Jean Walter C, Syed Hasan R, Felbaum Daniel, Ryan Joshua E, Anaizi Amjad
Neurosurgery, Medstar Georgetown University Hospital.
Cureus. 2016 Mar 3;8(3):e517. doi: 10.7759/cureus.517.
Traditional skull base techniques utilizing the microscope have allowed surgeons improved safe access to deep-seated lesions. More recent technical advances with the endoscope have allowed improved visibility and access to these previously difficult-to-reach regions. Most current literature emphasizes one technique over the other. We present a unique hybrid-type approach that tackles this not-infrequent surgical dilemma. This hybrid-type surgery resulted in a new technique that is a confluence of both open microsurgery and skull base corridors with an endoscope. Furthermore, a combined ventriculoscope approach adds extended assistance with resection. We detail the utility of this technique. A patient presented with a large suprasellar lesion that was suspicious for a craniopharyngioma. Given improved survival with extent of resection, the goal of surgical intervention was maximal safe resection. The location of the tumor would have involved certain morbidity with deliberate residual if a skull base approach or endoscope-based approach was employed independently. As a result, the patient underwent a hybrid-type operation using a multi-corridor split-surgical team approach for the resection of her tumor. The patient underwent hybrid surgery via a combined open microsurgical craniotomy, endoscopic resection, and a ventriculoscope-assisted approach. The ventriculoscope access allowed for resection of the intraventricular portion of the tumor and guided the extent of resection from the microsurgical corridor. Additionally, from a separate craniotomy, the suprasellar component was resected using both standard skull base and endoscope-assisted techniques. The patient tolerated the procedure well without additional morbidity provided from the multi-corridor hybrid technique. The hybrid surgery resulted in a new multi-modality, split-surgical team approach providing maximal visualization with minimal added morbidity to resect a lesion difficult to access. This hybrid technique may be an effective piece of the surgeon's armamentarium to provide improved patient outcomes.
传统的利用显微镜的颅底手术技术使外科医生能够更安全地接近深部病变。最近内窥镜技术的进步提高了对这些以前难以到达区域的可视性和可达性。目前大多数文献都更强调一种技术。我们提出了一种独特的混合型方法来解决这种并不罕见的手术困境。这种混合型手术产生了一种新技术，它是开放显微手术和带有内窥镜的颅底通道的融合。此外，联合脑室镜方法为切除提供了额外的帮助。我们详细介绍了该技术的实用性。一名患者出现鞍上大病变，怀疑为颅咽管瘤。鉴于切除范围可提高生存率，手术干预的目标是最大程度的安全切除。如果单独采用颅底入路或基于内窥镜的入路，肿瘤的位置会导致一定的并发症，且会有意残留肿瘤。因此，该患者采用多通道分手术团队方法进行混合型手术以切除肿瘤。患者通过联合开放显微手术开颅、内窥镜切除和脑室镜辅助入路接受了混合型手术。脑室镜入路允许切除肿瘤的脑室内部分，并从显微手术通道引导切除范围。此外，通过单独的开颅手术，使用标准颅底技术和内窥镜辅助技术切除鞍上部分。患者对手术耐受良好，多通道混合型技术未带来额外的并发症。混合型手术产生了一种新的多模式、分手术团队方法，以最大程度地提高可视性，同时在切除难以到达的病变时将额外的并发症降至最低。这种混合型技术可能是外科医生武器库中的有效工具，可改善患者的治疗效果。
