Sangha Miljyot S, Rajwani Kapil M, Price Sally-Ann, Wren Hilary, Pescador Ana M, Gullan Richard, Ashkan Keyoumars, Vergani Francesco, Bhangoo Ranjeev, Lavrador Jose P
Department of Neurosurgery, Kings College Hospital NHS Foundation, Denmark Hill, London, United Kingdom.
J Surg Case Rep. 2023 Oct 17;2023(10):rjad519. doi: 10.1093/jscr/rjad519. eCollection 2023 Oct.
Deep-seated brain tumours are surgically challenging to access. When planning approaches to these lesions, it is important to take into account eloquent cortical areas, grey matter nuclei, and subcortical white matter tracts. Traditionally, access to deep-seated lesions would require brain retraction; however, this is associated with secondary brain damage, which may impair neurological function. A trans-sulcal minimally invasive parafascicular approach allows gentle splitting of brain fibres and is thought to splay rather than sever white matter tracts. This is particularly important when approaching medially located, language-eloquent tumours, which lack brain surface expression. This video describes a minimally invasive approach to a deep-seated, language-eloquent brain tumour. We utilized preoperative cortical and subcortical planning to define a safe surgical corridor. We then demonstrate using intraoperative neuro-monitoring and mapping of the motor and language functions to define the boundaries of surgical resection. We find trans-sulcal minimally invasive parafascicular approach to be a safe and effective technique when approaching language-eloquent lesions medial to the main language subcortical networks.
深部脑肿瘤的手术入路具有挑战性。在规划这些病变的手术入路时，考虑明确的皮质区域、灰质核团和皮质下白质束非常重要。传统上，进入深部病变需要脑牵拉；然而，这与继发性脑损伤相关，可能会损害神经功能。经沟微创束旁入路允许轻柔地分离脑纤维，并且被认为是展开而不是切断白质束。当处理位于内侧、与语言相关的肿瘤（这些肿瘤在脑表面没有表现）时，这一点尤为重要。本视频描述了一种针对深部、与语言相关的脑肿瘤的微创入路。我们利用术前皮质和皮质下规划来确定安全的手术通道。然后，我们展示了如何使用术中神经监测以及运动和语言功能映射来确定手术切除的边界。我们发现，对于位于主要语言皮质下网络内侧、与语言相关的病变，经沟微创束旁入路是一种安全有效的技术。
