Endoscopic Surgery for Supratentorial Deep Cavernous Malformation Adjacent to Cortical Spinal Tract: Preliminary Experience and Technical Note.
Endoscopic Surgery for Supratentorial Deep Cavernous Malformation Adjacent to Cortical Spinal Tract: Preliminary Experience and Technical Note.
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邻近皮质脊髓束的幕上深部海绵体畸形的内镜手术：初步经验和技术说明
DOI：
10.3389/fneur.2021.678413
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发表时间：
2021
影响因子：
3.4
通讯作者：
Jiang C
中科院分区：
文献类型：
--
作者：
Lin F;Li C;Yan X;Wang D;Lin Y;Kang D;Jiang C
在这项研究中，我们的目的是介绍一个技术说明，并探讨内窥镜手术结合扩散张量成像（DTI）导航幕上脑深部海绵状血管畸形（CCM）的疗效。对CCM患者的前瞻性维护数据库进行了审查，以确定所有接受内镜手术治疗的CCM患者。术前行矢状位T1加权解剖磁共振成像（MRI）和DTI检查。根据术前DTI图像和术中DTI导航计划并实施内窥镜手术。术后随访6个月以上。随访时记录运动功能缺损和改良兰金量表（mRS）评分。最终mRS评分0-2被认为是良好结局，最终mRS评分>2被认为是不良结局。术后3个月行第二次DTI和3DT 1检查。我们在术前和术后的DTI图像上追踪了同侧皮质脊髓束（CST）。比较术前和术后DTI图像上追踪的CST的总平均FA值和纤维数。分析了与运动缺陷和不良结局相关的风险因素。本研究纳入了7例接受内镜手术治疗的深部CCM患者。术前mRS评分为1.5 ± 0.98，术后3个月恢复至0.86 ± 1.22。根据统计学分析，mRS评分显著改善（p = 0.012）。根据斯皮尔曼非参数检验，术后6个月仅同侧CST的DTI纤维数与肌力显著相关（p = 0.032）。与术前相比，术后同侧CST的FA值（p = 0.289）和纤维数（p = 0.289）变化不明显，说明内镜手术对CST有保护作用。基于DTI导航的内镜手术可能是保护幕上深部CCM患者纤维束并改善长期预后的有效方法。然而，需要更多的研究和案例来证实我们的发现。
In this study, we aimed to introduce a technical note and to explore the efficacy of endoscopic surgery combined with diffusion tensor imaging (DTI) navigation for supratentorial deep cerebral cavernous malformations (CCM). A prospectively maintained database of CCM patients was reviewed to identify all CCM patients treated by endoscopic surgery. The sagittal T1-weighted anatomical magnetic resonance imaging (MRI) and DTI were acquired before surgery. Endoscopic surgery was planned and performed based on preoperative DTI images and intraoperative DTI navigation. All patients were followed up more than 6 months. Motor function deficit and modified Rankin scale (mRS) scores were documented on follow-up. A final mRS score of 0–2 was considered a good outcome, and a final mRS score >2 was considered a poor outcome. Second DTI and 3DT1 were performed at 3 months after surgery. We tracked the ipsilateral corticospinal tract (CST) on pre- and postoperative DTI images. The overall mean FA values and the number of fibers of tracked CST were compared on pre- and postoperative DTI images. Risk factors associated with motor deficits and poor outcomes were analyzed. Seven patients with deep CCM and treated by endoscopic surgery were enrolled in this study. The mean value of preoperative mRS was 1.5 ± 0.98, but that score recovered to 0.86 ± 1.22 3 months later. The mRS scores were improved significantly according to statistical analysis (p = 0.012). According to the Spearman non-parametric test, only the fiber number of ipsilateral CST on postoperative DTI was significantly associated with muscle strength 6 months after surgery (p = 0.032). Compared with preoperative CST characteristics on DTI, the change of FA value (p = 0.289) and fiber number (p = 0.289) of ipsilateral CST on postoperative DTI was not significant It meant that the CST was protected during endoscopic surgery. Endoscopic surgery based on DTI navigation might be an effective method to protect fiber tracts in supratentorial deep CCM patients and improve long-term outcomes. However, more studies and cases are needed to confirm our findings.
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影响因子：
4.1
作者：
Chang, Edward F.;Gabriel, Rodney A.;Lawton, Michael T.
通讯作者：
Lawton, Michael T.
影响因子：
2.3
作者：
Eichberg, Daniel G.;Di, Long;Starke, Robert M.
通讯作者：
Starke, Robert M.
影响因子：
2.3
作者：
Skrap, Miran;Vescovi, Maria Caterina;Tuniz, Francesco
通讯作者：
Tuniz, Francesco
内镜手术治疗幕上高血压脑出血的疗效：与开颅手术的比较
影响因子：
4.1
作者：
Xu, Xinghua;Chen, Xiaolei;Xu, Bainan
通讯作者：
Xu, Bainan
影响因子：
8.3
作者：
Salman, Rustam Al-Shahi;Berg, Michel J.;Awad, Issam A.
通讯作者：
Awad, Issam A.