松果体病变占所有脑肿瘤的不到1%(Villani等人。,ClinNeurolNeurosurg109:1-6,2007)。糟糕的位置和关键的神经血管结构仍然是一个手术挑战,尽管微神经外科的出现。经典的枕骨下颅开颅手术,采用小脑下颅入路,由维克多·霍斯利爵士(Victor,ProcRSocMed3:77-78,1910),因其相当高的手术发病率和死亡率而臭名昭著。这后来由Stein进行了微神经手术升级,以改善手术结果(Stein,JNeurosurg35:197-202,1971)。Ruge等人。报道了通过该走廊对四叉神经蛛网膜囊肿进行的首次纯粹内窥镜开窗术(Ruge等人。,神经外科38:830-7,1996)。Cardia等人基于尸体的解剖学研究。证明了内窥镜辅助技术的可行性(Cardia等人。,JNeurosurg2006;104(6Suppl):409-14)。然而,Gore等人于2008年对松果体囊肿进行了首次纯内镜下脑上鼻下(eSCIT)入路.(戈尔PA等人。,神经外科62:108-9,2008)。与室管镜检查不同,eSCIT方法对穹窿没有机械风险,无论心室大小如何,都可以使用。更多的血管控制和由此导致的不受控出血的减少提高了实现完全切除的可行性。尤其是在拐角处(Zaidi等人,,世界神经外科84,2015)。重力依赖性定位和脑脊液(CSF)分流辅助小脑松弛,创造理想的解剖途径。此外,直窦的角度,tenorium,和盖层粘连通常会影响入路的选择;因此,直接的内窥镜可视化不仅会阻碍进入充血的Galenic复合体,而且还会促进蛛网膜的急剧解剖(Cardia等人。,JNeurosurg104:409-14,2006).这些策略有助于提供出色的照明与放大,使外科医生不那么疲劳(Broggi等人。,神经外科67:159-65,2010)。纯粹的内窥镜方法阻碍了空气栓塞的可怕风险,通过从一个小毛刺孔简单的大量灌溉(沙希尼安和拉,JNeurolSurgB颅底74:114-7,2013)。微小的开口和闭合很快就会产生,较小的伤口减少了术后疼痛和发病率。最近的文献支持它的众多优点和有利的结果,使其成为传统开放方法的有力竞争者。
Pineal lesions represent less than 1% of all brain tumors (Villani et al., Clin Neurol Neurosurg 109:1-6, 2007). The abysmal location and critical neurovascular structures remain a surgical challenge, despite the advent of microneurosurgery. The classical wide surgical suboccipital craniotomy with the supracerebellar infratentorial approach, described by Sir Victor Horsley (Victor, Proc R Soc Med 3:77-78, 1910), is infamous for its considerable surgical morbidity and mortality. This was later upgraded microneurosurgically by Stein to improve surgical outcomes (Stein, J Neurosurg 35:197-202, 1971).Ruge et al. reported the first purely endoscopic fenestration of quadrigeminal arachnoid cysts via this corridor (Ruge et al., Neurosurgery 38:830-7, 1996). A cadaver-based anatomical study by Cardia et al. demonstrated the viability for endoscope-assisted techniques (Cardia et al., J Neurosurg 2006;104(6 Suppl):409-14). However, the first purely endoscopic supracerebellar infratentorial (eSCIT) approach to a pineal cyst was performed in 2008 by Gore et al. (Gore PA et al., Neurosurgery 62:108-9, 2008).Unlike transventricular endoscopy, eSCIT approach poses no mechanical risk to the fornices and can be utilized irrespective of ventricular size. More vascular control and resultant reduction in uncontrolled hemorrhage improve the feasibility of attaining complete resection, especially around corners (Zaidi et al,, World Neurosurg 84, 2015). Gravity-dependent positioning and cerebrospinal fluid (CSF) diversion aid cerebellar relaxation, creating the ideal anatomical pathway. Also, angle of the straight sinus, tentorium, and tectal adherence can often influence the choice of approach; thus direct endoscopic visualization not only counteracts access to the engorged Galenic complex but also encourages sharp dissection of the arachnoid (Cardia et al., J Neurosurg 104:409-14, 2006). These tactics help provide excellent illumination with magnification, making it less fatiguing for the surgeon (Broggi et al., Neurosurgery 67:159-65, 2010).The purely endoscopic approach thwarts the dreaded risk of air embolisms, via simple copious irrigation from a small burr hole (Shahinian and Ra, J Neurol Surg B Skull Base 74:114-7, 2013). The tiny opening and closure are rapid to create, and the smaller wound decreases postoperative pain and morbidity. Recent literature supports its numerous advantages and favorable outcomes, making it a tough contender to traditional open methods.