Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
Neurosurgery. 2010 Mar;66(3 Suppl Operative):65-74. doi: 10.1227/01.NEU.0000365550.84124.BB.
We report our experience with anterior interhemispheric approach for tumors in and around the anterior third ventricle, including surgical technique, instrumentation, pre- and postoperative hormonal disturbances, and resection rate.
One hundred patients with 46 craniopharyngiomas, 12 hypothalamic gliomas, 12 meningiomas, 6 hypothalamic hamartomas, and 24 other lesions were operated on using an anterior interhemispheric approach with or without opening of the lamina terminalis. This surgical approach involves no frontal sinus opening; a narrow (approximately 15-20 mm in width) access between the bridging veins, which is sufficient to remove the tumor totally; and sparing of the anterior communicating artery. Specially designed long bipolar forceps and scissors are necessary for this approach, and concomitant use of angled instruments (endoscope, aspirator, and microforceps) is required frequently. The postsurgical follow-up period varied from 4 months to 18 years.
Total removal of the neoplasm was accomplished in 37 of 46 patients with craniopharyngiomas (80.4%), whereas subtotal resection was performed in hypothalamic gliomas. No significant differences in pre- and postoperative hormonal disturbances were observed in 37 craniopharyngiomas and 10 hypothalamic gliomas. There was no operative mortality. Visual acuity was preserved or improved in 68 of 75 patients assessed. The Karnofsky Performance Scale score did not deteriorate in 72 of 75 patients tested.
The minimally invasive anterior interhemispheric approach, with or without opening of the lamina terminalis, is useful for removal of tumors in and around the anterior third ventricle, such as craniopharyngiomas and hypothalamic gliomas.
我们报告使用经前纵裂入路治疗第三脑室内及周边肿瘤的经验，包括手术技术、器械、术前和术后激素紊乱以及切除率。
100 例患者（46 例颅咽管瘤、12 例下丘脑胶质瘤、12 例脑膜瘤、6 例下丘脑错构瘤和 24 例其他病变）采用经前纵裂入路手术治疗，部分病例打开终板。该手术入路不打开额窦；在桥静脉之间建立一个狭窄（宽度约 15-20 毫米）的通道，足以完全切除肿瘤；同时保留前交通动脉。该手术需要专门设计的长双极镊和剪刀，并且经常需要使用角度器械（内窥镜、吸引器和微型镊）。术后随访时间为 4 个月至 18 年。
46 例颅咽管瘤中有 37 例（80.4%）肿瘤全切除，下丘脑胶质瘤行次全切除。37 例颅咽管瘤和 10 例下丘脑胶质瘤患者术前和术后激素紊乱无显著差异。无手术死亡。75 例视力评估患者中，68 例视力保留或改善。75 例测试患者中，72 例 Karnofsky 表现量表评分无恶化。
经前纵裂入路（或不打开终板）是治疗第三脑室内及周边肿瘤（如颅咽管瘤和下丘脑胶质瘤）的一种微创方法。
