Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai , China.
Department of Neurosurgery, Shanghai Geriatric Medical Center, Shanghai , China.
Oper Neurosurg (Hagerstown). 2024 Aug 1;27(2):187-193. doi: 10.1227/ons.0000000000001114. Epub 2024 Mar 7.
Accessing lesions in the posterior-medial thalamus can be challenging because of their deep location and intricate neurovascular anatomy. This study aims to describe the techniques and feasibility of the endoscopic supracerebellar infratentorial transpineal approach for treating posterior-medial thalamus lesions.
We reviewed and analyzed the clinical outcomes and endoscopic surgical experience of 11 patients with posterior-medial thalamic lesions. The first 4 cases used the endoscopic midline supracerebellar infratentorial transpineal approach, whereas the subsequent 7 cases used the endoscopic contralateral paramedian supracerebellar infratentorial transpineal approach. All cases involved the upward transposition of the pineal gland to access the posterior-medial thalamus. The extent of resection and the endoscopic techniques were the main focus of analysis. Neurological examinations and MRI/computed tomography follow-up were conducted for 3-12 months after surgery.
The pathology of the group included 6 gliomas, 1 cavernous malformation, 1 inflammation, 1 melanoma, and 2 hematomas. All 11 patients achieved gross total resection (6 patients, 54.5%) or subtotal resection (5 patients, 45.5%) with no new neurological deficits. Most patients (9 patients, 81.8%) experienced improvement in Karnofsky Performance Status after surgery. Postoperative hydrocephalus occurred in 2 patients (18.2%) and was relieved by endoscopic third ventriculostomy.
The endoscopic supracerebellar infratentorial transpineal approach is an effective approach for removing posterior-medial thalamic lesions that require access through the third ventricle surfaces of the thalamus. The endoscopic contralateral paramedian supracerebellar infratentorial transpineal approach provides a more superior and lateral view of the posterior-medial thalamic lesions.
由于后内侧丘脑位置深，神经血管结构复杂，因此对其病变的处理极具挑战性。本研究旨在描述经内镜小脑上经蚓旁经齿状突入路治疗后内侧丘脑病变的技术和可行性。
回顾性分析 11 例后内侧丘脑病变患者的临床资料和内镜手术经验。前 4 例采用内镜中线小脑上经蚓旁经齿状突入路，后 7 例采用内镜对侧旁正中小脑上经蚓旁经齿状突入路。所有病例均采用松果体向上移位以进入后内侧丘脑。主要分析切除范围和内镜技术。术后 3-12 个月进行神经功能检查和 MRI/CT 随访。
本组病理包括胶质瘤 6 例、海绵状血管瘤 1 例、炎症 1 例、黑色素瘤 1 例、血肿 2 例。11 例患者均达到大体全切除（6 例，54.5%）或次全切除（5 例，45.5%），无新的神经功能缺损。术后 9 例（81.8%）患者 Karnofsky 功能状态评分改善。2 例（18.2%）术后发生脑积水，经内镜第三脑室造瘘术缓解。
经内镜小脑上经蚓旁经齿状突入路是一种有效治疗需要经丘脑第三脑室面进入的后内侧丘脑病变的方法。经内镜对侧旁正中小脑上经蚓旁经齿状突入路可提供更好的后内侧丘脑病变的上外侧视野。
