Department of Neurosurgery, The James Cancer Center Hospital, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA.
Department of Neurosurgery, The James Cancer Center Hospital, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA.
World Neurosurg. 2024 Jun;186:78-86. doi: 10.1016/j.wneu.2024.03.095. Epub 2024 Mar 24.
Traditional microsurgical approaches for addressing intraventricular craniopharyngioma provide limited access to the retrochiasmatic area and tumors with significant lateral or rostrocaudal extensions. Extended endoscopic endonasal approaches can effectively overcome many of limitations, yet they require a favorable working angle between the optic chiasm and pituitary gland, as well as the involvement of the third ventricle floor by the tumor.
Herein, the authors describe the surgical nuances of a keyhole technique for resecting third ventricle craniopharyngiomas via a fully endoscopic minimally invasive trans-eyebrow supraorbital translaminar approach (ESOTLA). A case description detailing the key surgical steps and application of the approach is provided, along with a series of cadaveric photographs to highlight the relevant anatomy and step-by-step dissection process.
The patient is a 44-year-old man who presented with polyuria, low urine specific gravity, and panhypopituitarism. Brain magnetic resonance imaging revealed a solid-cystic heterogeneous-enhanced retrochiasmatic mass within the third ventricle, consistent with craniopharyngioma. A 1-stage ESOTLA was indicated based on the narrow pituitary-chiasm angle and the high functional status of the patient. Near-total resection was achieved, and no new postoperative neurologic or endocrine change was observed. Targeted therapy was implemented based on the histologic result, and the most recent surveillance magnetic resonance imaging showed no evidence of the residual tumor.
By combining a keyhole approach with variable-angle endoscopic visualization through a smaller bony and soft tissue exposure, ESOTLA can provide enhanced illumination within the third ventricle, potentially addressing cosmetic concerns and limited exposure area/angle of freedom associated with its conventional microsurgical counterpart.
传统的显微手术方法在解决脑室颅咽管瘤时，提供了有限的进入视交叉后区和肿瘤的外侧或前后延伸的通道。扩展的内镜经鼻入路可以有效地克服许多限制，但它们需要视交叉和垂体之间的有利工作角度，以及肿瘤累及第三脑室底部。
本文作者介绍了一种通过完全内镜微创经眉眶上经颅窗入路（ESOTLA）切除第三脑室颅咽管瘤的锁孔技术的手术细节。详细描述了手术步骤和应用该方法的病例，并提供了一系列尸体照片，以突出相关解剖结构和逐步解剖过程。
患者为 44 岁男性，表现为多尿、低尿比重和全垂体功能减退。脑磁共振成像显示第三脑室中存在一个实性-囊性不均匀增强的视交叉后肿块，符合颅咽管瘤。由于垂体-视交叉角狭窄和患者的高功能状态，建议进行 1 期 ESOTLA。实现了近全切除，并且没有观察到新的术后神经或内分泌变化。根据组织学结果实施了靶向治疗，最近的磁共振成像随访显示没有残留肿瘤的证据。
通过将锁孔方法与通过更小的骨和软组织暴露的可变角度内镜可视化相结合，ESOTLA 可以提供第三脑室的增强照明，可能解决与传统显微手术方法相关的美容问题以及有限的暴露面积/自由度问题。
