背景:虽然锁孔神经外科在手术室中的应用越来越多,关于使用锁孔技术切除巨大颅内肿瘤的报道很少。本文讨论了这种方法的可行性和技术。
方法:我们回顾性分析了在2012年2月至2017年9月期间收治的95例颅内肿瘤最大直径>5cm的连续患者。在每种情况下,都使用锁孔方法切除这些肿瘤,包括眶上,亚时态,枕下,乳突后,额叶,temporal,枕骨,顶叶,翼点,颞顶骨锁孔联合入路,和通过纵向裂缝的方法。
结果:我们实现了68/95例(71.6%)的总切除和27/95例(28.4%)的次全切除。手术后无手术死亡或严重残疾,如昏迷和肢体运动障碍。在出院时,8例患者出现与颅神经功能受损相关的并发症。此外,2例患者出现脑积水,需要脑室-腹腔分流术,4例患者发生术后脑脊液漏,需要手术干预。
结论:经过精心设计和合理选择,使用微创锁孔入路切除巨大颅内肿瘤可以安全地完成,手术效果满意。
BACKGROUND: While keyhole neurosurgery is increasingly utilized in the operating room, there are few reports regarding the use of keyhole techniques to resect giant intracranial tumors. The feasibility and technique of that were discussed in this paper.
METHODS: We retrospectively reviewed 95 consecutive patients who were admitted to our service between February 2012 and September 2017 with a maximum intracranial tumor diameter >5 cm. Keyhole approaches were used to resect these tumors in each case, including supraorbital, subtemporal, suboccipital, retromastoid, frontal, temporal, occipital, parietal, pterional, a combined temporo-parietal keyhole approach, and an approach via the longitudinal fissure.
RESULTS: We achieved gross total resection in 68/95 cases (71.6%) and subtotal resection in 27/95 cases (28.4%). No surgical death or severe disabilities such as coma and limb dyskinesia occurred following surgery. At the time of discharge, 8 patients had complications related to impaired cranial nerve function. In addition, 2 patients developed hydrocephalus requiring ventriculo-peritoneal shunt placement, and 4 patients developed a postoperative CSF leak requiring surgical intervention.
CONCLUSIONS: With meticulous design and reasonable selection, resection of giant intracranial tumors utilizing minimally invasive keyhole approaches can be done safely with satisfactory surgical outcomes.