Staribacher Daniel, Feigl Guenther C, Britz Gavin, Kuzmin Dzmitry
Department of Neurosurgery, General Hospital Bamberg, Bamberg, Germany.
Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany.
J Korean Neurosurg Soc. 2025 Jan;68(1):67-74. doi: 10.3340/jkns.2024.0085. Epub 2024 Jun 11.
OBJECTIVE: Reoperations are part of neurosurgical practice. In these cases, an already formed craniotomy seems the most logical and appropriate. However, reoperations via large approaches can be quite traumatic for the patient. Then minimally invasive approaches, being less traumatic, can be a good alternative. METHODS: We describe seven consecutive patients who underwent reoperations using minimally invasive approaches in the areas of conventional craniotomies. Surgical Theater® visualization platform was used for preoperative planning. The study evaluated the size of surgical approach, surgical efficacy, and the presence of complications. RESULTS: The size of a minimally invasive craniotomy was significantly smaller than that of a conventional approach. The preoperative goals were achieved in all described cases. There were no complications in the early postoperative period. Although the anatomy of the operated brain region in reoperations is altered, keyhole approaches can be successfully used with the support of preoperative planning and intraoperative neuronavigation. Given that the goals of reoperations may differ from those of the primary surgery, and a large approach is more traumatic for the patient, minimally invasive craniotomy can be considered as a good alternative. The successful use of minimally invasive approaches in areas of conventional craniotomies reinforces the philosophy of keyhole neurosurgery. In cases where goals can be achieved using small approaches, it makes no sense to use large conventional ones. CONCLUSION: Minimally invasive approaches can be successfully used during reoperations in patients after conventional craniotomies.
目的:再次手术是神经外科实践的一部分。在这些情况下,已形成的开颅手术似乎是最合乎逻辑且合适的。然而,通过大切口进行再次手术对患者来说可能创伤很大。那么,创伤较小的微创方法可能是一个很好的选择。 方法:我们描述了连续7例在传统开颅区域采用微创方法进行再次手术的患者。使用手术模拟可视化平台进行术前规划。该研究评估了手术切口大小、手术效果及并发症情况。 结果:微创开颅手术的切口大小明显小于传统手术切口。所有病例均实现了术前目标。术后早期无并发症发生。尽管再次手术时手术脑区的解剖结构已改变,但在术前规划和术中神经导航的支持下,锁孔入路仍可成功应用。鉴于再次手术的目标可能与初次手术不同,且大切口对患者创伤更大,微创开颅手术可被视为一个很好的选择。在传统开颅区域成功应用微创方法强化了锁孔神经外科的理念。在能够通过小切口实现目标的情况下,采用大的传统切口是没有意义的。 结论:微创方法可成功应用于传统开颅术后患者的再次手术。
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