Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA.
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA.
World Neurosurg. 2022 Dec;168:227-231. doi: 10.1016/j.wneu.2022.08.071. Epub 2022 Aug 24.
Pilocytic astrocytomas account for approximately 5%-6% of all gliomas and are most commonly diagnosed between the ages of 8 and 13 years. Although they may occur throughout the neuraxis, approximately two thirds arise from the cerebellum and optic pathway. Other locations of origin include midline structures such as thalamus, hypothalamus, and periventricular regions. Surgical approaches to lateral or third ventricular tumors include anterior transcallosal, subfrontal translamina terminalis, and anterior transcortical approaches. The Aurora Surgiscope is a single-use, disposable minimally invasive neurological endoscope designed for intraparenchymal hemorrhage evacuation. We present the successful use of this system to aid resection of a large intraventricular pilocytic astrocytoma.
A 29-year-old man presented with signs of developing hydrocephalus and was found to have a large intraventricular tumor, which was later identified to be a rare intraventricular pilocytic astrocytoma. A ventriculostomy was performed as a temporizing measure, and he was transferred to our tertiary care facility for surgical management. Sulcal dissection was performed, and the endoscope was inserted to create a minimally invasive corridor to the lateral ventricle. Using the endoscope, bimanual surgery using multiple instruments simultaneously was possible and enabled gross total resection of the tumor.
The patient tolerated the procedure well and was discharged at his neurological baseline level.
Extensive sulcal dissection preceding placement of the endoscope allowed access to the intraventricular space with minimal passage of parenchymal tissue. High-definition visualization was provided and allowed the operating surgeon to freely use both hands during surgery.
毛细胞型星形细胞瘤约占所有胶质瘤的 5%-6%，最常见于 8-13 岁。尽管它们可能发生在整个中枢神经系统，但大约三分之二起源于小脑和视路。其他起源部位包括中线结构，如丘脑、下丘脑和脑室周围区域。侧脑室或第三脑室肿瘤的手术方法包括前纵裂经胼胝体、额下入路经终板和前皮质入路。Aurora Surgiscope 是一种一次性使用的微创神经内窥镜，用于脑实质出血清除。我们成功地使用该系统辅助切除了一个大型脑室毛细胞型星形细胞瘤。
一名 29 岁男性出现脑积水发展迹象，发现有一个大型脑室肿瘤，后来被确定为罕见的脑室毛细胞型星形细胞瘤。进行脑室造口术作为临时措施，并将他转至我们的三级护理机构进行手术治疗。进行脑沟分离，插入内窥镜以创建通往侧脑室的微创通道。使用内窥镜，同时使用多种器械进行双手手术成为可能，并实现了肿瘤的大体全切除。
患者手术耐受良好，出院时神经功能恢复至基线水平。
在放置内窥镜之前进行广泛的脑沟分离，允许通过最小的脑组织通道进入脑室空间。高清可视化提供了便利，并允许手术医生在手术过程中自由使用双手。
