Abstract：
BACKGROUND: Multicompartmental lesions within the central nervous system are challenging due to their complex anatomy. This study evaluates the efficacy, safety, and utility of hybrid endoscopic and microsurgery versus endoscope-assisted microsurgery(EAM) for excising these lesions.
METHODS: A retrospective comparative analysis was conducted on patients who underwent multicompartmental brain tumor surgery, utilizing either hybrid endoscopic and microsurgical techniques with the Endocameleon Hopkins telescope featuring a rotating lens system and knob (Karl Storz GmbH & Co., Tuttlingen, Germany), alternately used with a microscope (ZEISS PENTERO 800 S) (Group 1, n = 69), or endoscope-assisted microsurgery employing a fully high-definition, 45° angled endoscopic tool, QEVO®, integrated into the digital surgical microscope KINEVO 900 (Carl Zeiss Meditec, Oberkochen, Germany) as a plug-in feature (Group 2, n = 63), from July 2018 to March 2024. Data on demographics, clinical presentation, lesion characteristics, surgical details, and outcomes were meticulously collected and analyzed using rigorous statistical methods, including t-tests and chi-square tests.
RESULTS: Compared to Group 2, Group 1 had better ease of dissection and visualization of bleeders (p = 0.01) and fewer postoperative hematomas (p = 0.04). Surgical times were similar (p = 0.134). Postoperative follow-up revealed fewer recurrences in Group 1, though not statistically significant (p = 0.33). Group 1 patients reported higher cosmetic satisfaction and shorter hospital stays (p = 0.002). Logistic regression identified tumor vascularity(p = 0.001) and ease of dissection(p = 0.008) as significant factors for recurrence.
CONCLUSIONS: Hybrid endoscopic and microsurgery demonstrated superior intraoperative visualization, ease of dissection, and postoperative outcomes compared to endoscope-assisted microsurgery with the Quevo device. These findings suggest that the integrated approach may offer better outcomes for multicompartmental lesion excision regarding safety, efficacy, and patient satisfaction.
METHODS: A retrospective comparative analysis was conducted on patients who underwent multicompartmental brain tumor surgery, utilizing either hybrid endoscopic and microsurgical techniques with the Endocameleon Hopkins telescope featuring a rotating lens system and knob (Karl Storz GmbH & Co., Tuttlingen, Germany), alternately used with a microscope (ZEISS PENTERO 800 S) (Group 1, n = 69), or endoscope-assisted microsurgery employing a fully high-definition, 45° angled endoscopic tool, QEVO®, integrated into the digital surgical microscope KINEVO 900 (Carl Zeiss Meditec, Oberkochen, Germany) as a plug-in feature (Group 2, n = 63), from July 2018 to March 2024. Data on demographics, clinical presentation, lesion characteristics, surgical details, and outcomes were meticulously collected and analyzed using rigorous statistical methods, including t-tests and chi-square tests.
RESULTS: Compared to Group 2, Group 1 had better ease of dissection and visualization of bleeders (p = 0.01) and fewer postoperative hematomas (p = 0.04). Surgical times were similar (p = 0.134). Postoperative follow-up revealed fewer recurrences in Group 1, though not statistically significant (p = 0.33). Group 1 patients reported higher cosmetic satisfaction and shorter hospital stays (p = 0.002). Logistic regression identified tumor vascularity(p = 0.001) and ease of dissection(p = 0.008) as significant factors for recurrence.
CONCLUSIONS: Hybrid endoscopic and microsurgery demonstrated superior intraoperative visualization, ease of dissection, and postoperative outcomes compared to endoscope-assisted microsurgery with the Quevo device. These findings suggest that the integrated approach may offer better outcomes for multicompartmental lesion excision regarding safety, efficacy, and patient satisfaction.
摘要：
背景：中枢神经系统内的多室病变由于其复杂的解剖结构而具有挑战性。这项研究评估了疗效，安全,以及混合内窥镜和显微外科手术与内窥镜辅助显微外科手术（EAM）切除这些病变的实用性。
方法：对接受多室脑肿瘤手术的患者进行回顾性比较分析，利用内窥镜和显微外科技术与EndocameleonHopkins望远镜结合使用旋转透镜系统和旋钮（KarlStorzGmbH＆Co.，Tuttlingen,德国),与显微镜交替使用（蔡司PENTERO800S）（第1组，n=69），或采用完全高清晰度的内窥镜辅助显微外科手术，45°倾斜内窥镜工具，QEVO®,集成到数字手术显微镜KINEVO900(CarlZeissMeditec，Oberkochen,德国）作为插件功能（第2组，n=63），从2018年7月到2024年3月。人口统计数据，临床表现,病变特征,手术细节,并使用严格的统计方法精心收集和分析结果，包括t检验和卡方检验。
结果：与第2组相比，第1组更易于解剖和可见出血（p=0.01），术后血肿较少（p=0.04）。手术时间相似（p=0.134）。术后随访显示，第1组的复发较少，尽管没有统计学意义（p=0.33）。第1组患者报告较高的美容满意度和较短的住院时间（p=0.002）。Logistic回归将肿瘤血管分布（p=0.001）和解剖容易（p=0.008）确定为复发的重要因素。
结论：混合内镜和显微外科手术显示出较好的术中可视化，易于解剖，以及与使用Quevo装置的内窥镜辅助显微手术相比的术后结局。这些结果表明，在安全性方面，综合方法可能为多房室病变切除提供更好的结果。功效,患者满意度。
方法：对接受多室脑肿瘤手术的患者进行回顾性比较分析，利用内窥镜和显微外科技术与EndocameleonHopkins望远镜结合使用旋转透镜系统和旋钮（KarlStorzGmbH＆Co.，Tuttlingen,德国),与显微镜交替使用（蔡司PENTERO800S）（第1组，n=69），或采用完全高清晰度的内窥镜辅助显微外科手术，45°倾斜内窥镜工具，QEVO®,集成到数字手术显微镜KINEVO900(CarlZeissMeditec，Oberkochen,德国）作为插件功能（第2组，n=63），从2018年7月到2024年3月。人口统计数据，临床表现,病变特征,手术细节,并使用严格的统计方法精心收集和分析结果，包括t检验和卡方检验。
结果：与第2组相比，第1组更易于解剖和可见出血（p=0.01），术后血肿较少（p=0.04）。手术时间相似（p=0.134）。术后随访显示，第1组的复发较少，尽管没有统计学意义（p=0.33）。第1组患者报告较高的美容满意度和较短的住院时间（p=0.002）。Logistic回归将肿瘤血管分布（p=0.001）和解剖容易（p=0.008）确定为复发的重要因素。
结论：混合内镜和显微外科手术显示出较好的术中可视化，易于解剖，以及与使用Quevo装置的内窥镜辅助显微手术相比的术后结局。这些结果表明，在安全性方面，综合方法可能为多房室病变切除提供更好的结果。功效,患者满意度。
