Objective: To study the value of neuroendoscopy assisted microneurosurgery technique in the treatment of posterior cranial fossa lesion. Methods: Clinical data of 36 patients with posterior fossa lesions who accepted neuroendoscopy assisted microneurosurgery (NEAM group) in the department of neurosurgery of the First Affiliated Hospital of Chongqing Medical University, from January 2014 to December 2016, were retrospectively enrolled. A total of 113 cases diagnosed with the same lesions and accepted conventional microneurosurgery (non-NEAM group) in the same period were analyzed as control group. The total tumor resection rate, postoperative leakage of cerebrospinal fluid, intracranial infection, operating time and the recovery of facial nerve function were compared between the two groups. Results: Ninety-three patients with acoustic neuroma were analyzed, which were divided into non-NEAM group 78 cases (removed posterior lip of internal auditory canal in different degrees) and NEAM group 15 cases (not removed posterior lip of internal auditory canal). The total tumor resection rate and postoperative facial nerve function had no significant statistical differences between two groups. The operating time of NEAM group was longer than that of non-NEAM group (P=0.048, P<0.05), but the rate of leakage of cerebrospinal fluid and intracranial infection did not increase. Twenty-seven cases were diagnosed with cerebellopontine angle cholesteatoma. These cases were divided into two groups, 17 cases in non-NEAM group and 10 cases in NEAM group. NEAM group have higher total tumor resection rate (P=0.014, P<0.05), better short-term postoperative facial nerve function (P=0.039, P<0.05), and longer operating time (P=0.015, P<0.05), compared with non-NEAM group. No significant statistical differences were observed on long-term postoperative facial nerve function and postoperative complications. Of the 16 cases diagnosed tentorial meningioma, 10 cases were in non-NEAM group and 6 cases in NEAM group. Six cases in non-NEAM group and 4 cases in NEAM group were total removal. For the mean operating time, non-NEAM group was (6.6±1.0) hours and NEAM group was (7.1±0.7) hours. Thirteen cases were with fourth ventricular cholesteatoma, which all were totally resected, and 8 cases were in non-NEAM group and 5 cases in NEAM group. For non-NEAM group, 5 cases dissected cerebellar vermis and the mean operating time is (6.0±0.7) hours. However, NEAM group all did not dissect cerebellar vermis and the mean operating time is (6.4±0.4) hours. Conclusions: Neuroendoscopy assisted microneurosurgery for cranial fossa lesions was benefit to totally resect tumor and reduce unnecessary injury. It needed longer operating time, but not increase postoperative intracranial infection.
目的：探讨神经内镜在后颅窝显微手术中的辅助价值。 方法：回顾性收集重庆医科大学附属第一医院神经外科2014年1月至2016年12月3年内完成的36例神经内镜辅助后颅窝显微神经外科手术治疗的肿瘤患者(内镜辅助组)，对比同期113例后颅窝相同病变常规开颅手术治疗的肿瘤患者(常规手术组)，比较肿瘤全切除率、术后脑脊液漏及颅内感染发生率、手术时间、术后面神经功能等情况。 结果：听神经瘤共93例，其中常规手术组78例，全部不同程度磨除内听道后壁；内镜辅助组15例，均未磨除内听道后壁。听神经瘤内镜辅助组较常规手术组肿瘤全切除率、术后面神经功能无明显差异，而手术时间延长(P＝0.048，P<0.05)，但并不增加颅内感染风险。桥小脑角胆脂瘤共27例，常规手术组17例，其中内镜辅助手术组10例，桥小脑角胆脂瘤内镜辅助组较常规手术组肿瘤全切除率高(P＝0.014，P<0.05)，术后面神经功能近期效果好(P＝0.039，P<0.05)，远期效果无明显差异，手术时间延长(P＝0.015，P<0.05)，但不增加颅内感染风险。天幕脑膜瘤共16例，其中常规手术组10例，肿瘤全切6例，平均手术时间(6.6±1.0)h；内镜辅助组6例，肿瘤全切5例，平均手术时间(7.1±0.7)h。四脑室胆脂瘤共13例，其中常规手术组8例均全切，术中切开小脑蚓部共5例，平均手术时间(6.0±0.7)h；内镜辅助组中，5例患者均达到全切，未切开小脑蚓部下份，平均手术时间(6.4±0.4)h。 结论：神经内镜辅助后颅窝显微神经外科手术有利于肿瘤全切，可减少不必要损伤，虽然手术时间延长，但并不增加颅内感染风险。.
Keywords: Neuroendoscopy assisted Microneurosurgery; Posterior cranial fossa lesions.