Department of Neurosurgery, The James Cancer Hospital and Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
Adv Tech Stand Neurosurg. 2024;52:171-182. doi: 10.1007/978-3-031-61925-0_13.
Surgical selection for third ventricle tumors demands meticulous planning, given the complex anatomic milieu. Traditional open microsurgical approaches may be limited in their access to certain tumors, prompting the exploration of alternative techniques. The endoscopic supraorbital translaminar approach (ESOTLA) has emerged as a promising alternative for managing these tumors. By combining a minimally invasive keyhole approach with endoscopic visualization, the ESOTLA provides enhanced illumination and a wider angle of view within the third ventricle. This unique advantage allows for improved access to retrochiasmatic tumors and reduces the need for frontal lobe and optic chiasm retraction required of microscopic techniques, decreasing the risk of neurocognitive and visual deficits. Complications related to the ESOTLA are rare and primarily pertain to cosmetic issues and potential compromise of the hypothalamus or optic apparatus, which can be minimized through careful subarachnoid dissection. This chapter offers a comprehensive description of the technical aspects of the ESOTLA, providing insights into its application, advantages, and potential limitations. Additionally, a case description highlights the successful surgical extirpation of an intraventricular papillary craniopharyngioma via the ESOTLA followed by targeted therapy. To better illustrate the stepwise dissection through this novel approach, a series of cadaveric and intraoperative photographs are included.
对于第三脑室肿瘤的手术选择，由于其复杂的解剖环境，需要精心规划。传统的开放式显微外科方法在进入某些肿瘤时可能受到限制，促使人们探索替代技术。经眶上锁孔内镜入路（ESOTLA）作为一种有前途的治疗这些肿瘤的方法已经出现。该方法将微创锁孔入路与内镜可视化相结合，为第三脑室提供了更好的照明和更宽的视角。这种独特的优势可以更好地接近视交叉后肿瘤，减少对显微镜技术所需的额叶和视交叉牵开，从而降低神经认知和视觉缺陷的风险。与 ESOTLA 相关的并发症很少见，主要与美容问题和下丘脑或视器的潜在损伤有关，通过仔细的蛛网膜下腔解剖可以将这些风险降到最低。本章全面描述了 ESOTLA 的技术方面，包括其应用、优势和潜在的局限性。此外，通过一个病例描述强调了通过 ESOTLA 成功地进行了脑室乳头状颅咽管瘤的手术切除，并随后进行了靶向治疗。为了更好地说明通过这种新方法的逐步解剖，还包括了一系列尸体和术中照片。
