Kassam Amin B, Engh Johnathan A, Mintz Arlan H, Prevedello Daniel M
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
J Neurosurg. 2009 Jan;110(1):116-23. doi: 10.3171/2008.7.JNS08226.
The authors introduce a novel technique of intraparenchymal brain tumor resection using a rod lens endoscope and parallel instrumentation via a transparent conduit.
Over a 4-year period, 21 patients underwent completely endoscopic removal of a subcortical brain lesion by means of a transparent conduit. Image guidance was used to direct the cannulation and resection of all lesions. Postoperative MR imaging or CT was performed to assess for residual tumor in all patients, and all patients were followed up postoperatively to assess for new neurological deficits or other surgical complications.
The histopathological findings were as follows: 12 metastases, 5 glioblastomas, 3 cavernous malformations, and 1 hemangioblastoma. Total radiographically confirmed resection was achieved in 8 cases, near-total in 6 cases, and subtotal in 7 cases. There were no perioperative deaths. Complications included 1 infection and 1 pulmonary embolus. There were no postoperative hematomas, no postoperative seizures, and no worsened neurological deficits in the immediate postoperative period.
Fully endoscopic resection may be a technically feasible method of resection for selected subcortical masses. Further experience with this technique will help to determine its applicability and safety.
作者介绍一种使用棒状透镜内窥镜并通过透明导管进行平行器械操作的脑实质内脑肿瘤切除术的新技术。
在4年期间，21例患者通过透明导管接受了完全内镜下的皮质下脑病变切除术。使用图像引导来指导所有病变的插管和切除。对所有患者进行术后磁共振成像（MR）或计算机断层扫描（CT）以评估残留肿瘤，并且对所有患者进行术后随访以评估新的神经功能缺损或其他手术并发症。
组织病理学结果如下：12例转移瘤、5例胶质母细胞瘤、3例海绵状畸形和1例成血管细胞瘤。影像学证实完全切除8例，近全切除6例，次全切除7例。无围手术期死亡。并发症包括1例感染和1例肺栓塞。术后即刻无术后血肿、无术后癫痫发作且无神经功能缺损加重。
完全内镜下切除对于选定的皮质下肿块可能是一种技术上可行的切除方法。该技术的进一步经验将有助于确定其适用性和安全性。
