Abstract：
Trigeminal schwannomas (TSs) are mostly benign tumors. However, dumbbell-shaped TSs are most challenging for surgeons and pose a high surgical risk.
We describe the technique of the purely endoscopic far-lateral supracerebellar infratentorial approach (EFL-SCITA) for removing dumbbell-shaped TSs and further discuss the feasibility of this approach and our experience.
EFL-SCITA was performed for resection of 5 TSs between January 2020 and March 2023. The entire procedure was performed endoscopically with the goal of total tumor resection. During the operation, the tumor was exposed in close proximity and multiple angles under the endoscope, and the peri-tumor nerves were carefully identified and protected, especially the normal trigeminal fiber bundles around the tumor.
All the tumors of 5 patients involved the middle and posterior cranial fossa, of which total removal was achieved in 2 patients and near-total removal in 3 patients. The most common preoperative symptoms were relieved after surgery. Two patients had postoperative mild facial paralysis (House-Brackmann grade II), and 1 patient had abducens palsy; both recovered during the follow-up period. Two patients experienced new postoperative facial hypesthesia, and 1 experienced mastication weakness, which did not recover. There was no tumor recurrence or residual tumor growth during the follow-up period in any of the patients.
EFL-SCITA is a new and effective alternative for the surgical treatment of TSs. For dumbbell-shaped TSs, this approach provides sufficient surgical field exposure and freedom of operation.
We describe the technique of the purely endoscopic far-lateral supracerebellar infratentorial approach (EFL-SCITA) for removing dumbbell-shaped TSs and further discuss the feasibility of this approach and our experience.
EFL-SCITA was performed for resection of 5 TSs between January 2020 and March 2023. The entire procedure was performed endoscopically with the goal of total tumor resection. During the operation, the tumor was exposed in close proximity and multiple angles under the endoscope, and the peri-tumor nerves were carefully identified and protected, especially the normal trigeminal fiber bundles around the tumor.
All the tumors of 5 patients involved the middle and posterior cranial fossa, of which total removal was achieved in 2 patients and near-total removal in 3 patients. The most common preoperative symptoms were relieved after surgery. Two patients had postoperative mild facial paralysis (House-Brackmann grade II), and 1 patient had abducens palsy; both recovered during the follow-up period. Two patients experienced new postoperative facial hypesthesia, and 1 experienced mastication weakness, which did not recover. There was no tumor recurrence or residual tumor growth during the follow-up period in any of the patients.
EFL-SCITA is a new and effective alternative for the surgical treatment of TSs. For dumbbell-shaped TSs, this approach provides sufficient surgical field exposure and freedom of operation.
摘要：
背景：三叉神经鞘瘤（TS）主要是良性肿瘤。然而,哑铃形TS对外科医生来说是最具挑战性的，并且具有很高的手术风险。
目的：我们描述了单纯内镜下远外侧小脑下入路（EFL-SCITA）去除哑铃形TS的技术，并进一步讨论了这种方法的可行性和我们的经验。
方法：在2020年1月至2023年3月期间进行了EFL-SCITA切除5个TS。整个过程在内窥镜下进行，目的是完全切除肿瘤。在操作过程中,肿瘤在内窥镜下近距离和多个角度暴露，肿瘤周围的神经被仔细识别和保护，特别是肿瘤周围的正常三叉神经纤维束。
结果：5例患者肿瘤均累及中后颅窝，其中2例患者完全切除，3例患者几乎完全切除。最常见的术前症状在手术后缓解。两名患者术后出现轻度面瘫（House-BrackmannII级），1例患者患有外展麻痹；在随访期间均康复。两名患者经历了新的术后面部感觉过度，和1经历过咀嚼无力，它没有恢复。在随访期间，任何患者均无肿瘤复发或残留肿瘤生长。
结论：EFL-SCITA是TSs外科治疗的一种新的有效替代方法。对于哑铃形TS，这种方法提供了足够的手术野暴露和手术自由。
目的：我们描述了单纯内镜下远外侧小脑下入路（EFL-SCITA）去除哑铃形TS的技术，并进一步讨论了这种方法的可行性和我们的经验。
方法：在2020年1月至2023年3月期间进行了EFL-SCITA切除5个TS。整个过程在内窥镜下进行，目的是完全切除肿瘤。在操作过程中,肿瘤在内窥镜下近距离和多个角度暴露，肿瘤周围的神经被仔细识别和保护，特别是肿瘤周围的正常三叉神经纤维束。
结果：5例患者肿瘤均累及中后颅窝，其中2例患者完全切除，3例患者几乎完全切除。最常见的术前症状在手术后缓解。两名患者术后出现轻度面瘫（House-BrackmannII级），1例患者患有外展麻痹；在随访期间均康复。两名患者经历了新的术后面部感觉过度，和1经历过咀嚼无力，它没有恢复。在随访期间，任何患者均无肿瘤复发或残留肿瘤生长。
结论：EFL-SCITA是TSs外科治疗的一种新的有效替代方法。对于哑铃形TS，这种方法提供了足够的手术野暴露和手术自由。
