神经内镜辅助显微手术切除后颅窝表皮样囊肿的临床对照研究  

Clinical controlled study of neuroendoscope assisted microneurosurgery for epidermoid cysts of the posterior cranial fossa

作　　者：李运军[1] 樊娟[1] 赵浩[1] 李文德[1] 魏群[1] 陈立华[1] 徐如祥[1] 

机构地区：[1]北京军区总医院附属八一脑科医院,北京,100700

出　　处：《中华神经医学杂志》2014年第9期947-949,共3页Chinese Journal of Neuromedicine

摘　　要：目的 探讨神经内镜辅助显微手术治疗后颅窝表皮样囊肿的疗效. 方法 回顾性分析北京军区总医院附属八一脑科医院自2008年1月至2013年1月49例后颅窝表皮样囊肿患者的临床资料,将单独采用显微神经外科手术进行治疗的20例患者作为对照组;显微镜下大部切除肿瘤后,再用神经内镜进行探查,切除残余肿瘤的29例患者作为观察组;比较2组的手术时间、术后并发症发生率、肿瘤残存率. 结果 对照组20例术后复查MR发现有6例残存,并有4例出现了脑脊液漏、无菌性脑膜炎等并发症.观察组29例患者9例有肿瘤残余,予内镜下进一步切除,术后复查MR未发现残存,仅有1例术后出现三叉神经不全损伤症状的并发症.2组间并发症发生率与残存率的比较差异具有统计学意义（P＜0.05）. 结论 神经内镜辅助显微手术切除后颅窝表皮样囊肿可以明显提高全切率,降低手术并发症.Objective To summarize the experience of microsurgical treatment of posterior fossa epidermoid cyst in nearly five years,and to explore the effect of endoscopic assisted microsurgical treatment on posterior fossa epidermoid cysts.Methods A retrospective analysis of 49 patients with posterior fossa epidermoid cysts,admitted to our hospital from January 2008 to January 2013,was conducted.The controls were 20 patients treated only by micro-neurosurgery,and the other 29 were as observation subjects：the tumors were,first,mostly removed under micro-neurosurgery,and then,residual tumors were resected under neuroendoscopy.The operation time,complications and tumor residual rate were compared between the two groups.Results According to the different tumor location in posterior fossa,three surgical approaches were adopted：suboccipital posterior midline approach,suboccipital posterior sigmoid sinus approach and supratentorial infratentorial combined approach.Postoperative complications were aseptic meningitis,transient cranial nerve palsy and delayed intracranial hematoma.There was statistical significance between two surgical methods in residual tumor rate and incidence of complications （P〈0.05）,while no statistical significance in operation time was noted between the two groups （P〉0.05）.Conclusion With the assistant of neuroendoscopy,tumor removal rate of posterior fossa epidermoid cyst would be improved obviously and the incidence of complications would be decreased.

关 键 词：表皮样囊肿 后颅窝 显微外科手术 神经内镜 

分 类 号：R651.15[医药卫生—外科学]