Erkmen Kadir, Aboud Emad, Al-Mefty Ossama
Department of Neurosurgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
Arkansas Neuroscience Institute, Little Rock, Arkansas, USA.
Oper Neurosurg. 2021 May 13;20(6):E420-E421. doi: 10.1093/ons/opab045.
Microsurgical resection of craniopharyngiomas poses significant challenges, which are amplified with tumors in the retrochiasmatic location and larger size. Traditional pterional trans-sylvian, subfrontal translamia terminalis, or interhemispheric approaches provide narrow surgical corridors with obstructed visualization of the tumor by the prefixed chiasm and slit optic carotid window.1-5 The superior extension of the tumor compressing the hypothalamus and third ventricle are likewise inaccessible. Dissection through these approaches requires crossing and manipulation of the already compromised optic apparatus with surgical instruments. Finally, the basilar artery and its perforating branches are often adherent to the posterior aspect of the tumor, and are invisible. Endonasal endoscopic techniques have been utilized as a surgical approach that accesses the tumor without crossing the optic apparatus; however, these approaches have a significant risk of cerebrospinal fluid leakage and require dissection of the basilar artery and hypothalamus from long distances with lengthy instruments.6-9 Frequently, the surgeon achieves only partial removal. The petrosal approach is ideal for tumors in the retrochiasmatic location.10-13 Advantages include unhindered access to the retrochiasmatic space without crossing the optic nerve and chiasm. The angle of approach allows visualization superiorly to the hypothalamus. Additionally, the approach shortens the distance to the tumor, allowing for delicate bimanual dissection of the tumor, especially at the basilar artery and hypothalamic interfaces. This video demonstrates three cases of retrochiasmatic craniopharyngioma resection through the petrosal approach, highlighting these advantages to optimize patient outcome. The patients and guardians consented for the surgery, photography, and publication of the patient's image. Figures from Al-Mefty et al11 used with permission from the Journal of Neurosurgery Publishing Group. Additional figures republished from Al-Mefty et al.12 "The petrosal approach for the resection of retrochiasmatic craniopharyngiomas," Neurosurgery, 2008, volume 62, issue 5 Suppl 2 (ONS), ONS331-ONS336, by permission of the Congress of Neurological Surgeons.
颅咽管瘤的显微手术切除面临重大挑战，当肿瘤位于视交叉后方且体积较大时，这些挑战会进一步加剧。传统的翼点经侧裂、额下经终板或经半球间入路提供的手术通道狭窄，视交叉前置和视神经颈动脉间隙狭窄会阻碍对肿瘤的观察。1-5肿瘤向上延伸压迫下丘脑和第三脑室同样难以触及。通过这些入路进行解剖需要用手术器械穿过并操作已经受损的视器。最后，基底动脉及其穿支常常粘连在肿瘤后方，无法看见。鼻内镜技术已被用作一种不穿过视器就能到达肿瘤的手术入路；然而，这些入路有脑脊液漏的重大风险，并且需要用长器械从远距离对基底动脉和下丘脑进行解剖。6-9通常，外科医生只能实现部分切除。岩骨入路对于视交叉后方的肿瘤是理想的。10-13其优点包括能够无障碍地进入视交叉后方间隙，而无需穿过视神经和视交叉。入路角度便于向上观察下丘脑。此外，该入路缩短了到达肿瘤的距离，允许对肿瘤进行精细的双手解剖，尤其是在基底动脉和下丘脑界面处。本视频展示了3例通过岩骨入路切除视交叉后方颅咽管瘤的病例，突出这些优点以优化患者预后。患者及其监护人同意手术、摄影及公布患者图像。经神经外科杂志出版集团许可使用了来自Al-Mefty等人11的图片。其他图片转载自Al-Mefty等人12。“岩骨入路切除视交叉后方颅咽管瘤”，《神经外科》，2008年，第62卷，第5期增刊2（神经外科医师学会），ONS331-ONS336，经神经外科医师学会许可。
