Watanabe Tadashi, Sato Taku, Kishida Yugo, Ito Eiji, Ichikawa Masahiro, Sakuma Jun, Nagatani Tetsuya, Saito Kiyoshi
Department of Neurosurgery, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya-shi, Aichi, 466-8650, Japan,
Acta Neurochir (Wien). 2014 Jun;156(6):1145-50. doi: 10.1007/s00701-014-2085-x. Epub 2014 Apr 17.
We describe a new endoscopic technique, the dual-endoscopic method, in which two independent endoscopic systems are simultaneously used in the subtemporal space and intraparenchymal field for patients with pontine cystic tumours. Tumours were successfully removed through a sheath placed in the brainstem via the subtemporal keyhole approach, with safety ensured by the second subtemporal endoscope.
A purely endoscopic subtemporal approach was performed in three cases of pontine cystic tumour, including two low-grade gliomas and a recurrent chordoma. The gliomas showed nodules. Recurrent chordoma consisted of a mucinous component.
Using a keyhole subtemporal approach and a 4.0-mm rigid endoscope with a high-definition camera, a transparent puncture needle containing a 2.7-mm rigid endoscope was inserted into the cyst. The tumour was removed using suction, biopsy forceps, and scissors simultaneously placed with the 2.7-mm endoscope in a transparent sheath.
Since the 4.0-mm endoscope placed in the subtemporal space monitored all procedures of the 2.7-mm endoscope, tumour removal was performed safely without damaging the pons, cranial nerves, or vessels. We safely and successfully removed a cystic pontine tumour using a dual-endoscopic method. This new method ensures the safety of deep-seated endoscopic procedures via a minimally invasive transcranial approach.
我们描述了一种新的内镜技术——双内镜法，该方法在桥脑囊性肿瘤患者的颞下间隙和脑实质内同时使用两个独立的内镜系统。通过颞下锁孔入路将鞘置入脑干，肿瘤经鞘成功切除，第二个颞下内镜确保了手术安全。
对3例桥脑囊性肿瘤患者采用单纯内镜下颞下入路，其中包括2例低级别胶质瘤和1例复发性脊索瘤。胶质瘤表现为结节。复发性脊索瘤含有黏液成分。
采用锁孔颞下入路，使用带有高清摄像头的4.0毫米硬性内镜，将一根装有2.7毫米硬性内镜的透明穿刺针插入囊肿。使用吸引器、活检钳和剪刀与2.7毫米内镜同时置于透明鞘内切除肿瘤。
由于置于颞下间隙的4.0毫米内镜可监测2.7毫米内镜的所有操作，肿瘤切除过程安全，未损伤脑桥、颅神经或血管。我们使用双内镜法安全成功地切除了桥脑囊性肿瘤。这种新方法通过微创经颅入路确保了深部内镜手术的安全性。
