A comparative study of endoscopy and microscopy in exposure of posterior fossa through the intradural subtemporal keyhole approach

Q4 Medicine

中华神经外科杂志 Pub Date : 2019-12-28 DOI:10.3760/CMA.J.ISSN.1001-2346.2019.12.017

Zhemin Ding, Qing Wang, Xiaojie Lu, Bing Li, Xinwei Qian

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引用次数: 0

Abstract

Objective To comparatively analyze the differences between endoscopy and microscopy in area of exposure and surgical freedom in posterior fossa through the intradural subtemporal keyhole approach and to explore the advantages of neuronavigation in that approach. Methods Twenty endoscopic intradural subtemporal keyhole approaches (EISKA) were performed on 10 cadaveric adult heads. An intradural Kawase approach and a navigation-assisted intradural Kawase approach were then carried out on a random side of each specimen. Related anatomic structures were observed through endoscope and microscope at the end of each approach. Anatomic exposure and surgical freedom were measured by transparent graph paper and were analyzed. Results Compared with microscopy, the superior, inferior and medial limits through endoscopic exposure were increased by 2.9±1.0 mm, 15.7±1.5 mm and 10.2±1.1 mm, and the surgical freedom was increased by 2.9±1.0 mm, 7.6±1.9 mm and 6.0±1.7 mm (P<0.05) in the intradural subtemporal keyhole approach. In intradural Kawase approach, the anatomic exposure was increased by 2.7±0.9 mm, 20±1.2 mm and 29.5±0.7 mm and the surgical freedom was increased by 2.7±0.9 mm, 14.8±1.4 mm and 8.8±1.4 mm (all P<0.05). In navigation-assisted intradural Kawase approach, the anatomic exposure was increased by 3.1±1.0 mm, 20.3±2.4 mm and 29.9±0.7 mm, and the surgical freedom was increased by 3.1±1.0 mm, 15.3±1.6 mm and 8.8±1.3 mm (P<0.05). Using a frameless navigational device, the inferior limit of the anatomic exposure was increased by 3.8±2.2 mm in endoscopy and 3.5±0.7 mm in microscopy, and the surgical freedom was increased by 2.7±0.9 mm in endoscopy mm and 2.2±1.2 mm in microscopy (all P<0.05). Conclusions The EISKA could provide more anatomic exposure and surgical freedom mainly in the superior, inferior and medial directions of the brainstem regions. More inferior anatomic exposure and surgical freedom of the posterior cranial fossa could be obtained by navigational assistance. Key words: Natural orifice endoscopic surgery; Microsurgery; Neuronavigation; Subtemporal approach; Key hole; Kawase approach

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经硬膜下颞下锁孔入路暴露后窝的内镜和显微镜对照研究

目的比较分析经硬膜下颞下锁孔入路后窝暴露面积和手术自由度的内镜与显微镜的差异，探讨神经导航入路的优势。方法对10具成人尸头进行20例经内镜颞下硬膜下锁孔入路（EISKA）。然后对每个样本的随机侧进行硬膜内川崎入路和导航辅助硬膜内川崎进路。在每次入路结束时，通过内窥镜和显微镜观察相关解剖结构。解剖暴露和手术自由度用透明纸测量并进行分析。结果与显微镜检查相比，经内镜暴露的上、下、中限分别增加了2.9±1.0 mm、15.7±1.5 mm和10.2±1.1 mm，硬膜下锁孔入路的手术自由度分别增加了2.7±1.0 mm和7.6±1.9 mm，6.0±1.7 mm（P＜0.05）。在硬膜内Kawase入路中，解剖暴露增加了2.7±0.9 mm、20±1.2 mm和29.5±0.7 mm，手术自由度增加了2.7士0.9 mm、14.8士1.4 mm和8.8士1.4 mm（均P<0.05）。在导航辅助的硬膜内Kakase入路，解剖暴露增加了3.1士1.0 mm、20.3士2.4 mm和29.9士0.7 mm，15.3±1.6mm和8.8±1.3mm（P<0.05），结论EISKA能提供更多的解剖暴露和手术自由度，主要在脑干区的上、下、内侧方向。导航辅助可以获得更多的后颅窝下部解剖暴露和手术自由度。关键词：自然口内镜手术；显微外科；神经导航；次时态方法；钥匙孔；Kawase方法

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来源期刊

中华神经外科杂志 Medicine-Surgery

CiteScore

0.10

自引率

0.00%

发文量

10706

期刊介绍： Chinese Journal of Neurosurgery is one of the series of journals organized by the Chinese Medical Association under the supervision of the China Association for Science and Technology. The journal is aimed at neurosurgeons and related researchers, and reports on the leading scientific research results and clinical experience in the field of neurosurgery, as well as the basic theoretical research closely related to neurosurgery.Chinese Journal of Neurosurgery has been included in many famous domestic search organizations, such as China Knowledge Resources Database, China Biomedical Journal Citation Database, Chinese Biomedical Journal Literature Database, China Science Citation Database, China Biomedical Literature Database, China Science and Technology Paper Citation Statistical Analysis Database, and China Science and Technology Journal Full Text Database, Wanfang Data Database of Medical Journals, etc.