Brotchi J, Raftopoulos C, Levivier M, Dewitte O, Pirotte B, Vandesteene A, Baleriaux D, Noterman J
Service de Neurochirurgie, Hôpital Erasme, Bruxelles, Belgique.
Neurochirurgie. 1991;37(6):410-5.
Surgical treatment of pineal-tentorial region lesions remains a challenge. The difficulty in approaching the pineal region can be verified with the number of operative plans that have been proposed to reach this area: transcallosal, occipital transtentorial, infratentorial supracerebellar approaches and sitting, prone or Concorde positions. This emphasizes the surgeon's dissatisfaction with the surgical techniques described. Recently, a three-quarter prone position with the bone flap placed under the midline has been described (1, 3, 8). We have decided to test this approach that we have slightly modified and we report our results on 13 cases: 2 arachnoid cysts, 3 vascular malformations and 8 tumors (3 brainstem gliomas, 2 dysgerminomas, 1 quadrigeminal plate metastasis and 1 meningioma plus 1 metastasis of the falx). Keeping the table in a horizontal plane, risks of air embolus are eliminated. Using the natural effect of gravity, traction on the occipital lobe is no more necessary and hemianopsia no more occurs. We recommand the parieto-occipital route which is the shortest way to reach epiphysis and falco-tentorial notch. We confirm the results of american colleagues (1, 3, 8, 15) and we advise to use this approach which seems to us the best way to treat pineal-tentorial lesions.
松果体-小脑幕区域病变的外科治疗仍然是一项挑战。从已提出的到达该区域的手术方案数量可以看出接近松果体区域存在困难：经胼胝体、枕下小脑幕、幕下小脑上入路以及坐位、俯卧位或协和体位。这凸显了外科医生对所描述的手术技术的不满。最近，有人描述了一种将骨瓣置于中线下方的3/4俯卧位（1, 3, 8）。我们决定对这种方法进行略微修改后进行测试，并报告我们对13例病例的结果：2例蛛网膜囊肿、3例血管畸形和8例肿瘤（3例脑干胶质瘤、2例生殖细胞瘤、1例四叠体板转移瘤和1例脑膜瘤加1例镰旁转移瘤）。将手术台保持在水平平面，可消除空气栓塞的风险。利用重力的自然作用，不再需要对枕叶进行牵引，也不会再出现偏盲。我们推荐顶枕入路，这是到达松果体和小脑幕切迹的最短途径。我们证实了美国同行（1, 3, 8, 15）的结果，并建议采用这种方法，在我们看来这是治疗松果体-小脑幕病变的最佳方法。
