Practical Arachnoid Anatomy for the Technical Consideration of Galen Complex Dissection: Cadaveric and Clinical Evaluation
Practical Arachnoid Anatomy for the Technical Consideration of Galen Complex Dissection: Cadaveric and Clinical Evaluation
复制标题
用于盖伦复杂解剖技术考虑的实用蛛网膜解剖学：尸体和临床评估
DOI：
10.1016/j.wneu.2021.04.041
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发表时间：
2021
影响因子：
2
通讯作者：
Yamamoto Tetsuya
中科院分区：
文献类型：
--
作者：
Miyake Shigeta;Suenaga Jun;Nakamura Taishi;Akimoto Taisuke;Suzuki Ryosuke;Ohtake Makoto;Takase Hajime;Tateishi Kensuke;Shimizu Nobuyuki;Murata Hidetoshi;Funakoshi Kengo;Sawamura Yutaka;Yamamoto Tetsuya
枕部经小脑幕入路(OTA)是一种非常有用但具有挑战性的显露松果体区的方法，因为深层蛛网膜通常折叠并延伸到Galen大静脉(GVG)上，导致密度高和能见度低。此外，蛛网膜下腔解剖学的实用方面还没有得到很好的理解。我们的目的是根据蛛网膜下腔解剖的实际情况，开发一种安全的OTA手术方法。在严格遵守法律和伦理要求的情况下，通过OTA对5具身体的蛛网膜结构和手术方式进行了分析。结果所有身体都显示了两层蛛网膜结构-一层属于枕叶，另一层属于小脑。根据我们的身体分析，天幕顶端的蛛网膜附着物可以钝性剥离，平均距离为10.2 mm。在我们的临床表现中，我们发现一位14岁男孩患有松果体肿瘤并脑积水。在使用OTA扩大深部手术野的同时，将膜从天幕顶端分离出来，钝性剥离，显露深静脉。结论GVG由小脑幕上方和下方呈双层蛛网膜结构分布。小脑幕下蛛网膜钝地从GVG剥离到附着束，受到穿透静脉的限制。这种分离技术对于安全扩大OTA的手术范围是有用的。
BackgroundThe occipital transtentorial approach (OTA) is a very useful but challenging approach to expose the pineal region because the deep-seated arachnoid membranes usually fold and extend over the great vein of Galen (GVG), leading to dense and poor visibility. In addition, the practical aspects of arachnoid anatomy are not well understood. We aimed to develop a safe surgical procedure for the OTA according to the practical aspects of arachnoid anatomy.MethodsThe procedure is shown through an illustrative video of surgery and cadaver. Five cadavers were analyzed for their arachnoid structures and the surgical procedures via the OTA, in strict compliance with legal and ethical requirements.ResultsAll cadavers showed a 2-layered arachnoid structure—one belonging to the occipital lobe, and the other to the cerebellum. According to our cadaveric analysis, the arachnoid attachment of the tentorial apex can be peeled bluntly, with an average distance of 10.2 mm. For our clinical presentation, a pineal tumor with hydrocephalus was detected in a 14-year-old boy. While using the OTA and expanding the deep surgical field, we detached the membrane from the tentorial apex and bluntly peeled it to reveal the deep veins. Finally, gross total removal of the tumor was achieved.ConclusionsA 2-layered arachnoid structure interposes the GVG from above and below the tentorium. The arachnoid membrane below the tentorium can be peeled off bluntly from the GVG to the attachment bundle limited by the penetrating veins. This detachment technique is useful for safe enlargement of the surgical field for the OTA.