McLaughlin Nancy, Kelly Daniel F, Prevedello Daniel M, Carrau Ricardo L, Kassam Amin B
Brain Tumor Center and Pituitary Disorder Program, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, United States.
Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, United States.
J Neurol Surg A Cent Eur Neurosurg. 2014 Jan;75(1):42-7. doi: 10.1055/s-0032-1325631. Epub 2012 Oct 12.
Recently, stereotactic-guided removal of intraparenchymal lesions using endoscopic visualization through a brain port has been successfully reported. Although endoneurosurgical tumor resection uses the same principles as those used in microneurosurgery, the ability to control bleeding through the port requires an adapted technique.
We present a patient that underwent a completely endoscopic resection of a vascular brain tumor through a brain port and describe the hemostatic technique.
A 68 year-old female presented with progressive gait difficulties. She had been previously treated for a breast cancer. Magnetic resonance imaging (MRI) showed a right subcortical solitary cerebellar lesion that homogeneously enhanced. The patient underwent an endoscopic brain port removal of a supposed brain metastasis. After port cannulation, the tumor partly delivered itself into the port. Following initial tumor biopsy, active bleeding occurred. Irrigation and application of Surgifoam allowed to control the bleeding. Coagulation with an adapted bipolar and removal of coagulated tissue with the side-cutting aspiration device were sequentially repeated. Once the tumor was resected, the suction served as counter-traction elongating the vessels whereas the bipolar cauterized them over a long segment. Hemostasis was performed circumferentially along the cavity's walls from deep to superficial, benefiting from the endoscope's dynamic properties and magnification. Pathology confirmed intraoperative suspicion of hemangioblastoma.
Removal of vascular tumors is feasible through the brain port, despite a relatively narrow corridor of 11.5 mm. However, specific hemostasis techniques are required and adapted instruments are needed to ensure hemostasis through these small corridors.
最近，已有成功报道通过脑端口进行内镜可视化引导下切除脑实质内病变。尽管神经内镜肿瘤切除术与显微神经外科手术遵循相同的原则，但通过端口控制出血的能力需要采用一种适应性技术。
我们报告了一名通过脑端口接受完全内镜下血管性脑肿瘤切除术的患者，并描述了止血技术。
一名68岁女性，出现进行性步态困难。她曾接受过乳腺癌治疗。磁共振成像（MRI）显示右侧皮质下孤立性小脑病变，呈均匀强化。该患者接受了内镜下脑端口切除疑似脑转移瘤的手术。端口插管后，肿瘤部分自行进入端口。在进行初步肿瘤活检后，出现了活动性出血。通过冲洗并应用 Surgifoam 控制了出血。依次重复使用适配的双极电凝并使用侧切吸引装置清除凝血组织。一旦肿瘤切除，吸引起到反向牵引作用，拉长血管，而双极电凝在长段上对血管进行烧灼。利用内镜的动态特性和放大功能，从深到浅沿腔壁周向进行止血。病理检查证实术中怀疑为血管母细胞瘤。
尽管脑端口的通道相对狭窄，仅11.5毫米，但通过脑端口切除血管性肿瘤是可行的。然而，需要特定的止血技术和适配的器械，以确保通过这些小通道实现止血。
