目的:内窥镜检查为颅底手术提供了一种侵入性较小的方法,主要通过鼻内途径,但由于潜在的并发症,其应用受到限制。这项研究的目的是评估通过颞下锁孔对外侧和中央颅底进行单纯内镜硬膜外经颅入路的可行性,并通过内窥镜检查更好地了解相关解剖结构的潜在变形。
方法:用4毫米0°和30°内窥镜研究了十个新鲜的尸体头,以开发手术方法并确定手术标志。
结果:经颅中窝硬膜外腔暴露后,内镜下颞下入路分为3个部分:1)海绵窦外侧壁和耳前颞下窝暴露;2)前岩石切除术和后颅窝探查;3)鼓室神经去顶和面部暴露。这种锁孔内窥镜技术通过硬膜外颞下路径清晰地显示了外侧和中央颅底的解剖标志。
结论:内镜硬膜外颞下入路是可行的。这种方法可以显示广泛的外侧和中央颅底结构,并且侵入性最小。使用硬膜外空间将是进行安全有效的内窥镜颅底手术的关键。
OBJECTIVE: Endoscopy has provided a less invasive approach to skull base surgery, mainly through endonasal routes, but has been limited in its applications due to potential complications. The aims of this
study were to evaluate the feasibility of the purely endoscopic extradural transcranial approach to lateral and central skull base through a subtemporal keyhole and to better understand potential distortions of the related anatomy via endoscopy.
METHODS: Ten fresh cadaver heads were studied with 4-mm 0° and 30° endoscopes to develop the surgical approach and to identify surgical landmarks.
RESULTS: The endoscopic extradural subtemporal approach was divided into 3 sections after exposure of the extradural space in the middle cranial fossa: 1) exposure of the lateral wall of the cavernous sinus and the preauricular infratemporal fossa; 2) anterior petrosectomy and posterior cranial fossa exploration; and 3) unroofing of the tympanic cavity and exposure of the facial nerve. This keyhole endoscopic technique clearly visualized anatomical landmarks of the lateral and central skull base via an extradural subtemporal route.
CONCLUSIONS: The endoscopic extradural subtemporal approach was feasible. This approach could display a wide range of lateral and central skull base structures with minimal invasiveness. The use of extradural space would be key to performing safe and effective endoscopic skull base surgery.