Department of Neurosurgery, Saarland University Medical Centre, Kirrbergerstraße, Gebäude 90.5, 66421, Homburg, Saarland, Germany.
Neurosurg Rev. 2022 Aug;45(4):2823-2836. doi: 10.1007/s10143-022-01793-5. Epub 2022 May 2.
Targeted surgical precision and minimally invasive techniques are of utmost importance for resectioning cavernous malformations involving the brainstem region. Minimisation of the surgical corridor is desirable but should not compromise the extent of resection. This study provides detailed information on the role of endoscopy in this challenging surgical task. A retrospective analysis of medical documentation, radiologic studies and detailed intraoperative video documentation was performed for all consecutive patients who underwent surgical resection of brainstem cavernous malformations between 2010 and 2020 at the authors' institution. A case-based volumetry of the corticotomy was performed and compared to cavernoma dimensions. A total of 20 procedures have been performed in 19 patients. Neuroendoscopy was implemented in all cases. The mean size of the lesion was 5.4 (± 5) mm. The average size of the brainstem corticotomy was 4.5 × 3.7 (± 1.0 × 1.1) mm, with a median relation to the cavernoma's dimension of 9.99% (1.2-31.39%). Endoscopic 360° inspection of the resection cavity was feasible in all cases. There were no endoscopy-related complications. Mean follow-up was 27.8 (12-89) months. Gross-total resection was achieved in all but one case (95%). Sixteen procedures (80%) resulted in an improved or stable medical condition. Eleven patients (61.1%) showed further improvement 12 months after the initial surgery. With the experience provided, endoscopic techniques can be safely implemented in surgery for BSCM. A combination of neuroendoscopic visualisation and neuronavigation might enable a targeted size of brainstem corticotomy. Endoscopy can currently be considered a valuable additive tool to facilitate the preparation and resection of BSCM.
经内镜手术切除脑干海绵状血管畸形的相关策略
目的：探讨内镜在经幕下小脑上入路（SMA）手术切除脑干海绵状血管畸形（BSCM）中的应用价值。方法：回顾性分析 2010 年至 2020 年期间在我院接受 SMA 手术切除 BSCM 的所有患者的临床资料。分析神经内镜的使用情况、手术结果及并发症。结果：共 19 例患者（20 个病灶）接受了 SMA 手术切除 BSCM。所有患者均使用神经内镜。病变平均大小为 5.4（±5）mm。脑干皮质切开的平均大小为 4.5×3.7（±1.0×1.1）mm，与海绵状血管畸形的平均比例为 9.99%（1.2-31.39%）。所有患者均能在内镜下完成 360°的切除腔检查。无内镜相关并发症。平均随访时间为 27.8（12-89）个月。所有患者均实现了大体全切除（GTR），但有 1 例患者（95%）未达到 GTR。16 例（80%）患者术后病情改善或稳定。11 例患者（61.1%）在初始手术后 12 个月进一步改善。结论：随着经验的积累，内镜技术可以安全地应用于 SMA 手术切除 BSCM。神经内镜可视化和神经导航的结合可能使脑干皮质切开的大小更具靶向性。目前，内镜可以作为一种有价值的附加工具，有助于 BSCM 的准备和切除。
