Liu Xing-Wu, Lu Wei-Rong, Zhang Tian-Yi, Hou Xu-Sheng, Fa Zhi-Qiang, Zhang Shi-Zhong
Department of Functional Neurosurgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China.
Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China.
World J Clin Cases. 2022 Feb 26;10(6):1914-1921. doi: 10.12998/wjcc.v10.i6.1914.
Resection of deep intracranial tumors requires significant brain retraction, which frequently causes brain damage. In particular, tumor in the trigone of the lateral ventricular presents a surgical challenge due to its inaccessible location and intricate adjacent relationships with essential structures such as the optic radiation (OR) fibers. New brain retraction systems have been developed to minimize retraction-associated injury. To date, there is little evidence supporting the superiority of any retraction system in preserving the white matter tract integrity. This report illustrates the initial surgical excision in two patients using a new retraction system termed the cerebral corridor creator (CCC) and demonstrates its advantage in protecting OR fibers.
We report two patients with nonspecific symptoms, who had trigone ventricular lesions that involved the neighboring OR identified on preoperative diffusion tensor imaging (DTI). Both patients underwent successful surgical excision using the CCC. Total tumor removal was achieved without additional neurological deficit. DTI showed that the OR fibers were preserved along the surgical field. Preoperative symptoms were alleviated immediately after surgery. Clinical outcomes were improved according to the Glasgow-Outcome-Scale and Activity-of-Daily-Living Scale assessments.
In the two cases, the CCC was a safe and useful tool for creating access to the deep trigonal area while preserving the white matter tract integrity. The CCC is thus a promising alternative brain retractor.
切除深部颅内肿瘤需要显著牵拉脑组织，这常常会导致脑损伤。特别是侧脑室三角区的肿瘤，由于其位置难以接近且与视辐射（OR）纤维等重要结构的相邻关系复杂，给手术带来了挑战。已开发出新的脑牵拉系统以尽量减少与牵拉相关的损伤。迄今为止，几乎没有证据支持任何一种牵拉系统在保留白质束完整性方面具有优越性。本报告阐述了使用一种名为脑通道创建器（CCC）的新型牵拉系统对两名患者进行的首次手术切除，并展示了其在保护OR纤维方面的优势。
我们报告了两名有非特异性症状的患者，他们在术前弥散张量成像（DTI）上显示侧脑室三角区病变累及邻近的OR。两名患者均使用CCC成功进行了手术切除。实现了肿瘤全切且无额外神经功能缺损。DTI显示手术区域的OR纤维得以保留。术后患者术前症状立即得到缓解。根据格拉斯哥预后量表和日常生活活动量表评估，临床结局得到改善。
在这两例病例中，CCC是一种安全且有用的工具，可在保留白质束完整性的同时进入深部三角区。因此，CCC是一种很有前景的替代性脑牵拉器。
