Transsylvian-Transinsular Approaches to the Insula and Basal Ganglia: Operative Techniques and Results With Vascular Lesions
Transsylvian-Transinsular Approaches to the Insula and Basal Ganglia: Operative Techniques and Results With Vascular Lesions
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DOI：
10.1227/neu.0b013e318236760d
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发表时间：
2012-04-01
期刊：
影响因子：
4.8
通讯作者：
Lawton, Michael T.
中科院分区：
文献类型：
--
作者：
Potts, Matthew B.;Chang, Edward F.;Lawton, Michael T.
背景：脑岛和基底节的病变可能有切除的风险，因为它们的深度和接近关键结构，特别是在优势半球。目的：报告经大脑前入路治疗血管病变的经验。方法：前入路切开侧裂的蝶骨和岛叶部分，暴露岛缘和短回，后入路切开侧裂的岛叶和岛叶部分，暴露环状沟和长脑回。结果：41例血管病变患者，24例动静脉畸形，17例海绵窦畸形，均采用经额入路。87.5%的动静脉动静脉畸形和95%的海绵状畸形完全切除。与手术相关的永久性神经系统并发症2例(5%)，其余39例(95%)术后改善或无变化(改良Rankin评分0~2分占83%)。在优势半球病变的患者中没有新的语言障碍。结论：在保留额叶和颞叶上覆盖的口才皮质的情况下，经经岛入路安全地暴露了岛内或岛内深层的血管病变。根据裂开侧裂的技术差异和最终显露的解剖学差异，前路经横岛入路与后路入路不同。辨别病人的选择和仔细的显微外科技术是必不可少的。
BACKGROUND: Lesions in the insula and basal ganglia can be risky to resect because of their depth and proximity to critical structures, particularly in the dominant hemisphere. Transsylvian approaches shorten the surgical distance to these lesions, preserve perisylvian temporal and frontal cortex, and minimize brain transgression.OBJECTIVE: To report our experience with transsylvian-transinsular approaches to vascular lesions.METHODS: The anterior approach opened the sphenoidal and insular portions of the sylvian fissure and exposed the limen insulae and short gyri, whereas the posterior approach opened the insular and opercular portions of the sylvian fissure and exposed the circular sulcus and long gyri.RESULTS: Forty-one patients with vascular lesions (24 arteriovenous malformations [AVMs] and 17 cavernous malformations) were treated surgically with a transsylvian-transinsular approach. Complete resection was obtained in 87.5% of AVMs and 95% of cavernous malformations. Permanent neurological morbidity related to surgery was observed in 2 AVM patients (5%), with the remaining 39 patients (95%) improved or unchanged postoperatively (modified Rankin Scale scores 0-2 in 83%). There were no new language deficits in patients with dominant hemisphere lesions.CONCLUSION: Transsylvian-transinsular approaches safely expose vascular pathology in or deep to the insula while preserving overlying eloquent cortex in the frontal and temporal lobes. The anterior transsylvian-transinsular approach can be differentiated from the posterior approach based on technical differences in splitting the sylvian fissure and anatomic differences in final exposure. Discriminating patient selection and careful microsurgical technique are essential.