Donofrio Carmine A, Riccio Lucia, Capitanio Jody F, Herur-Raman Aalap, Panni Pietro, Gagliardi Filippo, Caputy Anthony J, Mortini Pietro
Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy -
Department of Neurosurgery, Manchester Center for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK -
J Neurosurg Sci. 2023 Apr;67(2):175-184. doi: 10.23736/S0390-5616.20.05122-X. Epub 2020 Sep 28.
Surgical approaches to the third ventricle (TV) have always represented a technical challenge in neurosurgery. Virtual reality (VR) is attaining increasing relevance in training programs and preoperative planning. The aim of this study is to demonstrate the worthwhile mutual contribution of VR simulations and specimen dissections to develop a new surgical approach to the TV.
The transcortical endoportal subchoroidal endoscope assisted (TEPSEA) approach was planned and simulated thanks to VR (Surgical Theater, LLC, Cleveland, OH, USA), and then implemented on cadaver specimens by using the VBAS portal system (Viewsite™ Brain Access System TC Model, Vycor Medical™ Inc., Boca Raton, FL, USA). We assessed anthropometric measurements during VR planning and evaluated surgical operability during anatomical dissections.
Surgical field depths measured between 75.6 and 85.3 mm to mammillary bodies and habenular commissure, which were in mean 20.2 mm away. An 18-mm movement was estimated for 15°-posterior tilting of a 70-mm long VBAS. Excellent exposure and maneuverability were achieved within the TV through a 2.47 cm portal working area. The 30°-endoscope assistance expanded the access towards the anterior and posterior walls of the TV particularly to the infundibular recess, mammillary bodies, habenular commissure and pineal recess.
We documented the utility of a step-by-step VR planning and simulation followed by anatomical dissections to study surgical approaches to deep brain areas. The TEPSEA exploits the portal system and endoscopic assistance to access the entire TV minimizing cortical and white matter manipulation.
第三脑室（TV）的手术入路一直是神经外科的一项技术挑战。虚拟现实（VR）在培训项目和术前规划中的重要性日益增加。本研究的目的是证明VR模拟和标本解剖在开发一种新的TV手术入路方面的相互贡献是值得的。
借助VR（美国俄亥俄州克利夫兰市Surgical Theater有限责任公司）规划并模拟经皮质内镜下脉络膜下辅助（TEPSEA）入路，然后使用VBAS门控系统（美国佛罗里达州博卡拉顿市Vycor Medical公司的Viewsite™脑接入系统TC模型）在尸体标本上实施该入路。我们在VR规划期间评估人体测量数据，并在解剖过程中评估手术可操作性。
到乳头体和缰连合的手术视野深度在75.6至85.3毫米之间，平均距离为20.2毫米。估计一个70毫米长的VBAS向后倾斜15°时移动18毫米。通过一个2.47厘米的门控工作区域，在第三脑室内实现了极佳的暴露和可操作性。30°内镜辅助扩大了进入第三脑室前壁和后壁的通道，特别是进入漏斗隐窝、乳头体、缰连合和松果体隐窝。
我们记录了通过逐步的VR规划和模拟，随后进行解剖来研究深部脑区手术入路的实用性。TEPSEA利用门控系统和内镜辅助进入整个第三脑室，最大限度地减少皮质和白质的操作。
