Sarris Christina E, Atwal Gursant S, Nakaji Peter
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
Handb Clin Neurol. 2017;143:297-302. doi: 10.1016/B978-0-444-63640-9.00029-1.
Cavernous malformations of the thalamus represent a particularly complex subset of cavernous malformations because of the highly eloquent nature of the involved tissue and their deep location. The decision about whether to operate on any individual lesion depends on the specific location of the lesion within the thalamus, the nature of the patient's symptoms, and the patient's history. When surgery is recommended, the approach must be chosen carefully. Each part of the thalamus is reached by a different surgical approach. These approaches include the orbitozygomatic approach to the anteroinferior thalamus, the anterior interhemispheric transcallosal approach to the medial thalamus, the anterior contralateral interhemispheric transcallosal approach to the lateral thalamus, the posterior interhemispheric transcallosal approach to the posterosuperior thalamus, the parieto-occipital transventricular approach to the lateral posteroinferior thalamus, and the suboccipital supracerebellar infratentorial/transtentorial approach to the medial posteroinferior thalamus. Careful attention to safe entry zones and image guidance can allow safe removal of these lesions when necessary.
丘脑海绵状血管畸形是海绵状血管畸形中特别复杂的一个子集，因为所累及组织功能高度明确且位置较深。对于是否对任何单个病变进行手术的决策取决于病变在丘脑内的具体位置、患者症状的性质以及患者的病史。当建议进行手术时，必须谨慎选择手术入路。丘脑的每个部位都可通过不同的手术入路到达。这些入路包括经眶颧入路至丘脑前下部、经前纵裂胼胝体入路至丘脑内侧、经对侧前纵裂胼胝体入路至丘脑外侧、经后纵裂胼胝体入路至丘脑后上部、经顶枕经脑室入路至丘脑外侧后下部以及经枕下小脑上幕下/经幕入路至丘脑内侧后下部。必要时，仔细关注安全入路区域并采用影像引导可实现这些病变的安全切除。
