Xiao Jin, Zhao Tianchen, Cheng Xiang, Sheng Qiang, Li Chao, Li Yan, Zhang Yiquan, Wang Xianxiang, Cheng Hongwei, Ye Lei
Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, P.R. China.
Neurosurg Rev. 2025 Jan 4;48(1):21. doi: 10.1007/s10143-025-03186-w.
Transcranial neurosurgery assisted by endoscopy and intraoperative ultrasound (IOUS) has become an effective approach for real-time visualization and guidance during tumor resection. This study explores the application of these techniques in falcine meningioma (FM) resection, assessing their feasibility and safety. Eleven FM patients underwent transcranial endoscopic resection with IOUS assistance. Preoperative neuroimaging, including magnetic resonance (MR) imaging, computed tomography, MR angiography, and MR venography, guided surgical planning. IOUS provided real-time tumor localization, boundary visualization, adjacent structure assessment, and guidance throughout the resection. Tumors were located in the anterior, middle, and posterior falx in 4, 5, and 2 patients, respectively. Of the 11 cases, 8 involved unilateral falx tumors and 3 involved bilateral falx tumors. Simpson grade 1 resection was achieved in 12 patients; one case involved a deeply located tumor closely associated with the deep venous plexus. Pathologically, 10 patients had World Health Organization (WHO) grade 1 meningiomas, and 1 had a WHO grade 3 anaplastic meningioma. Postoperative complications included temporary contralateral hemiplegia in one patient and pulmonary infection in another. The average follow-up period was 19.3 months, with all patients achieving Karnofsky Performance Status scores of > 90. In conclusion, endoscopic resection with IOUS assistance is both feasible and safe for FM patients.
经内镜和术中超声（IOUS）辅助的经颅神经外科手术已成为肿瘤切除术中实时可视化和引导的有效方法。本研究探讨了这些技术在大脑镰旁脑膜瘤（FM）切除术中的应用，评估其可行性和安全性。11例FM患者在IOUS辅助下接受了经颅内镜切除术。术前神经影像学检查，包括磁共振（MR）成像、计算机断层扫描、MR血管造影和MR静脉造影，指导手术规划。IOUS在整个切除过程中提供实时肿瘤定位、边界可视化、相邻结构评估和引导。肿瘤分别位于大脑镰前部、中部和后部的患者有4例、5例和2例。11例中，8例为单侧大脑镰旁肿瘤，3例为双侧大脑镰旁肿瘤。12例患者实现了辛普森1级切除；1例肿瘤位置深，与深部静脉丛密切相关。病理检查显示，10例患者为世界卫生组织（WHO）1级脑膜瘤，1例为WHO 3级间变性脑膜瘤。术后并发症包括1例患者出现暂时性对侧偏瘫，另1例患者出现肺部感染。平均随访期为19.3个月，所有患者的卡氏功能状态评分均>90。总之，IOUS辅助下的内镜切除术对FM患者是可行且安全的。
