Endoscopic Assisted Microscopic Skull Base Surgery

• 作者: Islam Alaghoy Maamon Abo-Shosha Magdy El Hawary Mohammed Attia
• 来源期刊: 现代神经外科学进展(英文)
• 学科: 医学
• 关键词: SKULL BASE ENDOSCOPIC ASSISTED
• 年，卷（期）: 2018,（2）
• 页码范围: 187-200
• 页数: 14页
• 分类号: R73

摘要

Background: Skull base tumors presented great challenge for neurosurgeons since decades due to their deep location, associated morbidity and limitation of operative field;however modern neurosurgery using the endoscope and/or the microscope served in minimizing peri-operative morbidities and improving the clinical outcome. Objective: To demonstrate the value of endoscope-assisted microsurgical technique for resection of skull base tumors. Patients and Methods: 30 patients divided into 3 groups (10 patients had medial sphenoid wing meningioma constituted group 1, 10 patients had suprasellar meningioma constituted group 2 and 10 patients had Cerbello-Pontine Angle (CPA) epidermoids constituted group 3) were operated through Endoscope Assisted Microscopic Skull Base Surgery technique at Al-Azhar University Hospitals during the period starting from January 2016 till the end of September 2017 using a rigid endoscope for inspection of tumor boundaries and neighboring vascularity in addition to confirm the extent of resection. Tumor resection was tried in all cases. Intra-operative resection rate and post-operative radiological outcomes were assessed. Results: Total gross resection was possible in 27 patients (90%). Subtotal resection was done in the other 3 cases (recurrent medial sphenoid wing meningiomas) due to excessive bleeding and adhesions of the tumors with vascular structures. Total resection of the tumor in post operative radiology was obtained in 24 patients (80%) and post-operative residual tumor was noticed in 6 patients in early post operative radiology and in only 3 cases at 3 months follow up radiology. Conclusion: Endoscopic-assisted microsurgical approach is a reliable, safe and effective option for adequate surgical resection of skull base tumors. The technique allowed proper inspection of the tumor relations and vascularity, detection of any residual portions, providing better chance for gross total resection with minimal tissue damage or vascular injury as well as convenient clinical outcome.