Selection of surgical approach for cerebellar hemangioblastomas based on venous drainage patterns
Selection of surgical approach for cerebellar hemangioblastomas based on venous drainage patterns
复制标题
DOI：
10.1007/s10143-021-01544-y
复制
发表时间：
2021-02
影响因子：
2.8
通讯作者：
Takashi Watanabe;Yuuki Suematsu;Kiyotaka Saito;G. Takeishi;Shinji Yamashita;H. Ohta;K. Yokogami;H. Takeshima
中科院分区：
文献类型：
--
作者：
Takashi Watanabe;Yuuki Suematsu;Kiyotaka Saito;G. Takeishi;Shinji Yamashita;H. Ohta;K. Yokogami;H. Takeshima
小脑血管母细胞瘤由于手术通道狭窄、较深和肿瘤血管丰富，手术仍具有挑战性。根据不同的部位采用不同的手术入路，但尚未确定最佳入路。我们提出了一种基于静脉引流系统的手术入路系统，以便于手术计划和实现可接受的神经结局。小脑血管母细胞瘤根据主要引流系统分为五种类型：引流至横窦（TS）或窦汇的枕下成血管细胞瘤、引流至小脑幕窦或直窦的小脑幕成血管细胞瘤、引流至上级岩窦（SPS）的岩部成血管细胞瘤、引流至盖伦系统的四叠体成血管细胞瘤、以及扁桃体血管母细胞瘤引流至TS或Torcula并与颈静脉球或SPS结合。根据该分类，回顾性分析了显微手术入路和患者结局。本研究包括17例接受21次手术切除的19例小脑血管母细胞瘤，其中枕下9例，小脑幕4例，岩骨2例，四叠体2例，扁桃体2例。标准枕下开颅术用于枕下成血管细胞瘤，枕经小脑幕入路（OTA）和小脑幕下入路用于小脑幕成血管细胞瘤，乙状窦后入路用于岩部成血管细胞瘤，OTA用于四叠体成血管细胞瘤，中线枕下入路用于扁桃体成血管细胞瘤。除1例外，所有患者均实现了大体全切除。两名患有大型血管母细胞瘤（扁桃体和四叠体）的患者需要二期手术，最终实现了大体全切除。没有任何一种方法的术后神经功能缺损的发生率明显更高。根据主要引流系统选择最佳手术入路是成功的。了解肿瘤的生长和静脉引流系统方面的扩展是至关重要的，以选择适当的手术方法。
Cerebellar hemangioblastomas remain surgically challenging because of the narrow, deep surgical corridors and tumor hypervascularity. Various surgical approaches are used according to the location, but optimal approaches have not been established. We propose a system of surgical approaches based on the venous drainage systems to facilitate surgical planning and achieve acceptable neurological outcomes. Cerebellar hemangioblastomas were divided into five types based on the main drainage systems: suboccipital hemangioblastomas draining to the transverse sinus (TS) or torcula, tentorial hemangioblastomas draining to the tentorial sinus or straight sinus, petrosal hemangioblastomas draining to the superior petrosal sinus (SPS), quadrigeminal hemangioblastomas draining to the galenic system, and tonsillar hemangioblastomas draining to the TS or torcula in conjunction with jugular bulb or SPS. Microsurgical approaches and patient outcome were retrospectively reviewed according to this classification. This study included 17 patients who underwent 21 operations for resection of 19 cerebellar hemangioblastomas, classified into 9 suboccipital, 4 tentorial, 2 petrosal, 2 quadrigeminal, and 2 tonsillar. Standard suboccipital craniotomies were utilized for suboccipital hemangioblastomas, the occipital transtentorial approach (OTA), and supracerebellar infratentorial approach for tentorial hemangioblastomas, the retrosigmoid approach for petrosal hemangioblastomas, OTA for quadrigeminal hemangioblastomas, and midline suboccipital approach for tonsillar hemangioblastomas. Gross total resection was achieved in all patients except one. Two patients with large hemangioblastomas (tonsillar and quadrigeminal) required second-stage operation which finally achieved gross total removal. No single approach had a significantly higher incidence of postoperative neurological deficits. Selection of the optimum surgical approach for cerebellar hemangioblastomas was successful based on the main drainage systems. Understanding of tumor growth and extension with respect to the venous drainage system is critical to select the appropriate surgical approach.