Abstract:
Two main surgical techniques are available for corpus callosotomy (CC): conventional microscopic CC and endoscopic CC.1 Microscopic CC is more familiar to neurosurgeons and allows three-dimensional visualization, but it requires a larger craniotomy and has a narrower visual angle in the deep part. Endoscopic CC has only recently been introduced to epilepsy surgery, but it is gaining increasing interest among epilepsy surgeons. The endoscope provides two-dimensional visualization and requires a camera as an additional instrument inserted into the surgical corridor. The merits of endoscopic CC include the smaller craniotomy and smaller skin incision, potentially reducing invasiveness.2 Bridging veins to the superior sagittal sinus are also less problematic because of the reduced need for brain retraction. The lack of need of arachnoid dissection is another advantage. Generally, an anterior approach is applied for CC, but this approach makes interhemispheric fissure dissection mandatory, especially at the cingulate gyri. In some cases, this procedure can take a long time. On the other hand, a posterior approach requires less interhemispheric arachnoid dissection, or sometimes none at all, due to the anatomy of the falx cerebri. These reasons have driven the development of a posterior approach for an endoscopic-alone technique.3 Here, we present a 5-year-old girl with medically intractable epileptic spasms that were diagnosed as infantile epileptic spasms syndrome, who underwent endoscopic total CC via a posterior approach to control her seizures (Video 1).
摘要:
两种主要的手术技术可用于骨体切开术(CC):常规显微镜CC;内窥镜CC.1显微镜CC对神经外科医生更熟悉,并允许3D可视化,但需要更大的开颅手术,深部的视角更窄。内窥镜CC是一种最近才被引入癫痫手术的技术,但癫痫外科医生越来越感兴趣。内窥镜提供2D可视化并且需要相机作为插入到外科手术通道中的附加器械。内窥镜CC的优点包括较小的开颅手术和较小的皮肤切口,2由于减少了对大脑回缩的需求,因此将静脉桥接到上矢状窦的问题也较少。不需要蛛网膜夹层是另一个优点。一般来说,前入路应用于CC,但是这种方法使得半球间裂隙解剖成为强制性的,特别是在扣带回。在某些情况下,这个过程可能需要很长时间。另一方面,后路需要较少的半球间蛛网膜夹层,甚至根本没有,由于大脑的解剖结构。这些原因推动了单独内窥镜技术的后入路的发展。3在这里,我们介绍了一名5岁女孩,患有医学上难治的癫痫痉挛,被诊断为IESS,通过后路入路进行内窥镜全CC以控制癫痫发作。