Montaser Alaa S, Revuelta Barbero Juan M, Shahein Mostafa, Todeschini Alexandre B, Otto Bradley A, Carrau Ricardo L, Prevedello Daniel M
Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, United States.
Department of Neurological Surgery, Ain Shams University Faculty of Medicine, Cairo, Egypt.
J Neurol Surg B Skull Base. 2018 Apr;79(Suppl 3):S279-S280. doi: 10.1055/s-0038-1624590. Epub 2018 Feb 19.
A 49-year-old female presented with intense headaches of 3 months duration. Brain magnetic resonance imaging (MRI) was performed and showed a sellar-suprasellar lesion extending into the third ventricle. A presumptive diagnosis of a craniopharyngioma was made. Since the patient did not have any visual deficits, she opted for conservative management. Four months later, she started to have progressive deterioration of vision; thus, surgery was indicated. The patient underwent endoscopic endonasal resection of the lesion through a transtuberculum sellae approach. The patient was positioned supine with the head slightly extended and the face turned to the right side. Following the essence of a binostril four-hand technique, a total gross resection of the lesion was achieved and multilayer skull base reconstruction was performed utilizing collagen matrix and nasoseptal flap; with no intraoperative complications. The patient's postoperative course was uneventful with the improvement in her vision, and she was discharged on postoperative day 4 with no new neurological deficits. Histopathological examination confirmed the diagnosis of an epidermoid cyst. Postoperative pituitary gland function was within normal limits except for mild diabetes insipidus for which she is on DDAVP 0.1 mg twice daily. At 4 years follow-up, the patient was doing well, her vision was normalized, and brain MRI revealed no evidence of residual or recurrent lesion. The link to the video can be found at: https://youtu.be/OqDFpa_Xq78 .
一名49岁女性出现持续3个月的剧烈头痛。进行了脑部磁共振成像（MRI）检查，显示鞍区-鞍上病变延伸至第三脑室。初步诊断为颅咽管瘤。由于患者没有任何视觉缺陷，她选择了保守治疗。4个月后，她开始出现视力进行性恶化；因此，建议进行手术。患者通过经蝶鞍结节入路接受了内镜下经鼻病变切除术。患者仰卧位，头部略伸展，面部转向右侧。按照双侧鼻孔四手操作技术的要点，实现了病变的全切除，并使用胶原基质和鼻中隔瓣进行了多层颅底重建；术中无并发症。患者术后恢复顺利，视力改善，术后第4天出院，无新的神经功能缺损。组织病理学检查确诊为表皮样囊肿。术后垂体功能除轻度尿崩症外均在正常范围内，她每天服用两次0.1毫克的去氨加压素。在4年的随访中，患者情况良好，视力恢复正常，脑部MRI显示无残留或复发病变迹象。视频链接可在：https://youtu.be/OqDFpa_Xq78 找到。
