Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, USA.
World Neurosurg. 2013 Feb;79(2 Suppl):S18.e1-8. doi: 10.1016/j.wneu.2012.02.022. Epub 2012 Feb 10.
Deep-seated intraventricular and intraparenchymal lesions have traditionally been resected via transcortical routes, often requiring the use of retractors to maintain the corridor created to reach the lesion and proceed with a bimanual microsurgical resection. A transparent cylindrical conduit (port) has been developed to resect deep-seated lesions using the endoscope or, more recently, Video Telescopic Operating Microscopy (VTOM) for visualization. We describe the surgical technique of the port technique and discuss the evolution of the concept of intraaxial brain surgery performed through a conduit.
Detailed description of the ventriculoport and brainport technique with illustrative cases.
Results of intraventricular and intraparenchymal port surgery have been published and document the feasibility and safety of this technique. Over the years, the technique has been improved. The port technique offers numerous potential advantages, including: 1) minimizing white matter disruption as the tip design minimizes the risk of fascicles injury during cannulation; 2) ensuring stability as the rigidity prevents inadvertent expansion of the initial diameter of the corticectomy and white fiber tract dissection throughout surgery; 3) protecting the surrounding tissues against iatrogenic injuries caused by instrument entry and reentry; 4) affording constant visualization of the tissue traversed given the transparent conduit design; 5) enabling homogeneous radial dispersion of the pressure on the surrounding tissue to minimize injury.
The port technique is an option for resection of intraventricular and intraparenchymal lesions. Additional studies are required to assess its impact on adjacent cerebral tissue morphology, blood flow, and metabolism. Quality-of-life assessments are also needed. High-definition fiber tracking, new visualization techniques (VTOM), and new instrumentation will add to the progress of endoscopic port surgery. We have already seen a significant evolution of the technology even since the preparation of this article.
传统上，通过皮质切开术切除深部脑室和脑实质内病变，通常需要使用牵开器来维持到达病变部位并进行双手显微切除术的通道。已经开发出一种透明的圆柱形导管（端口），以便使用内窥镜或最近的视频遥控手术显微镜（VTOM）进行可视化，切除深部病变。我们描述了端口技术的手术技术，并讨论了通过导管进行轴内脑手术概念的演变。
详细描述脑室端口和脑端口技术，并附有说明性病例。
脑室和脑内端口手术的结果已经发表，并证明了该技术的可行性和安全性。多年来，该技术得到了改进。端口技术具有许多潜在的优势，包括：1）最大限度地减少白质破坏，因为尖端设计最大限度地减少了在套管插入过程中纤维束损伤的风险；2）确保稳定性，因为刚性防止在整个手术过程中皮质切开术和白质纤维束解剖的初始直径意外扩张；3）保护周围组织免受器械进入和重新进入引起的医源性损伤；4）由于透明导管设计，始终可以观察到所经过的组织；5）使周围组织上的压力均匀径向分散，以最大限度地减少损伤。
端口技术是切除脑室和脑实质内病变的一种选择。需要进一步研究来评估其对邻近脑组织结构、血流和代谢的影响。还需要进行生活质量评估。高清纤维跟踪、新的可视化技术（VTOM）和新的仪器将为内窥镜端口手术的进展做出贡献。甚至自本文编写以来，我们已经看到该技术的显著发展。
