Infraoccipital Supratentorial Approach Resection of a Left Mesiotemporal and Atrium Epidermoid Cyst
Infraoccipital Supratentorial Approach Resection of a Left Mesiotemporal and Atrium Epidermoid Cyst
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枕下幕上入路切除左颞部和心房表皮样囊肿
DOI：
10.1016/j.wneu.2020.11.085
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发表时间：
2020
影响因子：
2
通讯作者：
Jinsong Wu
中科院分区：
文献类型：
--
作者：
N.U. Farrukh Hameed;Yuyao Zhou;Peng Wang;Rui Feng;Jinsong Wu
传统的颞叶内侧病变是从颞叶外侧入路，这经常损伤视觉和语言束。我们提出了后方的方法，通过该方法可以避免在颞角（迈耶环）的顶部和外侧壁的语言和视觉束，最大限度地减少神经损伤的风险。患者，一个32岁的男子，提出了与经历癫痫发作6年罕见的，全面的，强直阵挛性癫痫发作的主诉。体格检查显示无神经功能缺损，既往病史不明显。磁振造影显示左侧颞中病灶，病灶无增强，并浸润心房，手术时患者俯卧位，并将特制骨瓣提起。接下来，轻轻牵开枕叶以暴露病变。使用Penfield剥离器逐渐切除病变。在切除过程中暴露了心房的顶部和内壁。这些建筑受到保护。发现病变及其包膜的残留物附着在侧脑室上，仔细凝固并取出。海马体也被暴露并切除一小部分。暴露心房顶壁和内壁证实病变已全部切除，术中磁共振成像评估证实病变全部切除。病理证实为表皮样囊肿。认知评估结果显示术后没有缺陷，他的视野也没有受到手术的影响。获得了患者知情内容（视频1）。
Classically mesiotemporal lesions are approached from the lateral temporal approach, which frequently injures the visual and language tracts. We present the posterior approach through which the language tracts and visual tracts at the roof and lateral wall of the temporal horn (Meyer loop) can be avoided, minimizing the risk of neurologic injury.The patient, a 32-year-old man, presented with the chief complaint of experiencing seizures for 6 years with rare, generalized, tonic-clonic seizures. Physical examination showed no neurologic deficits and past medical history was not remarkable. Magnetic resonance imaging revealed a left mesiotemporal lesion, which showed no contrast enhancement and infiltrated the atrium.For surgery, the patient was laid in prone position and a tailored bone flap was lifted. Next the occipital lobe was retracted gently to expose the lesion. Penfield dissectors were used to gradually resect the lesion. The roof and inner wall of the atrium were exposed during resection. These structures were protected. Residues of the lesion and its capsule were seen attached to the lateral ventricle and were carefully coagulated and removed. The hippocampus was also exposed and a small segment resected. Exposure of the roof and inner wall of the atrium confirmed that the entire lesion has been resected.Intraoperative magnetic resonance imaging evaluation confirmed a total resection of the lesion. Pathological analysis confirmed the diagnosis of epidermoid cyst. Cognitive evaluation results showed no postoperative deficiencies and his visual field was also not affected by the surgery.Informed patient content was obtained (Video 1).