Eichberg Daniel G, Sedighim Shaina, Buttrick Simon, Komotar Ricardo J
Neurological Surgery, Univeresity of Miami Miller School of Medicine.
Neurological Surgery, University of Miami Miller School of Medicine.
Cureus. 2018 Jan 26;10(1):e2115. doi: 10.7759/cureus.2115.
When deciding on a surgical route to reach subcortical brain tumors and colloid cysts, many surgeons advocate the use of transcallosal, transsulcal, or skull base approaches over transcortical approaches due to a high reported incidence of postoperative seizures. We have retrospectively analyzed all patients operated upon by a senior neurosurgeon (Ricardo J. Komotar) who undertook transcortical approaches for the resection of subcortical brain tumors and colloid cysts. We have also performed a comprehensive review of the literature to estimate postoperative seizure risk after transcortical approaches for the resection of deep tumors and colloid cysts. Of 27 patients who underwent transcortical approaches for the resection of subcortical brain tumors and colloid cysts, zero had postoperative seizures. A comprehensive review of the literature shows an 8.3% postoperative risk of seizures after the transcortical approach. Our institution has never experienced a postoperative seizure following the transcortical approach for the resection of deep tumors and colloid cysts. For this reason, we advocate selecting a surgical approach that obtains adequate lesion exposure and minimizes the violation and retraction of eloquent cortex, venous structures, and white matter tracts, rather than on presumed postoperative seizure risk.
在决定采用何种手术路径来切除皮质下脑肿瘤和胶样囊肿时，由于术后癫痫发作的报道发生率较高，许多外科医生主张采用经胼胝体、经脑沟或颅底入路，而非经皮质入路。我们回顾性分析了一位资深神经外科医生（里卡多·J·科莫塔尔）采用经皮质入路切除皮质下脑肿瘤和胶样囊肿的所有患者。我们还对文献进行了全面综述，以评估经皮质入路切除深部肿瘤和胶样囊肿后的术后癫痫风险。在27例采用经皮质入路切除皮质下脑肿瘤和胶样囊肿的患者中，无一例出现术后癫痫发作。对文献的全面综述显示，经皮质入路术后癫痫发作风险为8.3%。我们机构在采用经皮质入路切除深部肿瘤和胶样囊肿后从未发生过术后癫痫发作。因此，我们主张选择一种能获得充分病变暴露并将对明确皮质、静脉结构和白质束的侵犯及牵拉降至最低的手术入路，而不是基于假定的术后癫痫风险。
