Labidi Moujahed, Watanabe Kentaro, Loit Marie-Pier, Hanakita Shunya, Froelich Sébastien
Department of Neurosurgery, Hôpital Lariboisière, Paris, France.
Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
J Neurol Surg B Skull Base. 2018 Feb;79(2):S205-S207. doi: 10.1055/s-0037-1620252. Epub 2018 Jan 16.
To discuss the use of the posterior petrosal approach for the resection of a retrochiasmatic craniopharyngioma. Operative video. In this case video, the authors discuss the surgical management of a large craniopharyngioma, presenting with mass effect on the third ventricle and optic apparatus. A first surgical stage, through an endoscopic endonasal transtubercular approach, allowed satisfactory decompression of the optic chiasma and nerves in preparation for adjuvant therapy. However, accelerated growth of the tumor, with renewed visual deficits and mass effect on the hypothalamus and third ventricle, warranted a supplementary resection. A posterior transpetrosal 1 2 (also called "retrolabyrinthine transtentorial") was performed to obtain a better exposure of the tumor and the surrounding anatomy (floor and walls of the third ventricle, perforating vessels, optic nerves, etc.) 3 . Nuances of technique and surgical pearls related to the posterior transpetrosal are discussed and illustrated in this operative video, including the posterior mobilization of the transverse-sigmoid sinuses junction, preservation of the venous anatomy during the tentorial incision, identification and preservation of the floor of the third ventricle during tumor resection, and a careful multilayer closure. Retrochiasmatic craniopharyngiomas are difficult to reach tumors that often require skull base approaches, either endoscopic endonasal or transcranial. The posterior transpetrosal approach is an important part of the surgical armamentarium to safely resect these complex tumors. The link to the video can be found at: https://youtu.be/2MyGLJ_v1kI .
讨论经岩骨后入路切除视交叉后颅咽管瘤的应用。手术视频。在本病例视频中，作者讨论了一例大型颅咽管瘤的手术治疗，该肿瘤对视神经和第三脑室产生占位效应。第一阶段手术通过鼻内镜经结节入路，对视交叉和神经进行了满意的减压，为辅助治疗做准备。然而，肿瘤加速生长，再次出现视力缺损以及对下丘脑和第三脑室产生占位效应，因此需要进行补充切除。采用经岩骨后入路（也称为“迷路后经小脑幕入路”）以更好地暴露肿瘤及其周围解剖结构（第三脑室底面和壁、穿支血管、视神经等）。本手术视频讨论并展示了与经岩骨后入路相关的技术细节和手术技巧，包括横窦 - 乙状窦交界处的后移、小脑幕切开时静脉解剖结构的保留、肿瘤切除过程中第三脑室底面的识别和保留以及仔细的多层缝合。视交叉后颅咽管瘤是难以触及的肿瘤，通常需要采用颅底入路，如鼻内镜经鼻入路或经颅入路。经岩骨后入路是安全切除这些复杂肿瘤的重要手术方法之一。视频链接：https://youtu.be/2MyGLJ_v1kI 。
