Department of Neurosurgery, Aurora St. Luke's Medical Center, Aurora Neuroscience Innovation Institute, 2801 W Kinnickinnic River Pkwy #680, Milwaukee, WI, 53215, USA.
Neuroanatomy Lab. Advocate - Aurora Research Institute, Milwaukee, WI, USA.
Neurosurg Rev. 2021 Jun;44(3):1611-1624. doi: 10.1007/s10143-020-01349-5. Epub 2020 Jul 18.
The minimally invasive port-based trans-sulcal parafascicular surgical corridor (TPSC) has incrementally evolved to provide a safe, feasible, and effective alternative to access subcortical and intraventricular pathologies. A detailed anatomical foundation is important in mitigating cortical and white matter tract injury with this corridor. Thus, the aims of this study are (1) to provide a detailed anatomical construct and overview of TPSCs and (2) to translate an anatomical framework to early clinical experience. Based on regional anatomical constraints, suitable parafascicular entry points were identified and described. Fiber tracts at both minimal and increased risks for each corridor were analyzed. TPSC-managed cases for metastatic or primary brain tumors were retrospectively reviewed. Adult patients 18 years or older with Karnofsky Performance Status (KPS) ≥ 70 were included. Subcortical brain metastases between 2 and 6 cm or primary brain tumors between 2 and 5 cm were included. Patient-specific corridors and trajectories were determined using MRI-tractography. Anatomy: The following TPSCs were described and translated to clinical practice: superior frontal, inferior frontal, inferior temporal, intraparietal, and postcentral sulci. Clinical: Eleven patients (5 males, 6 females) were included (mean age = 52 years). Seven tumors were metastatic, and 4 were primary. Gross total, near total, and subtotal resection was achieved in 7, 3, and 1 patient(s), respectively. Three patients developed intraoperative complications; all recovered from their intraoperative deficits and returned to baseline in 30 days. A detailed TPSC anatomical framework is critical in conducting safe and effective port-based surgical access. This review may represent one of the few early translational TPSC studies bridging anatomical data to clinical subcortical and intraventricular surgical practice.
经皮微创端口基经沟旁手术入路(TPSC)逐渐发展成为一种安全、可行且有效的替代方法,可用于治疗皮质下和脑室病变。该入路具有详细的解剖学基础,可减少皮质和白质束损伤。因此,本研究的目的是:(1)提供 TPSC 的详细解剖结构和概述;(2)将解剖学框架转化为早期临床经验。基于区域解剖学限制,确定并描述了合适的沟旁进入点。分析了每个通道的最小和最大风险纤维束。回顾性分析了经 TPSC 治疗的转移性或原发性脑肿瘤病例。纳入标准为:年龄 18 岁或以上,Karnofsky 表现状态(KPS)≥70 的成年患者;肿瘤最大直径 2-6cm 的皮质下脑转移瘤或最大直径 2-5cm 的原发性脑肿瘤。使用 MRI 纤维束追踪技术确定患者特定的通道和轨迹。解剖学:描述并将以下 TPSC 转化为临床实践:额上沟、额下沟、颞下回、顶内沟和中央后沟。临床:共纳入 11 例患者(男 5 例,女 6 例)(平均年龄 52 岁)。7 例肿瘤为转移性,4 例为原发性。7 例患者行肿瘤全切除、近全切除和次全切除,3 例患者术中发生并发症,所有患者的术中神经功能缺损均恢复,30 天内恢复至基线水平。详细的 TPSC 解剖学框架对于进行安全有效的端口基手术入路至关重要。本综述可能是为数不多的将解剖学数据转化为皮质下和脑室手术临床实践的早期 TPSC 研究之一。