摘要：

目的 探讨内镜技术在经颅入路侧颅底手术中的应用和手术疗效。方法 对2015年7月至 2018 年 7 月内镜下经颅入路侧颅底病变手术患者的临床资料进行分析。142 例患者中原发性偏侧面肌痉挛 32 例、原发性三叉神经痛 56 例、原发性舌咽神经痛 2 例、表皮样囊肿 15 例、听神经瘤 14 例、三叉神经鞘瘤3例、脑桥小脑三角区脑膜瘤18例、颈静脉孔区神经鞘瘤2例；其中90例（包括原发性偏侧面肌痉挛 32 例、原发性三叉神经痛 56 例、原发性舌咽神经痛 2 例）于内镜下行经颅入路微血管减压术，52 例（包括表皮样囊肿15例、听神经瘤14例、三叉神经鞘瘤3例、脑桥小脑三角区脑膜瘤18例、颈静脉孔区神经鞘瘤 2 例）于内镜下行经颅入路侧颅底肿瘤切除术。结果 142 例患者均全程于内镜下完成经颅入路侧颅底手术，单手操作 96 例（67.61%）；以气动臂持镜，双手操作 46 例（32.39%）。内镜下微血管减压术总体治愈率达 87.78%（79/90），内镜侧颅底肿瘤全切除率 90.38%（47/52）。平均随访（23.46 ± 8.93）个月，未发生严重并发症，无一例死亡。结论 在气动臂的配合下，内镜技术可以完成复杂经颅入路侧颅底手术，具有可近距离和多角度观察，视野清晰，神经血管辨识度高等优势，但对内镜技术、器械和辅助设备的要求较高，需接受内镜技术培训和积累一定的内镜手术经验方可尝试开展。

关键词: 内窥镜, 颅底, 神经外科手术

Abstract:

Objective To investigate the application of neuroendoscopy and curative effect of lateral skull base surgery via transcranial approach. Methods Clinical data of 142 cases undergoing endoscopic lateral skull base surgeries via transcranial approach from July 2015 to July 2018 were retrospectively analyzed. There were 32 cases of primary hemifacial spasm, 56 cases of primary trigeminal neuralgia, 2 cases of primary glossopharyngeal neuralgia, 15 cases of epidermoid cyst, 14 cases of acoustic neuroma, 3 cases of trigeminal schwannoma, 18 cases of pontocerebellar trigone meningioma, and 2 cases of jugular foramen schwannoma. Among them, 90 cases (32 cases of primary hemifacial spasm, 56 cases of primary trigeminal neuralgia and 2 cases of primary glossopharyngeal neuralgia) underwent endoscopic microvascular decompression (MVD) via transcranial approach, and 52 cases (15 cases of epidermoid cyst, 14 cases of acoustic neuroma, 3 cases of trigeminal schwannoma, 18 cases of pontocerebellar trigone meningioma, and 2 cases of jugular foramen schwannoma) underwent endoscopic removal of lateral skull base tumors via transcranial approach. Results All the operations were performed under endoscopy, including 96 cases (67.61%) operated by single hand (the endoscope was held by a pneumatic arm) and the rest 46 cases (32.39%) operated by both hands. The cure rate of MVD was 87.78% (79/90) and the total removal rate of lateral skull base tumors was 90.38% (47/52). The mean follow-up period was (23.46 ± 8.93) months. There was no death or other serious complications. Conclusions The complex lateral skull base surgery via transcranial approach can be performed by neuroendoscope with pneumatic endoscopic fixed arm. It has the advantages of near and multi-angle observation, clear visual field, full exposure and high recognition of nerve and blood vessels. However, the requirements for endoscopic technology, instruments and assistive equipments are high, and it is necessary to receive relevant trainings and experiences in endoscopic surgery.

Key words: Endoscopes, Skull base, Neurosurgical procedures