论著 · 临床研究

全神经内镜技术在后颅窝病变手术中的应用

  • 周至宜 ,
  • 赵浩 ,
  • 缪亦锋 ,
  • 朱池豪 ,
  • 杨溪 ,
  • 王思源 ,
  • 冯军峰 ,
  • 邱永明
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  • 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
周至宜(1990—),男,主治医师,博士;电子信箱:zzyhenry@sina.com
缪亦锋,副主任医师,博士;电子信箱:yifengm@qq.com

收稿日期: 2024-09-18

  录用日期: 2024-12-20

  网络出版日期: 2025-03-18

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 Zhiyi ,
  • ZHAO Hao ,
  • MIAO Yifeng ,
  • ZHU Chihao ,
  • YANG Xi ,
  • WANG Siyuan ,
  • FENG Junfeng ,
  • QIU Yongming
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  • 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
MIAO Yifeng, E-mail: yifengm@qq.com.

Received date: 2024-09-18

  Accepted date: 2024-12-20

  Online published: 2025-03-18

Supported by

Cultivation Fund for Clinical Research of Renji Hospital, Shanghai Jiao Tong University School of Medicine(LYPY-QN-03)

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。

本文引用格式

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 . DOI: 10.3969/j.issn.1674-8115.2025.03.014

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.

参考文献

1 BRAY H N, SAPPINGTON J M. A review of posterior fossa lesions[J]. Mo Med, 2022, 119(6): 553-558.
2 ROLDAN-VALADEZ E, GONZALEZ-HERMOSILLO L M, MENDOZA-LOPEZ A C. Brain death diagnosis in primary posterior fossa lesions[J]. Neurol India, 2023, 71(1): 164-165.
3 TAMURA R, KATAYAMA M, YAMAMOTO K, et al. Suboccipital transhorizontal fissure approach for posterior cranial fossa lesions: a cadaveric study and first clinical experience[J]. Oper Neurosurg (Hagerstown), 2021, 21(6): E479-E487.
4 GAO H, LIU C H, ZHANG Y Z. Neuro-endoscope for skull base tumors[J]. Clin Neurol Neurosurg, 2018, 170: 102-105.
5 LI C Z, ZHU H B, ZONG X Y, et al. History, current situation, and future development of endoscopic neurosurgery in China[J]. World Neurosurg, 2018, 110: 270-275.
6 HUA W, XU H, ZHANG X, et al. Pure endoscopic resection of pineal region tumors through supracerebellar infratentorial approach with ‘head-up’ park-bench position[J]. Neurol Res, 2023, 45(4): 354-362.
7 BOSE A, PRASAD U, KUMAR A, et al. Characterizing various posterior fossa tumors in children and adults with diffusion-weighted imaging and spectroscopy[J]. Cureus, 2023, 15(5): e39144.
8 ARNAOUT M M, LUZZI S, GALZIO R, et al. Supraorbital keyhole approach: pure endoscopic and endoscope-assisted perspective[J]. Clin Neurol Neurosurg, 2020, 189: 105623.
9 CHOO J, TAKEUCHI K, NAGATA Y, et al. Neuroendoscopic cylinder surgery and 5-aminolevulinic acid photodynamic diagnosis of deep-seated intracranial lesions[J]. World Neurosurg, 2018, 116: e35-e41.
10 SCHROEDER H W S, SGOUROS S. Neuroendoscopy: history, endoscopes, and instrumentation[J]. Childs Nerv Syst, 2023, 39(10): 2729-2735.
11 TOSI U, GUADIX S W, SOUWEIDANE M M. Neuroendoscopy: the state of the art[J]. World Neurosurg, 2023, 178: 305-310.
12 TOSI U, GUADIX S W, COHEN A R, et al. Neuroendoscopy: how we got here[J]. World Neurosurg, 2023, 178: 298-304.
13 BEER-FURLAN A, VELLUTINI E A S, BALSALOBRE L, et al. Endoscopic endonasal approach to ventral posterior fossa meningiomas: from case selection to surgical management[J]. Neurosurg Clin N Am, 2015, 26(3): 413-426.
14 IDRIS Z, TAN Y C, KANDASAMY R, et al. Transfrontal transaqueductal, transtrigonal, and suboccipital infratentorial supracerebellar endoscopic fenestration of posterior fossa arachnoid cysts: three surgical cases[J]. J Neurol Surg A Cent Eur Neurosurg, 2017, 78(2): 210-215.
15 李炯, 钟东, 吕东, 等. 神经内镜辅助后颅窝显微神经外科手术治疗脑肿瘤[J]. 中华医学杂志, 2018, 98(17): 1311-1316.
  LI J, ZHONG D, Lü D, et al. Neuroendoscopy assisted microneurosurgery for posterior cranial fossa lesion[J]. National Medical Journal of China, 2018, 98(17): 1311-1316.
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