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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。
Objective To summarize the experience of intracranial cholesteatoma microsurgery assisted by endoscopic treatment of the tumor in the dead angle of the microscope in order to improve the rate of total cholesteatoma. Methods A retrospective analysis of 251 patients with intracranial cholesteatoma surgically treated from August 2000 to August 2008 were performed. All patients were confirmed by CT and MRI before surgery and by pathology. The tumor located in the cerebellopontine angle in 151 cases, 61 cases of saddle, pineal region in 16 cases, 10 cases of brain parenchyma, 5 cases of longitudinal fissure, 4 cases of occipital large pool area, epidural median epidural in 4 cases. Select the appropriate site of the tumor by craniotomy craniotomy, the first under the microscope under the separation and resection of the tumor resected and its envelope, and then use the endoscope to observe whether there is residual tumor microscopic area and endoscopic resection. 248 cases of intracranial cholesteatoma without endoscope-assisted surgery admitted from August 1992 to July 2000 were selected as case-control. Results In the endoscopic assisted surgery group, 223 cases (88.84%) underwent resection and 28 cases (11.16%) underwent resection after the operation. Six cases (2.4%) had symptoms of neurological damage recently Surgical death. A total of 196 cases were followed up, with a follow-up period of 0.5 to 8 years. Both returned to normal work and study. In the control group, 162 cases (65.32%) were completely resected, 86 cases (34.68%) underwent resection, 7 cases (2.82%) had neurological impairment, and 1 died. Conclusion In microsurgery of intracranial cholesteatoma, assisted by endoscope can observe and remove the residual tumor in the dead angle of the microscope, thus significantly improving the rate of complete resection and effectively preventing tumor recurrence.