Application of microprobe vascular Doppler in the operation of skull base lesions

Abstract

Objective To investigate the effect of microprobe vascular Doppler (MVD) on the operation of skull base lesions. Methods From September 2017 to September 2018, 13 patients with skull base lesions at Neurosurgery Department of the first Affiliated Hospital of Soochow University were retrospectively analyzed. The 13 cases included 6 cases of meningioma in Sellar region, 2 cases of meningioma in petroclival region, 3 cases of pituitary adenoma of Knosp Ⅲ-Ⅳ grade, 1 case of chordoma in Sellar clival region, and 1 case of invasive growth of granulation tissue in intraorbital, skull base, sphenoid and ethmoid sinus after Aspergillus infection. The surgical methods included neuroendoscopic transnasal approach and microsurgical resection under craniotomy microscope. MVD was applied in all operations of this series. Medical imaging examination and follow-up were performed after operation. Results Among the 13 patients, total resection of meningioma in Sellar region was performed in 6 cases and subtotal resection in 2, total resection of Knosp grade Ⅲ-Ⅳ pituitary adenoma was conducted in 2 and subtotal resection in 1. Total resection was performed in 1 case of invasive growth of granulation tissue in intraorbital, skull base, sphenoid and ethmoid sinus after Aspergillus infection and 1 case of chordoma in Sellar base clival region. Uncorrected left eye vision was reported in the patient with Aspergillus infection post surgery. Postoperative symptoms of the other patients were improved. The prolactin level of 1 patient with prolactin adenoma was more than 204 ng/ml before operation. At 2 months post operation, the prolactin level was 105.66 ng/ml after oral bromocriptine combined with radiotherapy. The last reexamination was 11.3 ng/ml without hypophysis dysfunction. Six patients had varying degrees of electrolyte disorder after operation. Four patients had fever after operation and all returned to normal before discharge from hospital after treatment. All patients were followed up for (16.1±3.3) months(10-22 months), and there was no recurrence in imaging examination. Conclusion With the aid of MVD during the surgical resection of invasive growth lesions and large space occupying lesions in the skull base, the important blood vessels invaded, wrapped, pushed and displaced by the lesions can be monitored in real time, which might help avoid the disastrous consequences during and after operation and reduce the risk of surgery. Key words: Skull base neoplasms; Microsurgery; Natural orifice endoscopic surgery; Microprobe vascular Doppler