Jean Walter C, Singh Ameet
Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Department of Otolaryngology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Oper Neurosurg (Hagerstown). 2020 Aug 1;19(2):E179-E180. doi: 10.1093/ons/opaa017.
This video demonstrates the technique of the "Expanded Endoscopic Endonasal Transtuberculum Approach" and the utility of preoperative planning and surgical rehearsal in virtual reality (VR). VR can be utilized to improve endoscopic skull base surgery in various ways. The patient is a 57-yr-old woman with sudden right abducens palsy. Transcranial surgery has been the gold-standard treatment of the tuberculum sellae meningioma that was found, but for suitable tumors, the endoscopic endonasal approach is equally effective for tumor resection with better visual outcomes.1-4 The three-dimensional, 360°, multicolored VR rendering (Surgical Theater SRP7.4.0, Cleveland, Ohio) of her tuberculum sellae meningioma clearly demonstrated that there was no encasement of the anterior cerebral arteries, the tumor did not extend lateral to the carotid arteries, and the surgical corridor was wide enough for endoscopic endonasal resection. The surgical exposure was then rehearsed with the sphenoidectomy and drilling of the sella floor and tuberculum performed in VR space. The step-by-step process of the endoscopic endonasal transtuberculum resection is demonstrated in the operative video. Surgical planning in VR can be helpful to the early-career endoscopic surgeon. The three-dimensional renderings are quick to set up (15 min), and the examination of the anatomy is useful for choosing the surgical approach. Despite the lack of haptic feedback and tissue response such as vascularity and firmness in the current software, rehearsing the drilling for exposure can improve the efficiency in surgery. Patient consent was obtained prior to the creation of the video and is available on request.
本视频展示了“扩大经鼻内镜经结节入路”技术以及虚拟现实（VR）术前规划和手术预演的实用性。VR可通过多种方式用于改进内镜颅底手术。患者为一名57岁女性，突发右侧展神经麻痹。经颅手术一直是所发现的鞍结节脑膜瘤的金标准治疗方法，但对于合适的肿瘤，经鼻内镜入路在肿瘤切除方面同样有效，且视觉效果更好。1-4 她的鞍结节脑膜瘤的三维、360°、彩色VR渲染图（手术剧场SRP7.4.0，俄亥俄州克利夫兰）清楚地显示，大脑前动脉未被包绕，肿瘤未向颈动脉外侧延伸，手术通道足够宽，可进行经鼻内镜切除。然后在VR空间中进行蝶窦切开术以及鞍底和结节的钻孔，对手术暴露进行预演。手术视频展示了经鼻内镜经结节切除的逐步过程。VR中的手术规划对初涉内镜手术的外科医生可能有帮助。三维渲染图设置快速（15分钟），解剖结构检查有助于选择手术入路。尽管当前软件缺乏触觉反馈以及诸如血管分布和硬度等组织反应，但预演钻孔以暴露手术部位可提高手术效率。在制作视频之前已获得患者同意，如有需要可提供。
