An endoscopic-assisted technique for the enlarged middle cranial fossa approach to the petroclival region:an anatomic study
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摘要: 目的: 通过对单纯显微镜下和内镜辅助下经扩大颅中窝径路至岩斜区所暴露的毗邻解剖结构的观察与测量,定量比较内镜辅助下暴露范围相对于单纯显微镜暴露的优势。方法: 在10例(20侧)新鲜成人灌注尸头标本上行扩大颅中窝径路至岩斜区的显微镜下解剖暴露观察,随后在同一标本上进行内镜辅助扩大暴露,分别测量显微镜和内镜辅助下的手术暴露范围。结果: 显微镜下三叉神经根进入脑桥处与脑干腹侧中线所能暴露的最上界之间的距离为(15.95±0.48)mm;显微镜下面听束脑干发出点与脑干腹侧中线所能暴露的最下界之间的距离为(10.79±0.51)mm;内镜辅助下三叉神经根进入脑桥处与脑干腹侧中线所能暴露的最上界之间的距离为(18.88±0.36)mm;内镜辅助下面听束脑干发出点与脑干腹侧中线所能暴露的最下界之间的距离为(14.56±0.64)mm。结论: 在扩大颅中窝径路至岩斜区的解剖研究中,内镜辅助技术相对于单纯显微镜下操作有更广泛的暴露范围和灵活的视角,有助于手术中精确定位病变位置和大小,准确辨识病变周围重要的神经和血管,从而提高肿瘤切除率,减少复发率。Abstract: Objective: Through the observation and measurement of the adjacent anatomical structures exposed by the pure microscope and endoscopic-assisted technique for the enlarged middle cranial fossa approach to the petroclival region, quantitative compare the advantages of endoscopic-assisted technique and the pure microscope exposure.Method: The enlarged middle cranial fossa approach was performed on 10 cases (20 sides) fresh adult cadaveric head specimens in which the vessels were injected with colored silicone. At the end of every enlarged middle cranial fossa approachs, endoscope assisted technique was applied. The effective working areas were measured under pure microscope and endoscopic-assisted technique.Result: The distance between the trigeminal nerve root entering the pons and the upper limit of exposure to the middle of the ventral brainstem under the microscope was(15.95±0.48)mm;the distance from the initial point of the acoustic-facial bundle to the lower bound of exposure to the middle of the ventral brainstem under the microscope was(10.79±0.51)mm;The distance between the trigeminal nerve root entering the pons and the upper limit of exposure to the middle of the ventral brainstem under endoscopy was(18.88±0.36)mm;the distance from the initial point of the acoustic-facial bundle to the lower bound of exposure to the middle of the ventral brainstem under endoscopy was(14.56±0.64)mm.Conclusion: In the anatomic study of the enlarged middle cranial fossa approach to the petroclival region, the endoscopic assistance has a larger effective exposure space and flexible perspective compared with the operation under the microscope, which is helpful to accurately locate the position and size of the lesion during surgery, accurately identify the important nerves and blood vessels surrounding the lesion, so as to improve the resection rate and reduce the recurrence rate.
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[1] ISOLAN G R, WAYHS S Y, LEPSKI G A, et al.Petroclival Meningiomas:Factors Determining the Choice of Approach[J].J Neurol Surg B Skull Base, 2018, 79:367-378.
[2] TANG C T, KUROZUMI K, PILLAI P, et al.Quantitative analysis of surgical exposure and maneuverability associated with the endoscope and the microscope in the retrosigmoid and various posterior petrosectomy approaches to the petroclival region using computer tomograpy-based frameless stereotaxy[J].Clin Neurol Neurosurg, 2013, 115:1058-1062.
[3] HOUSE W F.Surgical exposure of the internal auditory canal and its contentsthrough the middle, cranial fossa[J].Laryngoscope, 1961, 71:1363-1385.
[4] EL SHAFIE R A, CZECH M, KESSEL K A, et al.Clinical outcome after particle therapy for meningiomas of the skull base:toxicity and local control in patients treated with active rasterscanning[J].Radiat Oncol, 2018, 13:54.
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