Takeuchi Kazuhito, Nagata Yuichi, Tanahashi Kuniaki, Araki Yoshio, Mizuno Akihiro, Sasaki Hiroo, Harada Hideyuki, Ito Keishi, Saito Ryuta
Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Turumai-cho, Nagoya City, Aichi, 466-8550, Japan.
Acta Neurochir (Wien). 2022 Oct;164(10):2587-2594. doi: 10.1007/s00701-022-05273-z. Epub 2022 Jun 22.
Cerebral cavernous malformations (CMs) presenting with focal neurological symptoms or mass effects require surgical removal. In recent years, cylindrical retractors have been widely utilized for the removal of deep-seated lesions during both microscopic and endoscopic surgery. In the present study, we evaluated the efficacy and safety of endoscopic transcylinder removal of CMs using a novel wet-field technique.
We included 13 patients with supratentorial CMs who had undergone endoscopic transcylinder surgery between April 2013 and March 2022. One patient experienced recurrence of the CM and underwent a second endoscopic transcylinder surgery. Therefore, we retrospectively evaluated 14 procedures. The surgical field was continuously irrigated with artificial cerebrospinal fluid to maintain expansion and visualization of the tumor bed. We termed this method as the "wet-field technique." Patient characteristics, symptoms, and pre- and postoperative magnetic resonance imaging results were obtained from medical records.
The average maximum CM diameter was 35.3 mm (range: 10-65 mm). Cylinder diameters were 6 mm in eight procedures, 10 mm in four procedures, and 17 mm in one procedure. Wet-field technique was applied in all cases. The endoscope provided a bright field of view even under water. Continuous water irrigation made it easier to observe the entire tumor bed which naturally expanded by water pressure. Gross total resection was achieved in 13 procedures, while subtotal resection was achieved in one procedure. No surgical complications were observed.
The endoscopic transcylinder removal using wet-field technique is safe and effective for the removal of symptomatic intracranial supratentorial CMs.
表现为局灶性神经症状或占位效应的脑海绵状血管畸形（CMs）需要手术切除。近年来，柱状牵开器已广泛应用于显微手术和内镜手术中深部病变的切除。在本研究中，我们评估了使用一种新型湿场技术通过内镜经柱状牵开器切除CMs的疗效和安全性。
我们纳入了2013年4月至2022年3月期间接受内镜经柱状牵开器手术的13例幕上CMs患者。1例患者CM复发并接受了第二次内镜经柱状牵开器手术。因此，我们回顾性评估了14例手术。手术视野用人工脑脊液持续冲洗，以维持肿瘤床的扩张和可视化。我们将这种方法称为“湿场技术”。从病历中获取患者的特征、症状以及术前和术后的磁共振成像结果。
CM的平均最大直径为35.3毫米（范围：10 - 65毫米）。8例手术使用的柱状牵开器直径为6毫米，4例为10毫米，1例为17毫米。所有病例均应用了湿场技术。即使在水下，内镜也能提供明亮的视野。持续的水冲洗使观察整个肿瘤床更加容易，肿瘤床因水压自然扩张。13例手术实现了全切，1例为次全切。未观察到手术并发症。
使用湿场技术通过内镜经柱状牵开器切除对于有症状的幕上颅内CMs的切除是安全有效的。
