Choque-Velasquez Joham, Hernesniemi Juha
Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.
International Center for Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China.
Surg Neurol Int. 2018 Dec 24;9:261. doi: 10.4103/sni.sni_356_18. eCollection 2018.
Pineal cysts are benign lesions of the pineal gland without a clear etiology. Currently, different approaches are described to deal with pineal region lesions and particularly with pineal cysts. Although endoscopic procedures are becoming more frequent, some technical advantages of the microsurgical resection still make it the gold standard. Our aim was to demonstrate the efficiency and safety of our microsurgical technique into deep brain territories under the principle "simple, clean, and preserving the normal anatomy." Herein, we present an unedited microneurosurgery of a histologically confirmed large benign pineal cyst.
A patient with antidepressant medication, psychotic attacks, memory problems, and progressively intense headache along the last months underwent sitting praying position and supracerebellar infratentorial paramedian approach. Under high magnification, the pineal region was accessed over the right cerebellar hemisphere. A lateral focused opening of the quadrigeminal cistern and the posterior wall of the pineal cyst were followed by partial aspiration of the cystic content. Small vessels running around the cyst were carefully dissected, and few of those attached to the wall were coagulated and cut. After careful devascularization of the lesion, the cyst was detached and pulled out using soft and continuous traction with a long ring microforceps in the right hand and thumb-controlled suction tube in the left one. The final steps included meticulous attention to any bleeding securing complete hemostasis of the surgical site. The postoperative course was uneventful and the patient improved dramatically with resolution of the headache and progressive reduction of psychiatric medication.
This unedited video offers all detailed aspects that a neurosurgeon as the senior author JH considers essential when performing an efficient and safe pineal cyst surgery.
松果体囊肿是松果体的良性病变，病因尚不明确。目前，针对松果体区病变尤其是松果体囊肿，有多种不同的处理方法。尽管内镜手术越来越频繁，但显微手术切除的一些技术优势仍使其成为金标准。我们的目的是在“简单、干净、保留正常解剖结构”的原则下，证明我们的显微手术技术在深部脑区的有效性和安全性。在此，我们展示一例经组织学证实的大型良性松果体囊肿的未经编辑的显微神经外科手术。
一名患者在过去几个月中服用抗抑郁药物，出现精神发作、记忆问题和逐渐加重的头痛，接受了坐位祈祷位和小脑上幕下旁正中入路手术。在高倍放大下，通过右侧小脑半球进入松果体区。打开四叠体池的外侧聚焦开口并切开松果体囊肿的后壁，随后部分抽吸囊内容物。小心解剖囊肿周围的小血管，对附着在囊壁上的少数血管进行凝固和切断。在仔细使病变去血管化后，用右手的长环显微镊轻柔持续牵拉，左手拇指控制吸引管，将囊肿分离并拔出。最后步骤包括仔细注意任何出血情况，确保手术部位完全止血。术后过程顺利，患者头痛缓解，精神类药物逐渐减量，病情明显改善。
这段未经编辑的视频展示了资深作者JH认为在进行高效安全的松果体囊肿手术时必不可少的所有详细方面。
