Department of Neurosurgery and Gamma Knife Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Br J Neurosurg. 2021 Oct;35(5):570-577. doi: 10.1080/02688697.2021.1918632. Epub 2021 Aug 5.
Deep lesions located in lateral and third ventricles can be accessed thorough interhemispheric transcallosal or transcortical trans-ventricular approaches. Traditional brain retractors are made by 'non-cerebral engineered' spatulas, which do not equally distribute pressure on surrounding structures damaging brain. In this paper, we present a series of 20 intraventricular tumours resected through a MRI/US-navigated microscopic transcortical endoportal approach.
Between January 2014 and December 2017, 20 patients underwent US-MRI neuronavigated (Esaote, Genova, Italy) transcortical endoportal (Vycor Viewsite Brain Access System TC Model, Vycor Medical Inc., Boca Raton, FL) surgery for intraventricular deep-seated lesions with the intent to reach maximal safe resection.
Gross total removal was achieved in 14 patients (70%). The only prognostic factor that resulted in statistical significance related to surgical radicality from multivariate analysis was white matter infiltration ( = 0.043), regardless of other tumour (dimensions, origin and location inside ventricular system, histopathology) and patient (age, gender, clinical presentation) characteristics. The mean duration of surgery was 225.9 min (± 59). Neither critical events, nor major bleedings, nor intraoperative deaths occurred during surgery. One case of postoperative CSF infection (5%) was registered. Six patients (30%) required permanent CSF drainage system (Ommaya reservoir, VP shunt) in the postoperative period. The mean Functional Independence Measure (FIM) score at last follow-up was 105 (range: 65-124).
Transcortical transventricular endoportal surgery seems to be a valuable alternative to transcallosal surgery, although further prospective multicentre studies with larger number of patients, evaluation of pre- and post-operative neuropsychological outcomes and achievement of postoperative DTI and f-MRI are needed to confirm our results.
位于侧脑室和第三脑室的深部病变可通过胼胝体间或皮质下经脑室入路进行治疗。传统的脑牵开器是由“非脑工程”的解剖刀制成的，它们不能均匀地分布压力，从而损伤周围的结构。在本文中，我们报告了一系列通过 MRI/US 导航显微镜下经皮质内脑室入路切除的 20 例脑室肿瘤。
2014 年 1 月至 2017 年 12 月，20 名患者接受了 US-MRI 神经导航（Esaote，Genova，意大利）经皮质内脑室入路（Vycor Viewsite Brain Access System TC 模型，Vycor Medical Inc.，Boca Raton，FL）手术，以切除深部脑室病变，达到最大安全切除。
14 名患者（70%）实现了大体全切除。从多变量分析来看，与手术根治性相关的唯一具有统计学意义的预后因素是白质浸润（ = 0.043），而与其他肿瘤（大小、起源和脑室系统内位置、组织病理学）和患者（年龄、性别、临床表现）特征无关。手术平均持续时间为 225.9 分钟（±59 分钟）。手术过程中未发生危急事件、大出血或术中死亡。术后仅发生 1 例（5%）CSF 感染。6 名患者（30%）在术后需要永久性 CSF 引流系统（Ommaya 储液囊、VP 分流）。末次随访时的平均功能独立性评分（FIM）为 105 分（范围：65-124 分）。
经皮质经脑室内入路手术似乎是胼胝体间手术的一种有价值的替代方法，但需要进一步开展前瞻性多中心研究，纳入更多患者，评估术前和术后神经心理学结果，并在术后进行 DTI 和 f-MRI 检查，以证实我们的结果。
