Santos Carlos, Velasquez Carlos, Esteban Jesus, Fernandez Leticia, Mandonnet Emmanuel, Duffau Hugues, Martino Juan
Department of Neurological Surgery and Spine Unit, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.
Oper Neurosurg (Hagerstown). 2021 Nov 15;21(6):E561-E562. doi: 10.1093/ons/opab342.
Transopercular approach to the insula is indicated for resection of insular low-grade gliomas, particularly for Yasargil's 3B, 5A, and 5B types. Nevertheless, the infrequent location and its challenging approach make it difficult to master the surgery. Consequently, a realistic laboratory training model might help to acquire key surgical skills. In this video, we describe a cadaveric-based model simulating the resection of a temporo-insular low-grade glioma. Kingler's fixation technique was used to fix the cadaver head before injecting red and blue colorants for a realistic vascular appearance. Hemisphere was frozen for white matter tract dissection. Tractography and intraoperative eloquent areas were extrapolated from a glioma patient by using a neuronavigation system. Then, a fronto-temporal craniotomy was performed through a question mark incision, exposing from inferior temporal gyrus up to middle frontal gyrus. After cortical anatomic landmark identification, eloquent areas were extrapolated creating a simulated functional cortical map. Then, transopercular noneloquent frontal and temporal corticectomies were performed, followed by subpial resection. Detailed identification of Sylvian vessels and insular cortex was demonstrated. Anatomic resection limits were exposed, and implicated white matter bundles, uncinate and fronto-occipital fascicles, were identified running through the temporal isthmus. Finally, a temporo-mesial resection was performed. In summary, this model provides a simple, cost-effective, and very realistic simulation of a transopercular approach to the insula, allowing the development of surgical skills needed to treat insular tumors in a safe environment. Besides, the integration of simulated navigation has proven useful in better understanding the complex white matter anatomy involved. Cadaver donation, subject or relatives, includes full consent for publication of the images. For the purpose of this video, no ethics committee approval was needed. Images correspond to a cadaver head donation. Cadaver donation, subject or relatives, includes full consent for any scientific purposes involving the corpse. The consent includes image or video recording. Regarding the intraoperative surgical video and tractography, the patient gave written consent for scientific divulgation prior to surgery.
经颞下窝入路切除岛叶低级别胶质瘤，尤其适用于Yasargil 3B、5A和5B型。然而，其位置罕见且手术入路具有挑战性，使得掌握该手术变得困难。因此，一个逼真的实验室训练模型可能有助于掌握关键手术技能。在本视频中，我们描述了一种基于尸体的模型，用于模拟颞叶-岛叶低级别胶质瘤的切除。在注入红色和蓝色染料以呈现逼真的血管外观之前，使用Kingler固定技术固定尸体头部。将大脑半球冷冻以进行白质纤维束解剖。通过神经导航系统从一名胶质瘤患者身上推断出纤维束成像和术中明确区域。然后，通过问号切口进行额颞开颅手术，从颞下回直至额中回进行暴露。在识别皮质解剖标志后，推断出明确区域，创建模拟功能皮质图谱。然后，进行经颞下窝非明确区域的额颞皮质切除术，随后进行软膜下切除术。展示了对大脑外侧裂血管和岛叶皮质的详细识别。暴露了解剖切除界限，并识别出穿过颞峡的受累白质束、钩束和额枕束。最后，进行颞叶内侧切除术。总之，该模型提供了一种简单、经济高效且非常逼真的经颞下窝入路切除岛叶的模拟方法，可在安全环境中培养治疗岛叶肿瘤所需的手术技能。此外，模拟导航的整合已证明有助于更好地理解所涉及的复杂白质解剖结构。尸体捐赠，捐赠者或其亲属，包括对图像发表的完全同意。出于本视频的目的，无需伦理委员会批准。图像对应于一具尸体头部捐赠。尸体捐赠，捐赠者或其亲属，包括对涉及尸体的任何科学目的的完全同意。同意包括图像或视频记录。关于术中手术视频和纤维束成像，患者在手术前已书面同意进行科学传播。
