目的:探讨外科技术,优势,和神经内镜下远端入路治疗脑干和第四脑室病变的缺点。
方法:回顾性分析2020年3月至2022年3月神经内镜下远端血管入路治疗5例患者的临床资料。
结果:在5例患者中,桥脑臂海绵状血管瘤3例,脑干和第四脑室肿瘤2例。所有患者均能顺利完成手术,4名患者恢复良好,另有1例患者因术后其他系统出现严重并发症而自动出院。
结论:端线法作为第四脑室和脑干病变的一种安全有效的策略,已经越来越受欢迎。然而,不移除地图集的后弓,在显微镜下很难进入第四脑室的上部。经颅神经内镜能有效弥补显微镜的缺点,无论是用作显微外科手术的辅助措施,还是单独使用熟练的内窥镜技术,它将在第四脑室和脑干病变的微创手术中提供更大的应用。通过利用经颅神经内镜的出色自由度,不需要打开地图集的后弓,使手术更具微创性。然而,这项研究的样本量很小,它是在我们团队非常成熟的神经内镜技术下完成的。其一般安全性和实用性仍需要广泛的临床研究验证。
OBJECTIVE: To explore the surgical techniques, advantages, and disadvantages of neuroendoscopic telovelar approach in the treatment of brainstem and fourth ventricle lesions.
METHODS: The clinical data of 5 patients treated by neuroendoscopic telovelar approach from March 2020 to March 2022 were analyzed retrospectively.
RESULTS: Among the 5 patients, there were 3 cavernous hemangiomas in pontine arm and 2 tumors in brainstem and fourth ventricle. All patients could successfully complete the operation, and 4 patients recovered well, other 1 patient discharged automatically for serious complications of other systems after the operation.
CONCLUSIONS: The telovelar approach has gained popularity as a safe and effective strategy for lesions in fourth ventricular and brainstem. However, without removing the posterior arch of the atlas, it is difficult to enter the upper part of the fourth ventricle under a microscope. Transcranial neuroendoscopy can effectively compensate for the shortcomings of microscopy, whether used as an auxiliary measure for microsurgery or alone with proficient endoscopic techniques, it will provide greater application in minimally invasive surgery for fourth ventricle and brainstem lesions. By utilizing the excellent degree of freedom of transcranial neuroendoscopy, there is no need to open the posterior arch of the atlas, making the surgery more minimally invasive. However, the sample size of this study is small, and it was completed under the very mature neuroendoscopic technology of our team. Its general safety and practicality still require extensive clinical research validation.