显微镜内镜联合技术在桥小脑角区手术中的应用

摘要

目的探讨显微镜、内镜联合技术在桥小脑角区手术中的应用。方法回顾性分析2006年1月至2015年1月采用显微镜内镜联合技术进行手术治疗的72例侧颅底疾病患者的临床资料，其中男35例，女37例，年龄36～73岁。疾病种类：听神经瘤22例，颅神经疾病45例（包括三叉神经痛21例、梅尼埃病17例，面肌痉挛5例，舌咽神经痛2例），桥小脑角胆脂瘤5例；手术进路：乙状窦后进路37例（其中听神经瘤20例、颅神经疾病15例、桥小脑角胆脂瘤2例），迷路后进路35例（其中听神经瘤2例，颅神经疾病30例，桥小脑角胆脂瘤3例）。手术在显微镜和不同角度内镜配合下完成，使用时将内镜图像与显微镜图像融合。所有病例术后均随访1～5年，对手术效果进行分析。结果所有病例手术均成功。45例颅神经病变患者术后症状均消失，无一例出现面神经麻痹或非责任神经并发症，所有病例听力与术前相比均无下降。22例听神经瘤患者肿瘤均全切除，术后无一例出现面神经麻痹或其他颅脑并发症，术后实用听力保留率72．7％（16／22）；随访1～5年，无复发。5例桥小脑角胆脂瘤患者胆脂瘤均彻底切除，术后无一例出现面神经麻痹或其他颅脑并发症，术后2例患者出现听力丧失，3例保存实用听力；随访1～5年，无复发。结论显微镜联合内镜在处理桥小脑角区域病变时能结合二者的优势，避免各自的不利之处，具有较好的应用前景，尤其适用于乙状窦后进路和迷路后进路的颅神经手术、听神经瘤手术以及桥小脑角胆脂瘤手术。%Objective To evaluate the application of combination use of microscope and endoscope in cerebral pontine angle ( CPA) surgery.Methods A total of 72 patients undergone lateral skull base surgeries via endoscope under microscopic control from January 2006 to January 2015 was reviewed respectively .The patients including 35 males and 37 females were composed of 22 cases of vestibular swannnomas , 45 cases of cranial neuropathy and 5 cases of CPA chelesteatoma .Twenty cases of vestibular swannnomas , 15 cases of cranial neuropathy and 2 cases of CPA chelesteatoma undergone the surgery via retrosigmoid approach , while other cases undergone the surgery via retrolabyrinthine approach .Surgical procedures were accomplished under the control of microscope and different angular endoscope with imaging fusion.The surgical results were evaluated according to subjective and objective criteria , and all patients were followed up for 15 years.Results The symptoms was disappeared in the cranial neuropathy patients , without facial paralysis , complication of other nerves or hearing loss .Twenty-two patients with vestibular schwannomas got total tumor removal without facial palsy or neurological deficits ; useful hearing was preserved in 16 of 22 patients (72.7%), and no tumor recurrence was found during 1-5 years follow-up. There was also no facial palsy or other complications in 5 cases of CPA chelesteatoma , which gained completely surgical removal;useful hearing was preserved in 3 of 5 cases of these patients and no recurrence was occurred during 1-1.5 years follow-up.Conclusions A combination use of endoscope and microscope could combine advantages and avoid disadvantages of two techniques .It can provide better exposure with minimal invasion in CPA surgery , and is especially applicable in surgery for cranial neuropathy , vestibular schwannoma and CPA cholesteatoma , which should be performed through retrosigmoid approach and retrolabyrinthine approach .