目的扩大内镜经鼻入路(EEA)在治疗中线颅底病变中显示出可喜的效果。关于使用EEA治疗动脉瘤的一些病例报告。然而,缺少这种方法与经典的经颅眶骨法对基底尖(BAX)区域的比较。本研究总结了一系列尸体手术模拟的结果,用于评估对BAX区域进行动脉瘤夹闭的EEA,并将其与作为治疗BAX动脉瘤最常用方法之一的经颅眶骨入路进行比较。方法对15具尸体标本进行了双侧眶zyg开颅手术以及EEA(首先没有垂体移位[PT],然后进行PT)以暴露BAX。测量了以下变量,记录,并比较眶骨入路和EEA:1)双侧大脑后动脉(PCAs)上的穿通动脉数;2)PCAs的暴露和修剪长度,小脑上动脉(SCAs),和近端基底动脉;和3)BAX区域暴露的手术区域。结果除了近端基底动脉暴露和夹闭,眶颧法为BAX区域的血管暴露和控制提供了统计学上显着更高的值(即,同侧和对侧SCA和PCA的暴露和削波)。与没有PT的EEA相比,有PT的EEA在暴露和修剪双侧PCAs方面明显更好。但不是其他测量变量。3种方法之间的手术暴露面积和PCA穿孔器计数没有显着差异。如果BAX位于背sum下方≥4mm,则EEA可提供更好的暴露和控制。结论对于位于鞍后区的BAX动脉瘤,通常需要PT来改善双侧PCA的暴露和控制。然而,入路BAX区的经颅入路通常优于两种内镜入路.考虑到使用EEA获得的近端基底动脉的优越暴露,当考虑对低洼BAX或中基底干动脉瘤(岛背下方≥4mm)进行手术治疗时,这可能是一个可行的选择.
The expanded endoscopic endonasal approach (EEA) has shown promising results in treatment of midline skull base lesions. Several case reports exist on the utilization of the EEA for treatment of aneurysms. However, a comparison of this approach with the classic transcranial orbitozygomatic approach to the basilar apex (BAX) region is missing.The present study summarizes the results of a series of cadaveric surgical simulations for assessment of the EEA to the BAX region for aneurysm clipping and its comparison with the transcranial orbitozygomatic approach as one of the most common approaches used to treat BAX aneurysms.
Fifteen cadaveric specimens underwent bilateral orbitozygomatic craniotomies as well as an EEA (first without a pituitary transposition [PT] and then with a PT) to expose the BAX. The following variables were measured, recorded, and compared between the orbitozygomatic approach and the EEA: 1) number of perforating arteries counted on bilateral posterior cerebral arteries (PCAs); 2) exposure and clipping lengths of the PCAs, superior cerebellar arteries (SCAs), and proximal basilar artery; and 3) surgical area of exposure in the BAX region.
Except for the proximal basilar artery exposure and clipping, the orbitozygomatic approach provided statistically significantly greater values for vascular exposure and control in the BAX region (i.e., exposure and clipping of ipsilateral and contralateral SCAs and PCAs). The EEA with PT was significantly better in exposing and clipping bilateral PCAs compared to EEA without a PT, but not in terms of other measured variables. The surgical area of exposure and PCA perforator counts were not significantly different between the 3 approaches. The EEA provided better exposure and control if the BAX was located ≥ 4 mm inferior to the dorsum sellae.
For BAX aneurysms located in the retrosellar area, PT is usually required to obtain improved exposure and control for the bilateral PCAs. However, the transcranial approach is generally superior to both endoscopic approaches for accessing the BAX region. Considering the superior exposure of the proximal basilar artery obtained with the EEA, it could be a viable option when surgical treatment is considered for a low-lying BAX or mid-basilar trunk aneurysms (≥ 4 mm inferior to dorsum sellae).