结果 A组手术时间(115.35±46.23)min、术后自动睁眼时间(5.22±3.43)h均短于B组(212.43±58.24)min、(8.74±4.51)h(P<0.05)。术后7 d A组GCS评分(11.92±2.73)分高于B组(9.85±2.46)分(P<0.05)。术后48 h行CT复查,A组血肿大部分清除率为80.49%(33/41)优于B组的56.52%(13/23)(P<0.05)。观察组与对照组并发症发生率无明显差异(39.02%vs.47.83%,P>0.05)。术后3个月随访,A组优良率为60.98%(25/41),明显高于B组的34.78%(8/23)(P<0.05)。术后12个月随访,A组优良率为72.50%(29/40),明显高于B组的47.62%(10/21)(P<0.05)。结论经侧裂-岛叶入路显微手术治疗脑出血是一种损伤小、疗效好、并发症少的治疗方法。展开更多
文摘目的比较神经内镜下经眶上锁孔入路与显微镜下经侧裂岛叶入路治疗高血压性基底节区脑出血的临床效果。方法选取52例进行手术治疗的高血压性基底节区脑出血患者进行回顾性分析,根据手术方式不同分为内镜组(28例,采用神经内镜下经眶上锁孔入路治疗)和显微镜组(24例,采用显微镜下经侧裂岛叶入路治疗)。比较两组患者手术时间、术中出血量、血肿清除率、住院时间、术后7 d格拉斯哥昏迷评分法(GCS)评分、神经功能缺损程度、术后并发症发生情况、颅内再出血情况及预后情况。结果内镜组手术时间(82.35±15.26)min、住院时间(11.58±2.09)d短于显微镜组的(162.47±20.43)min、(14.67±2.11)d,术中出血量(109.58±20.45)ml少于显微镜组的(161.67±38.78)ml,血肿清除率(88.24±8.68)%、术后7 d GCS评分(12.88±1.56)分高于显微镜组的(83.07±7.81)%、(11.16±1.24)分,差异有统计学意义(P<0.05)。两组术前美国国立卫生研究院卒中量表(NIHSS)评分比较差异无统计学意义(P>0.05);内镜组术后1周NIHSS评分(7.86±1.56)分低于显微镜组的(11.12±1.83)分,差异有统计学意义(P<0.05)。两组颅内感染、脑脊液漏、继发性脑梗发生率及颅内再出血发生率比较,差异均无统计学意义(P>0.05)。两组格拉斯哥预后评分法(GOS)评分比较,差异无统计学意义(P>0.05)。结论神经内镜下经眶上锁孔入路可以有效治疗高血压性基底节区脑出血,能明显减少术中出血量,提高血肿清除率、术后GCS评分,缩短手术时间和住院时间,且安全性和预后与显微镜下经侧裂岛叶入路手术无明显差异。
文摘Background Image-guided neurosurgery, endoscopic-assisted neurosurgery and the keyhole approach are three important parts of minimally invasive neurosurgery and have played a significant role in treating skull base lesions. This study aimed to investigate the potential usefulness of coupling of the endoscope with the far lateral keyhole approach and image guidance at the ventral craniocervical junction in a cadaver model. Methods We simulated far lateral keyhole approach bilaterally in five cadaveric head specimens （10 cranial hemispheres）. Computed tomography-based image guidance was used for intraoperative navigation and for quantitative measurements. Skull base structures were observed using both an operating microscope and a rigid endoscope. The jugular tubercle and one-third of the occipital condyle were then drilled, and all specimens were observed under the microscope again. We measured and compared the exposure of the petroclivus area provided by the endoscope and by the operating microscope. Statistical analysis was performed by analysis of variance followed by the Student-Newman-Keuls test. Results With endoscope assistance and image guidance, it was possible to observe the deep ventral craniocervical junction structures through three nerve gaps （among facial-acoustical nerves and the lower cranial nerves） and structures normally obstructed by the jugular tubercle and occipital condyle in the far lateral keyhole approach. The surgical area exposed in the petroclival region was significantly improved using the 0° endoscope （1147.80 mm2） compared with the operating microscope （（756.28±50.73） mm2）. The far lateral retrocondylar keyhole approach, using both 0° and 30° endoscopes, provided an exposure area （（1147.80±159.57） mm2 and （1409.94±155.18） mm2, respectively） greater than that of the far lateral transcondylar transtubercular keyhole approach （（1066.26±165.06） mm2） （P 〈0.05）. Conclusions With the aid of the endoscope and image guidance, it is possible to approach the ventral craniocervical junction with the far lateral keyhole approach. The use of an angled-lens endoscope can significantly improve the exposure of the petroclival region without drilling the jugular tubercle and occipital condyle.
文摘目的探讨经侧裂-岛叶人路显微手术对基底节区高血压脑出血的疗效。方法回顾性分析2010年1月-2013年6月64例基底节高血压脑出血患者临床资料。其中41例行经侧裂-岛叶入路显微手术(A组);另23例行常规骨瓣开颅手术(B组),比较2组治疗效果及近远期预后。结果 A组手术时间(115.35±46.23)min、术后自动睁眼时间(5.22±3.43)h均短于B组(212.43±58.24)min、(8.74±4.51)h(P<0.05)。术后7 d A组GCS评分(11.92±2.73)分高于B组(9.85±2.46)分(P<0.05)。术后48 h行CT复查,A组血肿大部分清除率为80.49%(33/41)优于B组的56.52%(13/23)(P<0.05)。观察组与对照组并发症发生率无明显差异(39.02%vs.47.83%,P>0.05)。术后3个月随访,A组优良率为60.98%(25/41),明显高于B组的34.78%(8/23)(P<0.05)。术后12个月随访,A组优良率为72.50%(29/40),明显高于B组的47.62%(10/21)(P<0.05)。结论经侧裂-岛叶入路显微手术治疗脑出血是一种损伤小、疗效好、并发症少的治疗方法。
