Department of Neurosurgery, Medical School Hannover, MHH, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Acta Neurochir (Wien). 2011 Mar;153(3):517-26. doi: 10.1007/s00701-010-0933-x. Epub 2011 Jan 18.
Endoscopic and stereotactic surgery have gained widespread acceptance as minimally invasive tools for the diagnosis of intracerebral pathologies. We investigated the specific advantages and disadvantages of each technique in the assessment of periventricular lesions.
This study included a retrospective series of 70 patients with periventricular lesions. Endoscopic surgery was performed in 17 patients (mean age, 37 years; range, 4 months-78 years) and stereotactic biopsy in 55 patients (mean age, 63 years; range, 23-80 years), including two patients who underwent both procedures.
Hydrocephalus was present in 13/17 patients in the endoscopic group (77%) and in 11/55 patients in the stereotactic group (20%). Diagnosis was achieved in all patients in the endoscopic group and in all but one patient in the stereotactic group, in whom histological diagnosis was obtained by endoscopic biopsy during a second operation. In the endoscopic group, additional procedures performed included ventriculostomy (2/17), cyst fenestration (3/17), endoscopic shunt revision (3/17) and placement of Rickham reservoirs or external cerebrospinal fluid drains (6/17). Adverse events occurred in one patient after endoscopy (chronic subdural hematoma) and in two patients after stereotactic surgery (one mild hemiparesis and one transitory paresis of the contralateral leg).
Endoscopic and stereotactic surgery have distinct advantages and disadvantages in approaching periventricular lesions. The advantages of endoscopy encompass the possibility to perform additional surgical procedures during the same session (e.g. tumour reduction, third ventriculostomy, fenestration of a cyst). The visual control reduces the hazard of injury to anatomical structures and allows for a better control of bleeding although there is a considerable blind-out in such situations. The advantages of stereotactic surgery include a smaller approach and precise planning of the trajectory. It is usually performed under local anaesthesia. Both methods provide a safe and efficient therapeutic option in periventricular lesions with low surgical-related morbidity.
内镜和立体定向手术已作为诊断脑内病变的微创工具得到广泛认可。我们研究了每种技术在评估脑室周围病变中的具体优缺点。
本研究纳入了 70 例脑室周围病变患者的回顾性系列研究。17 例行内镜手术（平均年龄 37 岁，范围 4 个月-78 岁），55 例行立体定向活检（平均年龄 63 岁，范围 23-80 岁），其中 2 例患者同时行两种手术。
内镜组 17 例患者中有 13 例（77%）存在脑积水，立体定向组 55 例患者中有 11 例（20%）存在脑积水。内镜组所有患者均获得诊断，立体定向组除 1 例患者外均获得诊断，该患者在第二次手术中通过内镜活检获得组织学诊断。在内镜组，其他手术包括脑室造口术（2/17）、囊肿开窗术（3/17）、内镜分流管修复术（3/17）和 Rickham 贮液囊或外脑脊液引流管放置术（6/17）。内镜后发生 1 例不良事件（慢性硬脑膜下血肿），立体定向手术后发生 2 例不良事件（1 例轻度偏瘫和 1 例对侧下肢短暂瘫痪）。
内镜和立体定向手术在处理脑室周围病变方面各有优势和不足。内镜的优势包括可在同一手术过程中进行其他手术（如肿瘤缩小、第三脑室造口术、囊肿开窗术）。视觉控制降低了损伤解剖结构的风险，并且可以更好地控制出血，尽管在这种情况下存在相当大的盲目性。立体定向手术的优势包括较小的手术入路和精确的轨迹规划。它通常在局部麻醉下进行。两种方法在脑室周围病变中均提供了安全有效的治疗选择，手术相关发病率低。
