Pediatric Division of Neurosurgery, University of California at San Diego, San Diego, California, USA.
Pediatric Division of Neurosurgery, University of California at San Diego, San Diego, California, USA.
World Neurosurg. 2020 Nov;143:83. doi: 10.1016/j.wneu.2020.06.243. Epub 2020 Jul 9.
Brainstem tumors represent formidable lesions for neurosurgical intervention. They should be approached with a thorough understanding of the anatomy and clear sense of surgical goals. A 14-year-old previously healthy girl presented with 2 weeks of nausea, headaches, diplopia, and gait instability. Workup revealed a 3.5 x 2.5 x 2.5 cm contrast-enhancing mass within the right midbrain. The patient consented to the surgical procedure. Preoperative imaging demonstrated superior displacement of the deep venous system because of the tumor, as well as inferior displacement of the fourth cranial nerve exit zone and posterior bowing of the entire tectal region. This allowed a safe corridor from a supracerebellar infratentorial approach. The three quarters lateral position was chosen to optimize surgeon ergonomics and allow for gravity to drain blood from the operative field. Near total resection was obtained without any new neurologic deficit. Final pathology was consistent with pilocytic astrocytoma, World Health Organization grade I. The video demonstrates the surgical approach in addition to techniques for brainstem tumor resection (Video 1).
脑干肿瘤是神经外科干预的棘手病变。在进行手术时，需要充分了解解剖结构，并明确手术目标。一名 14 岁的既往健康女孩因恶心、头痛、复视和步态不稳就诊，病史为 2 周。检查发现右侧中脑有一个 3.5x2.5x2.5cm 的增强肿块。患者同意进行手术。术前影像学显示由于肿瘤导致深部静脉系统向上移位，第四颅神经出口区向下移位，整个顶盖区向后弯曲。这为小脑幕上经小脑幕下入路提供了一个安全的通道。选择侧卧位以优化术者手术操作的舒适度，让重力将血液从手术区域排出。在不造成新的神经功能缺损的情况下，实现了近乎全切除。最终的病理结果与毛细胞型星形细胞瘤，世界卫生组织分级 I 级一致。该视频除了展示脑干肿瘤切除术的技术外，还展示了手术入路（视频 1）。
