Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas, USA.
World Neurosurg. 2022 May;161:110. doi: 10.1016/j.wneu.2022.02.058. Epub 2022 Feb 22.
We present a parietal interhemispheric approach to resect a pineal region falcotentorial meningioma. Three-dimensional (3D) modeling was used to visualize and plan the surgical approach in virtual reality (Video 1). A 78-year-old woman was incidentally found to have a slow-growing falcotentorial meningioma. The tumor was first treated with stereotactic radiosurgery, but the patient had progressive confusion, memory issues, and bilateral temporal field cuts with interval expansion of the tumor and significantly increased peritumoral vasogenic edema on magnetic resonance imaging. After recommending tumor resection, the patient consented to surgery and underwent resection via a posterior interhemispheric subsplenial approach. Using a 3D model in virtual reality, we discuss the advantages and disadvantages of various classical approaches to the pineal region for resection of this tumor. Falcotentorial meningiomas often displace the deep veins inferiorly, making an interhemispheric approach more favorable. Preoperative visualization of critical deep venous structures with the 3D model was a valuable adjunct to magnetic resonance imaging for achieving safe resection. We depict key steps of the surgical planning process using virtual reality and demonstrate how simulation can be used to evaluate risks and benefits of different surgical corridors. A small rim of residual tumor adherent to the deep cerebral veins was intentionally left behind in order to minimize risk of morbidity to the patient. At 1-month follow-up, the patient's cognition had returned to baseline and her vision had significantly improved. Ultimately, surgical planning using virtual reality promotes both neurosurgical education and patient safety through clear visualization and understanding of different surgical approaches.
我们提出了一种顶枕部大脑半球间入路切除松果体区颅咽管瘤的方法。使用三维（3D）建模在虚拟现实中可视化和规划手术入路（视频 1）。一名 78 岁女性偶然发现患有缓慢生长的颅咽管瘤。该肿瘤首先接受了立体定向放射外科治疗，但患者出现进行性意识混乱、记忆力问题，双侧颞叶视野缺失，肿瘤间隔扩张，肿瘤周围血管源性水肿明显增加。在建议进行肿瘤切除后，患者同意手术，并通过后半球间下蚓部入路进行了切除。我们使用虚拟现实中的 3D 模型讨论了切除这种肿瘤时各种经典松果体区入路的优缺点。颅咽管瘤常使深部静脉向下移位，因此采用大脑半球间入路更为有利。术前通过 3D 模型对关键的深部静脉结构进行可视化是磁共振成像的有益补充，有助于实现安全切除。我们使用虚拟现实描述了手术规划过程的关键步骤，并展示了如何利用模拟来评估不同手术通道的风险和收益。为了最大限度地降低对患者的发病率风险，我们故意留下一小部分紧贴深部脑静脉的肿瘤残端。术后 1 个月随访时，患者的认知功能已恢复到基线水平，视力显著改善。最终，通过虚拟现实进行手术规划，通过对不同手术入路的清晰可视化和理解，促进了神经外科学教育和患者安全。
