Section of Pediatric and Congenital Neurosurgery, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
World Neurosurg. 2010 Jun;73(6):713-8. doi: 10.1016/j.wneu.2010.02.068.
Although neuroendoscope is widely used, endoscopic removal of intraventricular solid tumors has rarely been reported. Most reported procedures were performed with special endoscopic instruments through the endoscope's working channel--intra-axial endoscopic procedures. We report two cases of combined intra-/extra-axial endoscopic procedures--intraventricular solid tumor resection for subependymal giant cell astrocytoma.
In 2007, two patients with subependymal giant cell astrocytoma with a long history of tuberous sclerosis underwent solely endoscopic, minimally invasive intraventricular tumor resection. Through a precoronal transcortical approach, intra-axial endoscopic techniques were used to biopsy tumors. After a 1- to 1.5-cm in diameter corridor was formed inside the frontal lobes, extra-axial endoscopic techniques were used to explore the tumors and resect them. During extra-axial procedures, microneurosurgical instruments were used around the endoscope.
In both patients, gross total resection of the tumors was achieved safely. Pathologic diagnoses were subependymal giant cell astrocytoma. There were no complications from surgery, and no neurological deficits. Patients were doing well and shunt free during the 8-month postoperative follow-ups. Postoperative magnetic resonance images showed minimal approach-related trauma along the surgical corridor.
In the present report endoscopic minimally invasive neurosurgery (EMIN) was defined as procedures in which the endoscope was used independently as the only optical device, for both illumination and visualization. Depending on the relationship between surgical instruments and the endoscope, EMIN was classified as intra-axial and extra-axial procedures. EMIN is a completive, safe procedure for intraventricular subependymal giant cell astrocytoma.
尽管神经内镜被广泛应用，但很少有报道内镜切除脑室实质性肿瘤。大多数报道的手术都是通过内镜工作通道（轴内内镜手术）使用特殊的内镜器械进行的。我们报告了两例联合轴内/轴外内镜手术的病例，即通过内镜切除室管膜下巨细胞星形细胞瘤。
2007 年，两名患有室管膜下巨细胞星形细胞瘤且病史较长的结节性硬化症患者仅接受了内镜微创脑室肿瘤切除术。通过冠状前皮质切开术，采用轴内内镜技术对肿瘤进行活检。在额叶内形成 1-1.5 厘米直径的通道后，采用轴外内镜技术探查肿瘤并切除。在轴外手术过程中，使用显微镜神经外科器械围绕内镜。
在这两名患者中，肿瘤均安全地实现了大体全切除。病理诊断为室管膜下巨细胞星形细胞瘤。手术无并发症，无神经功能缺损。患者在术后 8 个月的随访中恢复良好，无分流。术后磁共振成像显示手术通道处仅有轻微的与入路相关的创伤。
本报告中内镜微创神经外科（EMIN）被定义为内镜作为唯一的光学设备独立使用的手术，用于照明和可视化。根据手术器械与内镜的关系，EMIN 可分为轴内和轴外手术。EMIN 是一种安全有效的治疗脑室室管膜下巨细胞星形细胞瘤的方法。
