内窥镜辅助显微直视手术切除颅内胆脂瘤

目的总结颅内胆脂瘤显微直视手术中辅以内窥镜处理显微镜死角部位肿瘤的经验，以期提高颅内胆脂瘤的全切率。方法回顾性分析2000年8月至2008年8月手术治疗的颅内胆脂瘤患者251例，所有病人术前均经CT、MRI检查并经手术及病理证实。其中肿瘤位于小脑桥脑角151例，鞍区61例，松果体区16例，脑实质内10例，纵裂内5例，枕大池区4例，颅中窝底硬膜外4例。依肿瘤所在部位选择恰当骨瓣开颅，先在显微镜直视下分离切除所见肿瘤及其包膜，然后用内窥镜观察显微镜死角区域是否有残余肿瘤，并在内窥镜下切除之。同时以1992年8月至2000年7月收治的未用内窥镜辅助手术的颅内胆脂瘤248例作为病例对照。结果内窥镜辅助手术组术后经影像学检查，全切223例（88．84％），大部切除28例（11．16％）；术后近期出现神经功能损害症状者6例（2．4％）；无手术死亡。获随访196例，随访期0．5—8年，均恢复正常工作和学习。对照组全切162例（65．32％），大部切除86例（34．68％），出现神经功能损害者7例（2．82％），死亡1例。结论在颅内胆脂瘤显微直视手术中，辅以内窥镜可以观察并切除显微镜死角内的残余肿瘤，从而明显提高手术全切率，有效防止肿瘤复发。

Endoscope-assisted microneurosurgery for the treatment of intracranial cholesteatoma

Objective To achieve more complete removal of cholesteatoma, we summarized the experiences of endoseopes used to cope with the tumor located at the ＂dead angle＂ during mierosurgical treatment of intracrunial cholesteatoma. Methods We retrospectively analyzed 251 patients with cholesteatom who underwent endoscope- assisted mierosurgery from August 2000 to August 2008 and 248 patients with cholesteatom who underwent microsurgery from August 1992 to July 2000. All patients underwent computed tomography and magnetic resonance imaging of the head and brain, and were documented with cholesteatom by surgery. Among the patients who underwent endoscope- assisted mierosurgery, 151 lesions were located in the cerebellopontine angle, 61 in the sellar region, 16 in the pineal body, 10 in the cerebral parenchyma, 5 in the longitudinal fission, 4 in the cistema rrkagua, 4 in the epidural of middle cranial fossa. The selection of a surgical approach depended on the tumor location. Under the endoscope-assisted microsurgical procedure, we dissociated and removed the mass and capsule under microscope, then observed the area out of the microscope and removed remnant tumor using endoscope. Results Total removal was achieved in 233 （88.84%） patients, subtotal removal in 28 （11.16%） patients; neural dysfunctions were present in 6 （2. 4% ） patients after surgery; and there were no deaths in endoscope-assisted microsurgical patients. All of 196 follow-up patients （range from 0. 5 to 8 years） retured to work and study. In microsurgical patients, total removal was achieved in 162 （65.32%） patients, subtotal removal in 86（34.68% ） patients; neural dysfunctions were present in 7 （2.82%） patients after surgery; and there were one death. Conclusion Endoscope-assisted microsurgery can expose the remnant tumor in the area out of microscope and increase the rate of total removal, therefore, decrease the tumor recurrence.