眶尖神经鞘瘤内镜手术切除疗效分析及术中神经保护策略

Analysis on the effect of endoscopic surgical resection of orbital apex schwannoma and intraoperative neuroprotection strategy

摘要:

目的 探讨内镜手术治疗眶尖神经鞘瘤的疗效及术中神经保护策略。方法 回顾性分析2015年5月—2022年6月湘雅医院确诊并行内镜下手术治疗的9例眶尖神经鞘瘤的患者资料，术中均采用影像导航系统辅助，应用神经电生理监测技术监测动眼神经。采用描述性统计方法对患者进行分析，纳入临床、手术和预后资料等。结果 术后随访10~95个月，9例患者中8例肿瘤全切，1例次全切。全部患者的术前症状均得以好转或不同程度的改善，未出现手术死亡、颅内感染等手术并发症。9例患者术中均未发生相关神经损伤，术后均未出现神经功能障碍。结论 眶尖神经鞘瘤经内镜手术切除安全有效，配合术中应用影像导航系统和神经电生理监测技术具有全切率高、创伤小、并发症少及利于保护神经功能的优势。

关键词:内镜外科手术;神经保护;神经鞘瘤;眶尖肿瘤

Abstract:

Objective To discuss the effect of endoscopic surgery on orbital apex schwannoma and the strategy of intraoperative neuroprotection.Methods The data of 9 patients with orbital apex schwannoma who were diagnosed and underwent endoscopic surgery in Xiangya Hospital from May 2015 to June 2022 were retrospectively analyzed. Image navigation system was used to assist all operations. The oculomotor nerve was monitored by nerve electrophysiology monitoring technique during the operation. Descriptive statistical analysis method was adopted to analyze the demographic information, surgical and prognostic data.Results Eight of the 9 patients underwent total resection and 1 patient underwent subtotal resection with postoperative follow-up ranging from 10 to 95 months. The preoperative symptoms of all patients were relieved or improved to varying degrees. There were no surgical complications such as death or intracranial infection. None of the 9 patients had nerve injury during operation or neurological dysfunction after operation.Conclusions Endoscopic surgical resection of orbital apex schwannoma is safe and effective. Combined with the application of image navigation system and neuroelectrophysiological monitoring technology, it has the advantages of high total resection rate, less trauma, fewer complications and good preservation of neurological function.

Key words:Endoscopic surgery;Neuroprotection;Schwannoma;Orbital apex tumour