全神经内镜技术在后颅窝病变手术中的应用

doi:10.3969/j.issn.1674-8115.2025.03.014

上海交通大学学报（医学版） ›› 2025, Vol. 45 ›› Issue (3): 365-372.doi: 10.3969/j.issn.1674-8115.2025.03.014

全神经内镜技术在后颅窝病变手术中的应用

周至宜¹(), 赵浩², 缪亦锋¹(), 朱池豪¹, 杨溪¹, 王思源¹, 冯军峰¹, 邱永明¹

^1.上海交通大学医学院附属仁济医院神经外科，上海 200012
^2.福建省福鼎市医院神经外科，福鼎 355200

收稿日期:2024-09-18 接受日期:2024-12-20 出版日期:2025-03-28 发布日期:2025-03-18
通讯作者: 缪亦锋，副主任医师，博士；电子信箱：yifengm@qq.com。
作者简介:周至宜（1990—），男，主治医师，博士；电子信箱：zzyhenry@sina.com。
基金资助:
上海交通大学医学院附属仁济医院临床研究培育基金计划(LYPY-QN-03)

Application of full-neuroendoscopic technique in surgical treatment of posterior cranial fossa lesions

ZHOU Zhiyi¹(), ZHAO Hao², MIAO Yifeng¹(), ZHU Chihao¹, YANG Xi¹, WANG Siyuan¹, FENG Junfeng¹, QIU Yongming¹

^1.Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200012, China
^2.Department of Neurosurgery, Fuding Hospital, Fujian Province, Fuding 355200, China

Received:2024-09-18 Accepted:2024-12-20 Online:2025-03-28 Published:2025-03-18
Contact: MIAO Yifeng, E-mail: yifengm@qq.com.
Supported by:
Cultivation Fund for Clinical Research of Renji Hospital, Shanghai Jiao Tong University School of Medicine(LYPY-QN-03)

摘要/Abstract

摘要：

目的·探讨全神经内镜技术在手术治疗后颅窝病变中的具体应用效果及其优势。方法·通过回顾性分析方法，收集并整理2021年1月—2023年12月在上海交通大学医学院附属仁济医院神经外科接受全神经内镜下手术治疗的105例后颅窝病变患者的临床资料，包括患者的性别、年龄、病变部位、疾病性质以及手术过程和术后恢复情况。术后1个月复查头颅增强MRI，后期根据病变性质平均每3个月随访1次。结果·在105例后颅窝病变患者中，男性45例，平均年龄（56±17）岁；女性60例，平均年龄（62±12）岁。根据后颅窝的分区，病变主要集中在桥小脑角区（78例），其他还包括岩骨区（7例）、小脑（10例）和脑干（10例）。疾病性质方面，包括听神经瘤（11例）、脑膜瘤（7例）、胶质瘤（7例）、脑转移瘤（7例）、血管母细胞瘤（6例）、囊肿（1例），以及三叉神经痛（43例）、面肌痉挛（22例）和舌咽神经痛（1例）。所有患者均成功完成全神经内镜下病变切除、组织活检或微血管减压术。术后随访时间范围为3个月至3年，通过复查增强MRI确认肿瘤性病变中病灶全切34例（87.2%）、次全切除3例（7.7%）、组织活检2例（5.1%），随访过程中死亡3例。在血管神经性疾病患者中，有2例三叉神经痛患者术后疼痛未得到完全缓解，面肌痉挛和舌咽神经痛缓解率达100%；术后并发症3例，2例为术后脑积水，经脑室-腹腔分流后症状缓解，1例为伤口愈合不良。结论·全神经内镜技术在后颅窝病变手术中具有一定的应用潜力。

关键词: 后颅窝病变, 全神经内镜技术, 手术治疗, 三叉神经痛, 听神经瘤

Abstract:

Objective ·To investigate the application effects and benefits of full-neuroendoscopic technique in the surgical treatment of posterior cranial fossa lesions. Methods ·A retrospective analysis was conducted on the clinical data of 105 patients with posterior cranial fossa lesions who underwent surgery using full-neuroendoscopic techniques at the Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, between January 2021 and December 2023. The data included patients′ gender, age, lesion locations, nature of lesions, surgical procedures, and postoperative recovery. Follow-up with contrast-enhanced MRI was performed one month postoperatively, with subsequent follow-ups every three months on average, depending on the nature of the lesions. Results ·Among the 105 patients, there were 45 males with an average age of (56±17) years and 60 females with an average age of (62±12) years. Lesions were predominantly located in the cerebellopontine angle area (78 cases), with others in the petrous bone area (7 cases), cerebellum (10 cases), and brainstem (10 cases). The nature of lesions included vestibular schwannoma (11 cases), meningioma (7 cases), glioma (7 cases), brain metastases (7 cases), hemangioblastoma (6 cases), cyst (1 case), and neuropathic conditions such as trigeminal neuralgia (43 cases), hemifacial spasm (22 cases), and glossopharyngeal neuralgia (1 case). All patients successfully underwent resection or biopsy of their lesions or microvascular decompression under full-neuroendoscopy. The follow-up period ranged from 3 months to 3 years. Enhanced MRI confirmed complete resection in 34 tumor cases (87.2%), near-total resection in 3 cases (7.7%), and biopsy in 2 cases (5.1%). Three deaths occurred during follow-up. Among the patients with vascular neuropathic diseases, two with trigeminal neuralgia experienced incomplete pain relief postoperatively. The resolution rates for hemifacial spasm and glossopharyngeal neuralgia were 100%. Postoperative complications occurred in 3 cases, with 2 cases of hydrocephalus that were managed with ventriculoperitoneal shunting, and 1 case of poor wound healing. Conclusion ·Full-neuroendoscopic technique demonstrates potential in the surgical treatment of posterior cranial fossa lesions.

Key words: posterior fossa lesion, full-neuroendoscopic technique, surgical treatment, trigeminal neuralgia, acoustic neuroma

中图分类号:

R651.1

周至宜, 赵浩, 缪亦锋, 朱池豪, 杨溪, 王思源, 冯军峰, 邱永明. 全神经内镜技术在后颅窝病变手术中的应用[J]. 上海交通大学学报（医学版）, 2025, 45(3): 365-372.

ZHOU Zhiyi, ZHAO Hao, MIAO Yifeng, ZHU Chihao, YANG Xi, WANG Siyuan, FENG Junfeng, QIU Yongming. Application of full-neuroendoscopic technique in surgical treatment of posterior cranial fossa lesions[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(3): 365-372.

图/表 5

图1 全内镜下乙状窦后锁孔入路血管神经性病变微血管减压术Note： A. The patient′s position during operation. B. The surgical incision for trigeminal neuralgia. C. The surgical incision for facial spasm. D. The bone window. E. Vascular compression in the REZ area of the trigeminal nerve. F. Decompression with a Teflon patch in the REZ area of the trigeminal nerve. G. Vascular compression in the distal trigeminal nerve. H. Decompression with a Teflon patch in the distal trigeminal nerve. I. Vascular compression in the facial nerve observed by 0° neuroendoscopy. J. Vascular compression in the facial nerve observed by 30° neuroendoscopy. K. Decompression with a Teflon patch in the facial nerve. L. Microvascular decompression for glossopharyngeal neuralgia.

Fig 1 Microvascular decompression of angioneuropathy via retrosigmoid keyhole approach by full-endoscopic surgery

图2 全内镜下乙状窦后锁孔入路听神经瘤切除术Note： A. The magnetic resonance-enhanced axial image before the operation. B. The magnetic resonance-enhanced sagittal image before the operation. C. The magnetic resonance-enhanced coronal image before the operation. D. The cerebral vascular imaging in magnetic resonance angiography before the operation. E. The patient′s position during operation. F. The surgical incision. G. Placement of the endoscopic holder. H. A schematic diagram of placement of endoscopic and surgical instruments in the cerebellopontine angle. I. Releasing cerebrospinal fluid in the cisterna magna. J. Exposing the tumor. K. Separating the tumor capsule from the facial nerve and performing intracapsular resection of the tumor. L. The endoscopic image after tumor resection.

Fig 2 Resection of acoustic neurinoma via retrosigmoid keyhole approach by full-endoscopic surgery

图3 全内镜下幕下小脑上外侧入路岩斜区脑膜瘤切除术Note： A. The magnetic resonance-enhanced axial image before the operation. B. The magnetic resonance-enhanced sagittal image before the operation. C. The magnetic resonance-enhanced coronal image before the operation. D. The cerebral vascular imaging in magnetic resonance angiography before the operation. E. The patient′s position during operation. F. The surgical incision. G. Extending the bone window superiorly to expose the transverse sinus and sigmoid sinus. Two blue lines represent the transverse sinus and the sigmoid sinus. H. Releasing cerebrospinal fluid in the cisterna magna. I. Exposure of the tumor under neuroendoscopy. J. Intratumoral decompression by CUSA. K. Separation of the tumor capsule. L. Endoscopic imaging after tumor resection.

Fig 3 Resection of petroclival meningiomas via the superior lateral infratentorial approach by full-endoscopic surgery

图4 全内镜下小脑病变切除术Note： A‒F. The lateral cerebellar lesion (brain metastasis). A. The magnetic resonance-enhanced axial image before the operation. B. The magnetic resonance- enhanced coronal image before the operation. C. The patient′s position and the surgical incision. D. Intratumoral decompression under neuroendoscopy. E. Separating the tumor boundary and completely removing the tumor. F. Complete hemostasis in the tumor cavity. G‒L. The medial cerebellar lesion (hemangioblastoma). G. The magnetic resonance-enhanced axial image before the operation. H. The magnetic resonance-enhanced coronal image before the operation. I. The patient's position and the surgical incision. J. Exposing the tumor through the natural space under the tentorium. K. Separating the tumor boundary. L. Complete resection of the tumor in its entirety.

Fig 4 Resection of cerebellar lesions by full-endoscopic surgery

图5 全内镜下脑干病变切除术Note：A‒F. The pontine lesion. A. The magnetic resonance-enhanced axial image before the operation. B. The magnetic resonance-enhanced sagittal image before the operation. C. The patient′s position and the surgical incision. D. Exposure of the lateral pontine under neuroendoscopy. E. Pontine fistula and neuroendoscopic resection of the tumor. F. Neuroendoscopic imaging after tumor resection and complete hemostasis. G‒L. The midbrain lesion. G. The magnetic resonance-enhanced axial image before the operation. H. The magnetic resonance-enhanced sagittal image before the operation. I. The patient′s position and the surgical incision. J. Separation of the cisterna magna and exposure of the fourth ventricle. K. Resection of the tumor. L. Neuroendoscopic imaging after tumor resection and complete hemostasis.

Fig 5 Resection of brain stem lesions by full-endoscopic surgery

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全神经内镜技术在后颅窝病变手术中的应用

Application of full-neuroendoscopic technique in surgical treatment of posterior cranial fossa lesions

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