Sakata Tomohiro, Tanikawa Motoki, Yamada Hiroshi, Fujinami Ryota, Nishikawa Yusuke, Yamada Shigeki, Mase Mitsuhito
Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Front Neurol. 2023 Apr 21;14:1170045. doi: 10.3389/fneur.2023.1170045. eCollection 2023.
Although there have been some reports on endoscopic glioblastoma surgery, the indication has been limited to deep-seated lesions, and the difficulty of hemostasis has been a concern. In that light, we attempted to establish an endoscopic procedure for excision of glioblastoma which could be applied even to hypervascular or superficial lesions, in combination with pre-operative endovascular tumor embolization.
Medical records of six consecutive glioblastoma patients who received exclusive endoscopic removal between September and November 2020 were analyzed. Preoperative tumor embolization was performed in cases with marked tumor stain and proper feeder arteries having an abnormal shape, for instance, tortuous or dilated, without passing through branches to the normal brain. Endoscopic tumor removal through a key-hole craniotomy was performed by using an inside-out excision for a deep-seated lesion, with the addition of an outside-in extirpation for a shallow portion when needed.
Endoscopic removal was successfully performed in all six cases. Before resection, endovascular tumor embolization was performed in four cases with no resulting complications, including ischemia or brain swelling. Gross total resection was achieved in three cases, and near total resection in the other three cases. Intraoperative blood loss exceeded 1,000 ml in only one case, whose tumor showed a prominent tumor stain but no proper feeder artery for embolization. In all patients, a smooth transition to adjuvant therapy was possible with no surgical site infection.
Endoscopic removal for glioblastoma was considered to be a promising procedure with minimal invasiveness and a favorable impact on prognosis.
尽管已有一些关于内镜下胶质母细胞瘤手术的报道，但其适应证仅限于深部病变，止血困难一直是一个问题。有鉴于此，我们尝试建立一种内镜下切除胶质母细胞瘤的手术方法，该方法甚至可应用于血管丰富或浅表病变，并结合术前血管内肿瘤栓塞术。
分析了2020年9月至11月期间连续6例接受单纯内镜下切除的胶质母细胞瘤患者的病历。对于有明显肿瘤染色且供血动脉形态异常（如迂曲或扩张）且不经过正常脑组织分支的病例，进行术前肿瘤栓塞。通过锁孔开颅进行内镜下肿瘤切除，对于深部病变采用由内向外切除，必要时对浅部病变增加由外向内切除。
6例均成功进行了内镜下切除。4例在切除前进行了血管内肿瘤栓塞，未出现包括缺血或脑肿胀在内的并发症。3例实现了肉眼全切，另外3例实现了近全切。仅1例术中失血超过1000ml，该例肿瘤显示明显的肿瘤染色，但无合适的栓塞供血动脉。所有患者均顺利过渡到辅助治疗，无手术部位感染。
内镜下切除胶质母细胞瘤被认为是一种有前景的手术方法，具有微创性且对预后有良好影响。
