Endoscopic approaches to brainstem cavernous malformations: Case series and review of the literature.
Endoscopic approaches to brainstem cavernous malformations: Case series and review of the literature.
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DOI：
10.4103/2152-7806.155807
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发表时间：
2015
影响因子：
--
通讯作者：
Lee JY
中科院分区：
文献类型：
--
作者：
Nayak NR;Thawani JP;Sanborn MR;Storm PB;Lee JY
累及脑干的症状性海绵状畸形通常难以通过传统方法进入。传统的颅底入路需要显著的脑回缩或骨切除以提供足够的手术通道。虽然有一种趋势是限制使用最具侵入性的手术方法，但内窥镜技术的最新进展可能会补充现有方法，以进入这些难以到达的区域。连续4例患者通过全内窥镜入路（鼻内、经肝叶;乙状窦后;小脑外侧上、幕下;鼻内、经肝叶）治疗症状性出血性脑干海绵状血管畸形。总之，这些病变包括脑干的所有三个部分。其中3例患者的海绵状血管畸形完全切除，而1例患者在长期随访时有稳定的残留。在2例患者中保留了相关的发育性静脉畸形，其中1例在术前确定。4例患者中有3例在手术后神经系统检查保持稳定或改善，而1例患者出现同侧颅神经VII和VIII麻痹。第一个经肝门入路导致症状性脑脊液漏，需要再次手术，但第二个没有。尽管内窥镜入路存在挑战，但相对于我们之前在类似病例中的显微手术经验，手术通道的可视化和照明具有上级优势，对手术活动性没有明显限制。内窥镜是一种有前途的辅助神经外科医生的能力，接近难以进入脑干海绵状畸形。它允许外科医生实现照明良好的全景视图，并通过组合方法，可以提供对脑干大部分区域的微创访问。
Symptomatic cavernous malformations involving the brainstem are frequently difficult to access via traditional methods. Conventional skull-base approaches require significant brain retraction or bone removal to provide an adequate operative corridor. While there has been a trend toward limited employment of the most invasive surgical approaches, recent advances in endoscopic technology may complement existing methods to access these difficult to reach areas. Four consecutive patients were treated for symptomatic, hemorrhagic brainstem cavernous malformations via fully endoscopic approaches (endonasal, transclival; retrosigmoid; lateral supracerebellar, infratentorial; endonasal, transclival). Together, these lesions encompassed all three segments of the brainstem. Three of the patients had complete resection of the cavernous malformation, while one patient had stable residual at long-term follow up. Associated developmental venous anomalies were preserved in the two patients where one was identified preoperatively. Three of the four patients maintained stable or improved neurological examinations following surgery, while one patient experienced ipsilateral palsies of cranial nerves VII and VIII. The first transclival approach resulted in a symptomatic cerebrospinal fluid leak requiring re-operation, but the second did not. Although there are challenges associated with endoscopic approaches, relative to our prior microsurgical experience with similar cases, visualization and illumination of the surgical corridors were superior without significant limitations on operative mobility. The endoscope is a promising adjunct to the neurosurgeon's ability to approach difficult to access brainstem cavernous malformations. It allows the surgeon to achieve well-illuminated, panoramic views, and by combining approaches, can provide minimally invasive access to most regions of the brainstem.