Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
World Neurosurg. 2021 Jul;151:e355-e362. doi: 10.1016/j.wneu.2021.04.044. Epub 2021 Apr 19.
The fence post technique, which involves insertion of catheters as fence posts around a tumor, has been widely used to demarcate the tumor border for maximal resection of intraparenchymal tumors, such as gliomas. However, a standard procedure for fence post insertion has not been established, and there are some limitations. To overcome this problem, a simple microscopic navigation-guided fence post technique was developed. The feasibility and efficacy of this novel technique during glioma surgery were assessed.
The microscopic navigation-guided fence post technique was used in 46 glioma surgeries performed in 42 patients. Intraoperatively, the preplanned trajectory was overlaid on the microscopic surgical field, and the microscope angle was changed until the entry and target points of the trajectory overlapped. A fence post catheter was inserted as planned under microscopic view, and the tumor was resected with fence post guidance. Preoperative tumor characteristics and surgical outcomes were evaluated.
Mean age of patients was 50 years (range, 16-78 years), and 19 (45%) of 42 patients were women. Maximal safe resection was successfully achieved in 45 surgeries (97.8%), which was planned preoperatively with identification of the tumor border with fence posts without adverse effects of brain shift. No surgical complications attributable to fence post insertion occurred.
Clinical experience indicated that the microscopic navigation-guided fence post technique, in which fence posts can be placed without requiring the surgeon to take their eyes off the microscope, is safe and useful in glioma surgery.
fence post 技术（将导管作为 fence post 插入肿瘤周围）已广泛用于标记脑内肿瘤（如胶质瘤）的最大切除边界。然而，尚未建立 fence post 插入的标准程序，并且存在一些局限性。为了解决这个问题，开发了一种简单的显微镜导航引导的 fence post 技术。评估了该新技术在胶质瘤手术中的可行性和疗效。
在 42 名患者的 46 例胶质瘤手术中使用了显微镜导航引导的 fence post 技术。术中，将预定轨迹叠加在显微镜手术视野上，并改变显微镜角度，直到轨迹的进入点和目标点重叠。在显微镜下按计划插入 fence post 导管，并在 fence post 引导下切除肿瘤。评估术前肿瘤特征和手术结果。
患者的平均年龄为 50 岁（范围 16-78 岁），42 名患者中有 19 名（45%）为女性。45 例手术（97.8%）成功实现了最大安全切除，术前通过 fence post 识别肿瘤边界，无脑移位的不良影响。没有因 fence post 插入而发生的手术并发症。
临床经验表明，显微镜导航引导的 fence post 技术安全且有用，在胶质瘤手术中，无需术者将视线从显微镜上移开即可放置 fence post。
