de Oliveira Ricardo Santos, Viana Dinark Conceição, Augusto Lucas Pires, Santos Marcelo Volpon, Machado Hélio Rubens
Division of Pediatric Neurosurgery of the Department of Surgery and Anatomy, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, Brazil.
Childs Nerv Syst. 2018 Mar;34(3):547-553. doi: 10.1007/s00381-017-3615-7. Epub 2017 Oct 16.
Craniopharyngiomas can be a surgical challenge for the pediatric neurosurgeon. Ideally, total removal must be achieved. However, the need to reduce surgical morbidity and preserve quality of life has led to a number of neurosurgical approaches in order to attain this goal. The aim of this article is to present an alternative surgical approach to these lesions and to provide the rationale for this technique.
Medical charts and operative records of eight pediatric patients harboring craniopharyngiomas who underwent surgical treatment using a supraorbital eyebrow approach (SOA) were reviewed from 2014 to 2016. Only patients younger than 18 years with a minimum follow-up of 12 months were included in this study. Using pre-operative magnetic resonance (MRI) scans, tumors were classified according to their degree of hypothalamic involvement. The surgical technique is also described in detail.
The study group included six males and two females with a mean age of 10 years (range, 2-16 years). The SOA was used successfully in elective surgery of eight craniopharyngiomas. The hypothalamus was displaced by the tumor in three patients and severely involved in five patients. Subtotal resection was undertaken in six patients, whereas gross-total resection was achieved in two. Endoscopic assistance was used after standard microscopic visualization in two out of eight cases. Cosmetic outcomes were excellent, and the complication rate related to the surgical procedure was quite low, apart from diabetes insipidus (which occurred in three out of the eight patients). In one patient, a large subdural collection needed surgery for evacuation. Mean follow-up was 23.2 months (range, 12-36 months). Additionally, no CSF leak or wound infection was identified.
The supraorbital eyebrow approach is an alternative route to operate on craniopharyngiomas in properly selected cases of all pediatric age ranges, from infants to teenagers. There is sufficient working space for the endoscope and all instruments, allowing for endoscopic assistance and bimanual surgical technique. Cosmetic results are excellent, and complications related to the approach are minimal.
颅咽管瘤对小儿神经外科医生来说是一项手术挑战。理想情况下，必须实现全切。然而，为了降低手术发病率并保留生活质量，已出现多种神经外科手术方法来实现这一目标。本文旨在介绍针对这些病变的另一种手术方法，并阐述该技术的理论依据。
回顾了2014年至2016年期间8例患有颅咽管瘤的小儿患者的病历和手术记录，这些患者采用眶上眉弓入路（SOA）进行了手术治疗。本研究仅纳入年龄小于18岁且随访至少12个月的患者。利用术前磁共振成像（MRI）扫描，根据肿瘤对下丘脑的累及程度对肿瘤进行分类。同时详细描述了手术技术。
研究组包括6名男性和2名女性，平均年龄为10岁（范围2 - 16岁）。SOA成功应用于8例颅咽管瘤的择期手术。3例患者的下丘脑被肿瘤推移，5例患者下丘脑严重受累。6例患者进行了次全切除，2例实现了全切。8例中有2例在标准显微镜观察后使用了内镜辅助。美容效果极佳，除尿崩症（8例患者中有3例发生）外，与手术相关的并发症发生率相当低。1例患者出现大量硬膜下积液，需要手术引流。平均随访时间为23.2个月（范围12 - 36个月）。此外，未发现脑脊液漏或伤口感染。
眶上眉弓入路是在所有小儿年龄范围（从婴儿到青少年）经适当选择的病例中用于颅咽管瘤手术的另一种途径。为内镜和所有器械提供了足够的操作空间，允许进行内镜辅助和双手操作手术技术。美容效果极佳，与该入路相关的并发症极少。
