Clinic of Neurosurgery, University Clinical Center of Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.
Semmes-Murphey Clinic and Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, USA.
World Neurosurg. 2024 Sep;189:209-210. doi: 10.1016/j.wneu.2024.06.078. Epub 2024 Jun 20.
The hypothalamic region is susceptible to involvement of several processes. Lesions in this region remain challenging for surgical access and treatment. Strategies include both endoscopic and microsurgical approaches. A cranio-orbital approach with extradural clinoidectomy and optic canal unroofing provides the necessary corridor to visualize and decompress the optic nerve/chiasm and remains an important tool in achieving complete tumor resection with favorable functional and visual outcomes. Endoscope assistance in transcranial surgery is well established, used to provide direct visualization of hidden adjacent tissues. A 25-year-old woman presented with headache and progressive visual loss to blindness (hand waving and light perception) on admission. Magnetic resonance imaging demonstrated a 28-mm-diameter tumor in the hypothalamic region with no significant postcontrast enhancement. She underwent right cranio-orbital craniotomy, extradural anterior clinoidectomy, and optic canal unroofing with a 2-mm high-speed diamond drill and copious irrigation. After ipsilateral falciform ligament release, the tumor capsule was coagulated, sharply opened, and resected in a piecemeal fashion. Endoscopic assistance warranted the removal of hidden parts and confirmed tumor removal. Histopathology and next-generation sequencing confirmed the diagnosis of rosette-forming glioneural tumor. Follow-up revealed gross total tumor removal on magnetic resonance imaging and complete recovery of visual function as per ophthalmologist examination. Rosette-forming glioneural tumors are considered rare and classified as World Health Organization grade I tumors usually found in the fourth ventricle. To our knowledge, we present the first operative video (Video 1) demonstrating the removal of rosette-forming glioneural tumor in the hypothalamic region with endoscopic assistance.
下丘脑区域容易受到多种过程的影响。该区域的病变仍然难以进行手术治疗。策略包括内镜和显微镜手术方法。颅眶入路联合硬膜外岩骨切除术和视神经管减压术提供了必要的通道，可用于可视化和减压视神经/视交叉，并仍然是实现完全肿瘤切除和良好的功能及视觉效果的重要工具。内镜在经颅手术中的辅助作用已经得到充分证实，用于提供对隐藏的邻近组织的直接可视化。一位 25 岁的女性因头痛和进行性视力丧失（手动摸索和光感）入院。磁共振成像显示下丘脑区域有一个 28 毫米直径的肿瘤，没有明显的对比增强。她接受了右侧颅眶开颅术、硬膜外前岩骨切除术和视神经管减压术，使用 2 毫米高速金刚石钻头和大量冲洗液。同侧镰状韧带松解后，肿瘤囊被凝固、锐性打开，并以分片方式切除。内镜辅助需要切除隐藏部分并确认肿瘤切除。组织病理学和下一代测序证实了胶神经元肿瘤的诊断。随访显示磁共振成像上大体全切除肿瘤，眼科检查显示视觉功能完全恢复。胶神经元肿瘤被认为是罕见的，被归类为世界卫生组织一级肿瘤，通常发生在第四脑室。据我们所知，我们展示了第一个手术视频（视频 1），演示了在内镜辅助下切除下丘脑的胶神经元肿瘤。
