Papadimitriou Kyriakos, Cossu Giulia, Hewer Ekkehard, Diezi Manuel, Daniel Roy Thomas, Messerer Mahmoud
Department of Neurosurgery, University Hospital of Lausanne and University of Lausanne, 1015 Lausanne, Switzerland.
Department of Pathology, University Hospital of Lausanne and University of Lausanne, 1015 Lausanne, Switzerland.
Children (Basel). 2022 Apr 29;9(5):640. doi: 10.3390/children9050640.
(1) Background: Superior cerebellar peduncle (SCP) lesions are sparsely reported in the literature. The surgical approaches to the cerebello-mesencephalic region remain challenging. In this article, we present the extreme lateral supracerebellar infratentorial (ELSI) approach to treat a large hemorrhagic pilocytic astrocytoma of the SCP. (2) Methods: An 11-year-old boy, known for neurofibromatosis Type I, presented to the emergency department of our institution with symptoms and signs of intracranial hypertension. The cerebral magnetic resonance imaging (MRI) revealed a large hemorrhagic lesion centered on the SCP provoking obstructive hydrocephalus. Following an emergency endoscopic third ventriculocisternostomy (ETV), he underwent a tumor resection via an endoscope-assisted ELSI approach. (3) Results: ELSI approach allows for a wide exposure with direct access to lesions of the SCP. The post-operative course was uneventful, and the patient was discharged home on post-operative day 5. Post-operative MRI revealed a near total resection with a small residual tumor within the mesencephalon. (4) Conclusion: ELSI approach offers an excellent exposure with the surgical angles necessary for median and paramedian lesions. The park-bench position with appropriate head flexion and rotation offers a gravity-assisted relaxation of the tentorial and petrosal cerebellar surfaces. The endoscope can be an adjunct to illuminate the blind areas of the surgical corridor for an improved tumor resection without significant cerebellar retraction.
(1) 背景：文献中关于小脑上脚（SCP）病变的报道较为稀少。小脑-中脑区域的手术入路仍然具有挑战性。在本文中，我们介绍了经小脑幕下外侧极外侧（ELSI）入路治疗SCP的大型出血性毛细胞型星形细胞瘤。(2) 方法：一名11岁患有I型神经纤维瘤病的男孩因颅内高压的症状和体征就诊于我院急诊科。脑部磁共振成像（MRI）显示一个以SCP为中心的大型出血性病变，引发梗阻性脑积水。在紧急内镜下第三脑室造瘘术（ETV）后，他通过内镜辅助的ELSI入路进行了肿瘤切除。(3) 结果：ELSI入路可实现广泛暴露，能够直接到达SCP病变部位。术后过程顺利，患者在术后第5天出院。术后MRI显示肿瘤几乎全切，中脑内有一小部分残留肿瘤。(4) 结论：ELSI入路能提供良好的暴露，具备处理中线和旁中线病变所需的手术角度。采用合适的头部屈曲和旋转的公园长椅体位可利用重力辅助使小脑幕和岩骨小脑表面松弛。内镜可作为辅助工具照亮手术通道的盲区，以在不显著牵拉小脑的情况下改善肿瘤切除效果。
