Endoscope-Assisted Microsurgical Removal of an Epidermoid Tumor within the Cavernous Sinus

Epidermoid tumor of the cavernous sinus is rare. The aim of this case report is to discuss the role of neuroendoscopes in the removal of such lesions. A 21-year-old man presented with 6-year history of progressive headache, diplopia, and visual disturbance. Work-up revealed an epidermoid tumor located in the right cavernous sinus. An extradural transcavernous approach was utilized via a traditional frontotemporal craniotomy with endoscopic assistance. The postoperative course was uneventful with immediate improvement of the patient''s headache. Postoperative magnetic resonance imaging demonstrated complete removal of the tumor. There were no signs of recurrence during a 2-year follow-up period. The endoscope is a useful tool for removing epidermoid tumors from the cavernous sinus and enhances visualization of areas that would otherwise be difficult to visualize with microscopes alone. Endoscopes also help minimize the retraction of neurovascular structures.     

内镜辅助下扩大额下入路到达颅底中央部的显微解剖

目的研究内镜辅助扩大额下人路到达颅底中央部的显微解剖及显露范围,为临床神经外科提供解剖学依据。方法测量20例干颅骨标本的骨性结构,用20例成人尸头湿性标本模拟扩大额下入路操作,使用内镜和显微镜观察并测量。结果扩大额下入路截除眶顶后能够使眉问到达颅底靶点之间的距离明显缩短（P〈0．05）,视角明显增加（P〈0．05）,利于术者操作,减少手术副损伤。内镜辅助下手术能够克服和避免单纯显微镜下操作颅底暴露的“死角”和不足。结论内镜辅助扩大额下入路能够较好地显露颅底中央部,熟悉颅底中央部的解剖结构有助于开展经扩大额下人路切除该部位巨大肿瘤的准确定位及术中安全操作,提高肿瘤的全切率。     

Vascular Decompression of Trigeminal and Facial Nerves in the Posterior Fossa under Endoscope-Assisted Keyhole Conditions

Objective: The aim of this study was to determine the use and safety of the endoscope as an adjunct during trigeminal and facial nerve decompression procedures performed under keyhole conditions in the posterior fossa. Method: We performed 67 surgeries in 65 patients with symptomatic trigeminal and facial nerve compression syndromes. The diagnosis was made mainly on the basis of clinical history, examination, and magnetic resonance imaging scans. Surgery was performed in all cases under endoscope-assisted keyhole conditions. The follow-up was 1 week postoperatively, 6 months, and then yearly up to 7 years. All 34 patients with trigeminal neuralgia received preoperative medication treatment and experienced failure with it. Eighteen patients out of 30 with hemifacial spasm had been previously treated with botulinum toxin injections. One patient suffered from both trigeminal neuralgia and facial spasm, because of a megadolichobasilar and vertebral artery with compression of both cranial nerves. Results: Sixty-four of the 65 patients became symptom free after surgical treatment; one revision surgery was necessary because of disappearance of the decompression muscle piece. No mortalities or minor morbidities were observed in this series. Conclusion: A precise planned keyhole craniotomy and the simultaneous use of the microscope and the endoscope render the procedure of the decompression less traumatic.     

Thin endoscope-assisted endoscopic submucosal dissection for large colorectal tumors (with videos)

BACKGROUND: Endoscopic submucosal dissection (ESD) enables direct submucosal dissection so even large early stage GI tumors can be resected en bloc. Colorectal ESD is technically more difficult, however, and there is an increased risk of complications such as perforation and bleeding compared with gastric ESD. As a result, further refinements are required in this procedure. OBJECTIVE: Our purpose was to evaluate thin endoscope-assisted (TEA) ESD, a new traction system for improving submucosal cutting line visualization. DESIGN: Case series. SETTING: Okayama University Hospital. MAIN OUTCOME MEASUREMENTS: Efficacy and safety of the TEA-ESD procedure. RESULTS: Three cases of large, flat, elevated colorectal tumors (laterally spreading tumors) in the rectum and rectosigmoid colon were safely and successfully removed en bloc without complications. Total procedure times were 3 hours, 40 minutes, and 30 minutes with resected specimens measuring 70 x 68 mm, 38 x 35 mm, and 30 x 20 mm, respectively. LIMITATIONS: TEA-ESD was performed in only the rectum and rectosigmoid colon. CONCLUSIONS: This limited case series demonstrated that large laterally spreading tumors in the rectum and rectosigmoid colon could be safely resected en bloc with TEA-ESD.     

Path to the Interpeduncular Fossa: Anatomical Comparison of Endoscopic-Assisted versus Standard Subtemporal Approach

Objective The aim of this study was to assess the assumed advantage of endoscopic assistance to the standard subtemporal approach. The idea was to measure qualitatively and quantitatively visibility versus operability.Design We performed eight subtemporal dissections on four cadaver heads. Our dissections integrated an operating microscope, endoscope, and neuronavigation. Comparison was made between visibility and operability afforded by the microscope alone or by the microscope–endoscope combination. Visibility was recorded as complete or incomplete and was quantified for key structures using linear measurements taken by the navigation system. Operability was determined by whichever maneuvers could be safely and comfortably accomplished in the space afforded.Results From our survey, the structures whose visibility most benefitted from the addition of the endoscope include: contralateral third nerve, posterior perforated substance, mammillary bodies, and contralateral superior cerebellar artery. With regard to quantitative evaluation, we found increased visibility of both basilar artery and posterior cerebral artery. With regard to the operability, no objective advantage was afforded by the addition of the endoscope. Subjectively, the maneuvers were easier to perform while using the endoscope.Conclusion Using the endoscope as an assistance tool during conducting classical subtemporal approach can help in overcome a lot of the classical subtemporal approach limitations.     

Endoscope-assisted minilaparotomic radical retropubic prostatectomy

OBJECTIVE: To assess the clinical efficacy of endoscope-assisted minilaparotomic radical retropubic prostatectomy (EAM-RRP) compared with conventional radical retropubic prostatectomy (cRRP). METHODS: From September 2001 to December 2003, 30 patients with localized prostate cancer were treated by EAM-RRP. The surgical manipulation was performed through the wound with thoracoscopic assistance, using standard surgical instruments. In all cases, 800 mL of blood was collected from the patient for autotransfusion. For both EAM-RRP and cRRP, the internal iliac and obturator lymph nodes were dissected before the prostate removal. Clinical indicators such as operation time, blood loss, and duration of postoperative urine incontinence were analysed in the two groups. RESULTS: The postoperative period before ambulation and the duration of postoperative urine incontinence were significantly shorter after EAM-RRP than after cRRP, while no significant difference was found in operation time, blood loss, and duration of urethral catheterization. None of the cases required allotransfusion. CONCLUSION: EAM-RRP, which had a shorter postoperative period before ambulation and continence, is considered a safe and useful technique for radical prostatectomy.     

神经内窥镜治疗颅内囊性病变

目的：探讨颅内囊性病变的神经内窥镜治疗方法。方法：应用神经内窥镜对20例透明隔囊肿行囊肿－侧脑室造瘘,19例蛛网膜囊肿行囊肿－脑池,脑室造瘘,4例脑实质内囊肿行囊肿－脑室造瘘,1例第三脑室囊肿行囊肿大部切除：结果：44例中41例有效,3例无效,3例术后出现少量硬膜下出血,1例出现单侧暂时性动眼神经麻痹,结论：颅内囊性病变是神经内窥镜手术较好的适应证,对于有症状的颅内囊性病变应首选内窥镜治疗。     

Technologies for microendoscopes of the future: The MINOP project

Summary

The MINOP project involves the development of microsystems technology for use in minimally invasive neuro-surgical operation techniques. New methods for cranial endoscopy have been developed in association with seven partners from medicine, technology and industry. Some of these methods have already been put into clinical operation. Methods being developed include: two wavelength laser (setup and tests on a model); biportal endoscopic approaches; endoscope-assisted techniques; deflectable instruments, based on Nitinol (nickel/titanium alloy); micro-technologically manufactured endoscope lenses; and fluid-controlled flexible endoscopes.     

内镜辅助切除下牙槽神经管内神经鞘瘤1例

<正>1病例报告1.1病例资料患者,女性,39岁。发现左下颌骨囊性病变2周。患者于外院常规牙科检查,拍摄下颌全景片时发现左下颌支近下颌角处一囊性病变,无法确诊,前来我院就诊。患者无疼痛,无张口受限,无下唇麻木。常规     

内镜下锁孔硬膜外入路处理三叉神经的临床解剖学研究

目的探讨内镜锁孔硬膜外入路治疗三叉神经痛的可行性及其解剖。方法5例(10侧)成人干性颅骨,测量棘孔、卵圆孔及圆孔的相互距离及其连线与水平线的角度以及颧弓后根到棘孔、卵圆孔及圆孔的距离。5例(10侧)10%甲醛固定的成人头颅湿标本,观察三叉神经及其分支等结构。2例(4侧)成人头颅湿标本,平颧弓根部向上在颞骨上凿开2cm×2cm大小骨窗,暴露硬脑膜。在0°鼻内镜下垂向深部中线剥离硬脑膜,显露脑膜中动脉与三叉神经上颌神经与下颌神经支。结果棘孔到卵圆孔距离为8±2mm,其连线与水平线角度为40°±10°,卵圆孔到圆孔距离为11±2mm,其连线与水平线角度为70°±8°,棘孔到圆孔距离为18±2mm,其连线与水平线角度为50°±11°。颧弓后根与棘孔、卵圆孔以及圆孔的距离分别为32±8、41±9与50±7mm。内镜锁孔入路能完全显露三叉神经及其分支。结论内镜锁孔硬膜外入路能满意显露三叉神经及其分支,创伤小,是治疗三叉神经病变的一种微创手术入路。