Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, 801507, India.
Acta Neurochir (Wien). 2023 Nov;165(11):3249-3254. doi: 10.1007/s00701-023-05798-x. Epub 2023 Sep 14.
The narrow surgical passage provided by the supraorbital keyhole craniotomy restricts the instrument's maneuverability and presents a number of technical challenges. Inadequate brain relaxation may eventually result in unavoidable brain retraction and neurological impairments. The article aims to provide a novel intraoperative ventriculostomy to assist in overcoming the barrier of a narrow surgical corridor and assess its feasibility and safety compared to other techniques.
The craniometric point was planned on one normal computed tomography (CT) brain. The coordinates were verified on 43 magnetic resonance imaging (MRI) brain images uploaded on the neuronavigation system (StealthStation S8 version 1.0; Medtronic, Louisville, USA). The ventriculostomy point was 3 cm superior to glabella, 2 cm lateral to midline, 6 cm deep to the brain surface in the perpendicular direction, and parallel to the floor of the anterior cranial fossa. Subsequently, the abovementioned radiologically calculated ventriculostomy trajectory was confirmed on 32 consecutive patients (without neuronavigation) of suprasellar mass undergoing supraorbital craniotomy between February 2022 and April 2023. The technical issues, feasibility, and outcomes were assessed.
Out of 32 patients, in 29 patients, ventricular hit was attained in a single attempt, and the rest 3 patients needed two attempts. The intraoperative ventricular hit rate was 100% with 90.6% success in a single attempt. No ventriculostomy-related complications occurred. Compared to ELD (external lumbar drainage), performing an intraoperative ventriculostomy had no discernible difference in the perception of the brain retraction force. Intraoperative ventriculostomy fully eliminated the low back pain or radiculopathy that patients with ELD rarely have even after drain removal.
The novel intraoperative frontal ventriculostomy is a safe trajectory and is a valid alternative to Menovsky's ventriculostomy or external lumbar drainage. The authors recommend this technique be generally utilized in supraorbital keyhole approaches to optimize brain relaxation and minimize secondary adverse events.
眶上锁孔入路提供的狭窄手术通道限制了器械的操作灵活性，并带来了许多技术挑战。脑松弛不足最终可能导致不可避免的脑牵拉和神经损伤。本文旨在提供一种新的术中脑室穿刺术，以帮助克服狭窄手术通道的障碍，并评估其与其他技术相比的可行性和安全性。
在一个正常的 CT 脑上规划颅测量点。将坐标在上传到神经导航系统（StealthStation S8 版本 1.0；Medtronic，美国路易斯维尔）的 43 个 MRI 脑图像上进行验证。脑室穿刺点位于眉间上方 3cm，中线外侧 2cm，垂直方向脑表面下 6cm，与前颅窝底平行。随后，在 2022 年 2 月至 2023 年 4 月期间，对 32 例接受眶上锁孔入路治疗鞍上肿块的连续患者（无神经导航）进行了上述影像学计算的脑室穿刺轨迹验证。评估了技术问题、可行性和结果。
在 32 例患者中，29 例患者在单次尝试中达到了脑室穿刺，其余 3 例患者需要尝试 2 次。术中脑室穿刺成功率为 100%，单次尝试成功率为 90.6%。未发生脑室穿刺相关并发症。与 ELD（腰椎外引流）相比，进行术中脑室穿刺术在脑牵拉力的感知方面没有明显差异。与 ELD 患者在拔管后很少出现的腰痛或神经根病相比，术中脑室穿刺术完全消除了腰痛或神经根病。
新的术中额部脑室穿刺术是一种安全的轨迹，是 Menovsky 脑室穿刺术或腰椎外引流的有效替代方法。作者建议在眶上锁孔入路中普遍应用该技术，以优化脑松弛，减少继发性不良事件。
