Lan Qing, Sughrue Michael E, Briggs Robert G
Department of Neurosurgery, 2nd Affiliated Hospital, Soochow University, Suzhou, China.
Center for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia.
Chin Neurosurg J. 2022 Aug 5;8(1):19. doi: 10.1186/s41016-022-00289-x.
While keyhole neurosurgery is increasingly utilized in the operating room, there are few reports regarding the use of keyhole techniques to resect giant intracranial tumors. The feasibility and technique of that were discussed in this paper.
We retrospectively reviewed 95 consecutive patients who were admitted to our service between February 2012 and September 2017 with a maximum intracranial tumor diameter >5 cm. Keyhole approaches were used to resect these tumors in each case, including supraorbital, subtemporal, suboccipital, retromastoid, frontal, temporal, occipital, parietal, pterional, a combined temporo-parietal keyhole approach, and an approach via the longitudinal fissure.
We achieved gross total resection in 68/95 cases (71.6%) and subtotal resection in 27/95 cases (28.4%). No surgical death or severe disabilities such as coma and limb dyskinesia occurred following surgery. At the time of discharge, 8 patients had complications related to impaired cranial nerve function. In addition, 2 patients developed hydrocephalus requiring ventriculo-peritoneal shunt placement, and 4 patients developed a postoperative CSF leak requiring surgical intervention.
With meticulous design and reasonable selection, resection of giant intracranial tumors utilizing minimally invasive keyhole approaches can be done safely with satisfactory surgical outcomes.
虽然锁孔神经外科手术在手术室中的应用越来越广泛，但关于使用锁孔技术切除巨大颅内肿瘤的报道却很少。本文讨论了其可行性和技术。
我们回顾性分析了2012年2月至2017年9月期间连续收治的95例最大颅内肿瘤直径>5 cm的患者。每例均采用锁孔入路切除这些肿瘤，包括眶上入路、颞下入路、枕下入路、乳突后入路、额部入路、颞部入路、枕部入路、顶叶入路、翼点入路、颞顶联合锁孔入路以及经纵裂入路。
95例患者中，68例（71.6%）实现了肿瘤全切除，27例（28.4%）实现了次全切除。术后未发生手术死亡或昏迷、肢体运动障碍等严重残疾情况。出院时，8例患者出现与颅神经功能受损相关的并发症。此外，2例患者发生脑积水，需要进行脑室-腹腔分流术；4例患者出现术后脑脊液漏，需要手术干预。
通过精心设计和合理选择，采用微创锁孔入路切除巨大颅内肿瘤可以安全进行，并取得满意的手术效果。
