Clinical Application Of Neuroendoscopy-Assisted Microsurgery In The Epidermoid Cyst Of The Cerebellopontine Angle

Background:Intracranial epidermoid cyst,also known as pearl tumor and cholesteatoma,accounts for about 1-1.8%of the incidence of intracranial tumors,and 40-50%of the intracranial epidermoid cyst occurs in the cerebellopontine Angle,and extends to the subarachnoid space or the area with small intracranial resistance.Due to its benign and slow growth,it is often found when the tumor is large and stretches in many parts,which brings difficulties to the complete treatment of the disease.Surgical resection is the only treatment for this disease.In recent years,with the continuous development of neuroendoscopic technology,neuroendoscopy-assisted microsurgery has been gradually applied in the resection of epidermoid cysts in the cerebellopontine horn area.Research purposes:In order to explore both minor trauma,and cerebellopontine Angle area tumors were resected totally possible method,we compared the pure microscope microscopic surgery and neural endoscopic assisted microsurgical operative cerebellopontine Angle cholesteatoma in surgical resection rate,operation time,postoperative complications and short-term curative effect of surgery.To analyze the curative effect of two different surgical methods and provide guidance for clinical work.Methods:This study included patients who underwent cholesteatoma surgery in the cerebellopontine Angle area in the department of neurosurgery,QiLu hospital of Shandong University from April 2014 to October 2018,including 51 patients in the microscope group and 21 patients in the neuroendoscopy-assisted microscope group.Relevant clinical and imaging data of all cases were collected,including the medical history,clinical manifestations,gender,lesion side,preoperative and postoperative magnetic resonance imaging(MRI),operative time,length of stay,postoperative manifestations and postoperative complications,etc.,for sorting and analysis,and the differences between the two different surgical methods were compared.(data analysis and processing were completed on SPSS 20.0 statistical software)Results:1.In the simple microscope group,total excision was performed in 36 cases,and total excision was not performed in 15 cases;2.In the neuroendoscopy-assisted group,a total of 20 cases were totally resected,and 1 case was not completely resected,P=0.028<0.05,indicating statistical significance.It was believed that the rate of total resection of lesions in the neuroendoscopy-assisted microsurgery group was higher than that in the simple microscope group.In the patients in the neuroendoscope-assisted microsurgery group,after the lesion was resected under the microscope,neuroendoscopic exploration was performed again,and it was found that tumor residues were found in the dead corner in 14 cases,so the tumor and capsule were resected under the neuroendoscopy.In the neuroendoscopy-assisted group,14 patients were found to have tumor residues at the dead corner by neuroendoscopic exploration,and 11 of them were large tumors(the maximum tumor size was>3cm).2.The average operation time of the simple microscope group was(217.84±51.58min).The average operative time of the neuroendoscopy-assisted microsurgery group was(256.43±81.61min),and there was a statistical difference between the two groups(t=-2.414,P=0.018<0.05).The operative time of the neuroendoscopy-assisted microsurgery group was longer than that of the microsurgery group.The mean hospitalization time was(20.20±7.87day)in the simple microscope group and(20.43±4.21day)in the neuroendoscopy-assisted group.After the t-test analysis of two independent samples,there was no statistical difference between the two groups(t=-0.128,P=0.899>0.05).3.Among the 51 patients in the simple microscope group,14 patients(27.4%)had postoperative aseptic meningitis,1 patient(2%)had cerebrospinal fluid leakage,4 patients(7.8%)had postoperative facial paralysis,and 1 patient(2%)had postoperative intracranial hematoma and underwent intracranial decompression plus hematoma removal.In the endoscope assisted microsurgery treatment of 21 cases,4 cases(19.1%)patients with postoperative aseptic meningitis,1 case(4.8%)patients with postoperative cerebrospinal fluid leakage,1 case(4.8%),facial paralysis,for different data by chi-square test or Fisher's exact test analysis two groups of operation method in the cerebrospinal fluid leakage(P = 0.501>0.05),facial paralysis(P =0.640>0.05),intracranial hematoma(P = 0.519>0.05)no statistical difference in such aspects.In terms of aseptic meningitis,the patients were regrouped according to tumor size.In the large tumor group(the maximum tumor size was>3cm),a total of 19 patients were treated with simple microscope,including 10 patients with postoperative aseptic meningitis,and 2 patients in the endoscopy-assisted surgery group were treated with postoperative aseptic meningitis.Chi-square test or Fisher's precise analysis of the two groups showed that there was no difference in the incidence of aseptic meningitis in the small tumor group(P=0.597>0.05).There was a statistically significant difference in postoperative aseptic meningitis in the large tumor group(P=0.045<0.05),suggesting that neuroendoscopy-assisted surgery reduced the incidence of aseptic meningitis in the large tumor group.Conclusion:Endoscopy-assisted surgery is helpful to improve the total resection rate of epidermoid cyst in the cerebellopontine Angle area,and secondary endoscopic exploration after tumor resection under microscope can be used as an effective index for immediate postoperative evaluation of surgical resection.For large epidermoid cysts in the cerebellopontine horn,neuroendoscopy-assisted surgery can reduce the incidence of postoperative aseptic meningitis.Neuroendoscopy-assisted microsurgeryrequires secondary implantation of neuroendoscopic exploration and further resection of the lesion under endoscopic surgery,which increases the operation time but provides an effective guarantee for total surgical resection and safety.