Sánchez Jose Juan González, Rincon-Torroella Jordina, Prats-Galino Alberto, de Notaris Matteo, Berenguer Joan, Rodríguez Enrique Ferrer, Benet Arnau
Departments of Neurosurgery and.
J Neurosurg. 2014 Sep;121(3):751-9. doi: 10.3171/2014.5.JNS132309. Epub 2014 Jul 4.
The temporal horn of the lateral ventricle is a complex structure affected by specific pathological conditions. Current approaches to the temporal horn involve a certain amount of corticotomy and white matter disruption. Surgeons therefore set aside anterior temporal lobectomy as a last resource and avoid it in the dominant hemisphere. The authors propose a minimally invasive endoscopic intraventricular approach to the temporal horn and describe a standardized analysis and technical assessment of the feasibility of this approach.
To determine the best trajectory, angulation, and entry point to the temporal horn of the lateral ventricle, the authors evaluated 50 cranial MRI studies (100 temporal lobes) from healthy patients. They studied and systematized the neurosurgical endoscopic anatomy. They also simulated the proposed approach in 9 cadaveric specimens (18 approaches).
Mean scalp entry point coordinates (± SD) were 2.7 ± 0.28 cm lateral to the inion and 5.6 ± 0.41 cm superior to the inion. The mean total distance from the uncal recess to the scalp (± SD) was 10.64 ± 0.6 cm. The mean total intraparenchymal distance crossed by the endoscope was 3.76 ± 0.36 cm. The approach was successfully completed in all studied specimens.
In this study, the endoscopic intraventricular approach to the temporal horn is standardized. The morphometric analysis makes this approach anatomically feasible and replicable. This approach provides minimally invasive endoscopic access to the uncal recess, amygdala, hippocampus, fornix, and paraventricular temporal lobe structures. The following essential strategies enabled access to and maneuverability inside the temporal horn: tailored preoperative planning of the trajectory and use of anatomical and radiological references, constant irrigation, and an angled endoscopic lens. Safety assessment and novel instruments and techniques may be proposed to advance this very promising route to pathological changes in the temporal lobe.
侧脑室颞角是一个受特定病理状况影响的复杂结构。目前针对颞角的手术方法会涉及一定程度的皮质切开和白质破坏。因此，外科医生将前颞叶切除术作为最后的手段，并且在优势半球避免使用该方法。作者提出一种微创内镜经脑室入路至颞角的方法，并描述了该方法可行性的标准化分析和技术评估。
为确定进入侧脑室颞角的最佳轨迹、角度和入点，作者评估了50例健康患者的头颅MRI研究（100个颞叶）。他们研究并系统化了神经外科内镜解剖结构。他们还在9个尸体标本上模拟了所提出的入路（18次入路）。
平均头皮入点坐标（±标准差）为枕外隆凸外侧2.7±0.28cm，枕外隆凸上方5.6±0.41cm。从钩回隐窝到头皮的平均总距离（±标准差）为10.64±0.6cm。内镜穿过的平均脑实质内总距离为3.76±0.36cm。在所研究的所有标本中该入路均成功完成。
在本研究中，内镜经脑室入路至颞角是标准化的。形态学分析使该入路在解剖学上可行且可重复。该入路提供了微创内镜进入钩回隐窝、杏仁核、海马、穹窿和颞叶脑室旁结构的途径。以下关键策略实现了进入颞角并在其中进行操作：根据具体情况术前规划轨迹并使用解剖学和影像学参考，持续冲洗，以及使用有角度的内镜镜头。可提出安全性评估以及新颖的器械和技术，以推进这条极有前景的针对颞叶病变的手术路径。
