Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan; Department of Neurosurgery, Stanford University, Palo Alto, California, USA.
World Neurosurg. 2022 Oct;166:e237-e244. doi: 10.1016/j.wneu.2022.06.148. Epub 2022 Jul 7.
Falcine meningioma is usually approached ipsilaterally, and the technique for tumor removal has traditionally been performed under microscopy. We report a surgical procedure for large falcine meningioma by an endoscopic contralateral interhemispheric transfalcine keyhole approach.
The study period was from September 2019 to March 2021. Study participants were patients with World Health Organization grade I meningioma showing falx attachment, excluding neurofibromatosis, who underwent initial surgery at our institution. The surgical procedure begins with a small contralateral craniotomy of about 3 cm, followed by insertion of an endoscope. The tumor attachment to the falx is excised, exposing the tumor. Internal decompression is performed, and the lesion is dissected from the surrounding brain before removal through the falx.
An endoscopic contralateral interhemispheric transfalcine keyhole approach was used to resect 4 cases of large falcine meningioma. The mean operation time was 265 minutes (range: 216-294 minutes), achieving Simpson grade I removal in all cases. No evidence of cerebral infarction, cerebral edema, or new neurological complaints related to impaired venous return was seen using this surgical method.
In the case of falcine meningioma, the endoscopic keyhole contralateral technique allows detachment of the tumor from the falx and safe manipulation in a minor field of view. In addition, because the craniotomy is smaller and the operation time is shorter, this procedure offers a less-invasive approach for the patient. This technique is thus, in our opinion, quite advantageous.
镰状脑膜瘤通常采用同侧入路，肿瘤切除的传统技术是在显微镜下进行。我们报告了一种通过内镜对侧大脑半球间镰下入路的手术方法，用于治疗大型镰状脑膜瘤。
研究期间为 2019 年 9 月至 2021 年 3 月。研究对象为在我院行初次手术的、具有镰状附着的 I 级世界卫生组织（WHO）脑膜瘤患者，且排除神经纤维瘤病。手术过程始于约 3cm 的对侧小颅骨切开术，然后插入内镜。切除镰状附着的肿瘤，暴露出肿瘤。进行内减压，然后从周围脑组织中分离病变，最后通过镰状突切除。
采用内镜对侧大脑半球间镰下入路切除 4 例大型镰状脑膜瘤。平均手术时间为 265 分钟（范围：216-294 分钟），所有病例均达到 Simpson Ⅰ级切除。使用这种手术方法，没有证据表明与静脉回流受损相关的脑梗死、脑水肿或新的神经功能障碍。
在镰状脑膜瘤的情况下，内镜锁孔对侧技术允许从镰状突上分离肿瘤，并在较小的视野内进行安全操作。此外，由于颅骨切开术较小，手术时间较短，因此该手术为患者提供了一种微创方法。因此，我们认为这种技术非常有优势。
