Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
Department of Neuropathology Klinikum rechts der Isar Institute of Pathology School of Medicine, Technical University Munich, Munich, Germany.
Neurosurg Rev. 2021 Aug;44(4):2099-2110. doi: 10.1007/s10143-020-01372-6. Epub 2020 Aug 27.
Exposure of the anterior skull base is challenging due to strategic structures. The interhemispheric approach (IHA) has turned out to be a feasible technique. We report our experience with IHAs in patients with extraaxial lesions (EAL). We performed a retrospective chart review at a tertiary neurosurgical center between April 2009 and March 2020. We included patients with resection of EAL through IHAs concentrating on surgical technique, complete resection rate, postoperative outcome, and complications. Seventy-four patients resected by an IHA were included: 49 (66.2%) frontal (FIA), nine (12.1%) parietooccipital (PIA), and 16 (21.6%) frontobasal IHAs (FBIAs). Median age at time of surgery was 59 years (range 16-88 years), 47 (63.5%) female and 27 (36.5%) male. Complete resection rate was 83.8% (FIA 89.8%, PIA 55.6%, FBIA 81.3%). Rate of new minor deficits was 17.6%, rate of major deficits 5.4%, total rate 23.0%. 51 (68.9%) WHO°I meningiomas, ten (13.5%) WHO°II meningiomas, two (2.7%) WHO°III meningiomas, nine (12.2%) metastases, one (1.4%) sarcoma, and one (1.4%) local adenocarcinoma were resected. Total complication rate was 27.0%. Rate of major complications requiring intervention was 9.6%. Mean follow-up was 34.2 (± 33.2) months. In patients with lesions of the interhemispheric fissure, overall morbidity and complications are comparatively high. Extensions of IHAs with potential even higher morbidity are not necessary though; we support the use of standardized IHAs. Our findings suggest regular usage of relatively feasible IHAs for a satisfying outcome. Invasive, complicated, or contralateral trajectories were not needed.
由于战略结构的原因，前颅底的暴露具有挑战性。 半球间入路（IHA）已被证明是一种可行的技术。 我们报告了在轴外病变（EAL）患者中进行 IHA 的经验。 在 2009 年 4 月至 2020 年 3 月期间，我们在一家三级神经外科中心进行了回顾性图表审查。 我们纳入了通过 IHA 切除 EAL 的患者，重点关注手术技术、完全切除率、术后结果和并发症。 通过 IHA 切除的 74 例患者包括：49 例（66.2%）额（FIA）、9 例（12.1%）顶枕（PIA）和 16 例（21.6%）额基底 IHA（FBIAs）。 手术时的中位年龄为 59 岁（范围 16-88 岁），47 例（63.5%）为女性，27 例（36.5%）为男性。 完全切除率为 83.8%（FIA 89.8%，PIA 55.6%，FBIAs 81.3%）。 新发小缺陷发生率为 17.6%，大缺陷发生率为 5.4%，总发生率为 23.0%。 切除了 51 例（68.9%）WHO°I 脑膜瘤、10 例（13.5%）WHO°II 脑膜瘤、2 例（2.7%）WHO°III 脑膜瘤、9 例（12.2%）转移瘤、1 例（1.4%）肉瘤和 1 例（1.4%）局部腺癌。 总并发症发生率为 27.0%。 需要干预的严重并发症发生率为 9.6%。 平均随访 34.2（±33.2）个月。 在存在半球间裂病变的患者中，总体发病率和并发症相对较高。 不过，不需要扩展具有潜在更高发病率的 IHA；我们支持使用标准化的 IHA。 我们的研究结果表明，常规使用相对可行的 IHA 可以获得满意的结果。 不需要进行侵袭性、复杂或对侧的手术路径。
