Sayyahmelli Sima, Ruan Jian, Avci Emel, Başkaya Mustafa K
Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.
Oper Neurosurg (Hagerstown). 2021 Mar 15;20(4):E304-E305. doi: 10.1093/ons/opaa411.
Tectal gliomas are a rare subset of intrinsic brainstem lesions. The microsurgical resection of these lesions remains a major challenge.1,2 Transcollicular approaches on one side, via the superior or inferior colliculi or both, are neurologically well tolerated without obvious or major auditory or oculomotor consequences. However, any postoperative acute visually triggered saccadic abnormalities caused by iatrogenic superior colliculus damage generally resolve during the postoperative period, as other oculomotor structures compensate for these functions in unilateral lesions. In this surgical video, we present a 37-yr-old man with long-standing seizures, new onset headaches, progressive ataxic gait, and imbalance. Magnetic resonance imaging (MRI) showed a circumscribed nonenhancing dorsal midbrain cystic mass with compression on the aqueduct causing hydrocephalus. The lesion had a low signal intensity on T1-weighted images and a high signal intensity on T2-weighted images. The patient first underwent an endoscopic third ventriculostomy. Although his headaches greatly improved after the third ventriculostomy, he remained quite symptomatic in terms of gait imbalance and ataxia. The patient underwent a supracerebellar, infratentorial, transcollicular approach for resection of the tectal tumor. Simultaneously, motor and somatosensory evoked potentials were monitored. Both the surgery and the postoperative course were uneventful, with postoperative MRI showing gross total resection of the mass, and histopathology indicating a WHO (World Health Organization) grade I pilocytic astrocytoma. The patient continued to do well without recurrence at 2-yr follow-up. In this video, we demonstrate step-by-step microsurgical techniques for resecting these challenging tectal gliomas via the infratentorial-supracerebellar-transcollicular approach. The patient consented to the procedure and publication of his images.
顶盖胶质瘤是脑干原发性病变中的一个罕见亚型。对这些病变进行显微手术切除仍然是一项重大挑战。1,2 经一侧上丘或下丘或两者的经丘方法在神经学上耐受性良好，不会产生明显或严重的听觉或动眼神经后果。然而，由医源性上丘损伤引起的任何术后急性视觉触发的扫视异常通常在术后期间会得到缓解，因为在单侧病变中其他动眼神经结构会代偿这些功能。在本手术视频中，我们展示了一名37岁男性，他有长期癫痫发作、新发头痛、进行性共济失调步态和平衡障碍。磁共振成像（MRI）显示一个边界清晰的中脑背侧囊性肿块，压迫导水管导致脑积水。该病变在T1加权图像上呈低信号强度，在T2加权图像上呈高信号强度。患者首先接受了内镜下第三脑室造瘘术。尽管第三脑室造瘘术后他的头痛有了很大改善，但他在步态失衡和共济失调方面仍有相当明显的症状。患者接受了经小脑上、幕下、经丘入路切除顶盖肿瘤。同时，监测运动和体感诱发电位。手术和术后过程均顺利，术后MRI显示肿块全切，组织病理学显示为世界卫生组织（WHO）I级毛细胞型星形细胞瘤。在2年的随访中，患者持续情况良好，无复发。在本视频中，我们展示了通过幕下-小脑上-经丘入路切除这些具有挑战性的顶盖胶质瘤的分步显微手术技术。患者同意进行该手术并同意公布其图像。
