Endoscope-assisted lateral skull base surgery / 中国医师进修杂志

Objective To explore the therapeutic efficacy and complications of endoscope-assisted lateral skull base surgery. Methods Assisted by hard-tube ear endoscope, 11 patients with acoustic neuroma were operated via labyrinthine approach and retrosigmoid approach, and 5 patients with petrous apex cholesteatoma were operated via middle cranial fossa approach and mastoid-middle cranial fessa approach. Results Among 11 patients with acoustic neuroma, total removal was achieved in 9 cases (81.8%), subtotal in 2 cases (18.2%). Facial nerves and cochlear nerves were preserved completely during operation. After operation there was no facial paralysis in 9 cases (81.8%), mild peripheral facial paralysis in 2 cases (18.2%), the same hearing level as that of preoperation in 2 patients (18.2%), hearing impairment in different degrees in 9 cases (81.8%), among which moderate sensorinural hearing loss in 1 patient (9.1%), moderate to severe in 2 patients (18.2%), severe in 3 patients (27.3%), profound in 3 patients (27.3%). Among 5 patients with petrous apex cholesteatoma, total removal was achieved in all cases. After operation, preoperative facial paralysis in 3 patients disappeared within 9 months, and moderate to severe conduction deafness appeared in 2 patients. Conclusions The application of ear endoscope in lateral skull base surgery can improve the total removal of lesions and the salvage rate of vessels and nerves. However, its disadvantages make it only be an assistant method for micresurgery.

Endoscope-assisted surgical resection of acoustic neuroma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the therapeutic efficacy and complications of endoscope-assisted surgical resection of acoustic neuroma.@*METHOD@#Assisted by hard-tube ear endoscope, 11 patients with acoustic neuroma were operated via labyrinthine approach and retrosigmoid approach.@*RESULT@#Total removal was achieved in 9 (81.8%) cases, while subtotal removal was achieved in 2 (18.2%) cases. Facial nerves and cochlear nerves were preserved completely during operation in all cases. After operation 9 (81.8%) cases had no facial paralysis, while the other 2 cases (18.2%) had mild peripheral facial paralysis. The same hearing level as that of preoperation in 2 patients (18.2%), hearing impairment in different degrees in 9 patients (81.8%), among which moderate sensorineural hearing loss in 1 patient, moderate to severe in 2 patients, severe in 3 patients, profound in 3 patients.@*CONCLUSION@#The application of ear endoscope in acoustic neuroma surgery can improve the total removal rate of tumors and the salvage rate of vessels and nerves. However, its disadvantages make it an assistant method for microsurgery.

Microsurgical treatment for tumors in jugular foramen and its around / 中华显微外科杂志

Objective To explore the micresurgical techniques and outcome of tumors in jugular foramen and its around. Methods Eleven patients with jugular foramen tumors were operated through suboccipital-retrosigmoid approach (2 cases), jugular foramen approach (2 cases), temporal fossa approach (4 cases) and mastoid-cervical combined approach (3 cases). Results Nine tumors were totally removed and 2 were subtotally removed. Of those cases, there were 4 neurinoma, 4 paragangliome, I meningioma, 1 mucochondrosarcoma, and 1 low-differentiated carcinoma. Postoperative complications included transient cerebrespinal fluid leak(1 case) and new lower cranial nerve injury (2 cases). All cases were followed up for mere than 8 months. The postoperative hearing was improved in 1 case, stable in 6 cases, deteriorated in 4 cases. Postoperative facial paralysis of grade Ⅱ- Ⅲ occurred in 3 of 9 patients without facial paralysis, which recovered in half a year. Of 2 patients with facial paralysis before surgery, facial function was improved in 1 case and stable in 1 case. Conclusion Proper surgical approaches and micrceurgical techniques, which were adopted according to the types, the location, and the expansion of tumors, the function of facial nerve and lower cranial nerves, and hearing level, are good for reducing complications, exposing and removing jugular foramen tumors.