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岛叶胶质瘤中豆纹动脉穿支的显微外科保留：两点顺行骨骼化技术

Microsurgical preservation of lenticulostriate artery perforators in insular glioma: the two point antegrade skeletonization technique.

作者信息

Das Kuntal Kanti, Rai Shreyash, Katyayan Ila, Madhesiya Sudhakar, Srivastava Arun Kumar, Jaiswal Awadhesh Kumar

机构信息

Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, Uttar Pradesh, India.

出版信息

Acta Neurochir (Wien). 2025 Jan 11;167(1):11. doi: 10.1007/s00701-025-06422-w.

DOI:10.1007/s00701-025-06422-w
PMID:39798001
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11724791/
Abstract

BACKGROUND

Reaching parenchymal segments of the lateral lenticulostriate artery (LSA) perforators, which represent the medial resection limit in insular gliomas (IG), remains a challenge. The currently described methods are indirect and sometimes, imprecise.

METHODS

We report an antegrade direct skeletonization technique to identify these tiny arteries at the medial end of IGs with an illustrative case of grade 2 astrocytoma. The patient recovered uneventfully following a near total tumor resection without any postoperative radiological ischemia in the LSA territory.

CONCLUSIONS

Our microsurgical technique of antegrade LSA skeletonization may be useful in insular gliomas with a sharp medial border.

摘要

背景

到达外侧豆纹动脉（LSA）穿支的实质段是一项挑战，该穿支代表岛叶胶质瘤（IG）的内侧切除界限。目前描述的方法是间接的，有时并不精确。

方法

我们报告一种顺行直接骨骼化技术，用于在IG内侧端识别这些微小动脉，并以一例2级星形细胞瘤为例进行说明。患者在近乎全肿瘤切除后恢复顺利，LSA区域无任何术后放射性缺血。

结论

我们的LSA顺行骨骼化显微手术技术可能对内侧边界清晰的岛叶胶质瘤有用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca14/11724791/7567ad75888a/701_2025_6422_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca14/11724791/653f70bc6aa8/701_2025_6422_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca14/11724791/be0cb250cb5b/701_2025_6422_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca14/11724791/79a5f2106120/701_2025_6422_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca14/11724791/7567ad75888a/701_2025_6422_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca14/11724791/653f70bc6aa8/701_2025_6422_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca14/11724791/be0cb250cb5b/701_2025_6422_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca14/11724791/79a5f2106120/701_2025_6422_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca14/11724791/7567ad75888a/701_2025_6422_Fig4_HTML.jpg

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本文引用的文献

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Balancing the Extent of Resection and Ischemic Complications in Insular Glioma Surgery: Technical Nuances and Proposal of a Novel Composite Postoperative Outcome Index.平衡岛叶胶质瘤手术的切除范围和缺血性并发症：技术细节及一种新的复合术后结局指数的提出。
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Complication avoidance: resection of the insular glioma complicated by iatrogenic injury to the lenticulostriate artery.并发症预防：岛叶胶质瘤切除术并发纹状体动脉医源性损伤。
Acta Neurochir (Wien). 2021 Nov;163(11):3093-3096. doi: 10.1007/s00701-021-04806-2. Epub 2021 Mar 22.
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Insular glioma surgery: an evolution of thought and practice.
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J Neurosurg. 2019 Jan 1;130(1):9-16. doi: 10.3171/2018.10.JNS181519.
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Indocyanine green as an adjunct for resection of insular gliomas.吲哚菁绿作为岛叶胶质瘤切除术的辅助手段。
Asian J Neurosurg. 2016 Jul-Sep;11(3):276-81. doi: 10.4103/1793-5482.175626.
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Visualization of lenticulostriate arteries during insular low-grade glioma surgeries by navigated 3D ultrasound power Doppler: technical note.导航三维超声动力成像在岛叶低级别胶质瘤手术中显示纹状体动脉:技术说明。
J Neurosurg. 2016 Oct;125(4):1016-1023. doi: 10.3171/2015.10.JNS151907. Epub 2016 Feb 5.
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Functional neuroanatomy of the insular lobe.岛叶的功能神经解剖学。
Brain Struct Funct. 2011 Jun;216(2):137-49. doi: 10.1007/s00429-010-0296-3. Epub 2010 Dec 14.
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Resection of insular gliomas: the importance of lenticulostriate artery position.岛叶胶质瘤切除术：豆纹动脉位置的重要性。
J Neurosurg. 2008 Nov;109(5):825-34. doi: 10.3171/JNS/2008/109/11/0825.
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Surgical resection of intrinsic insular tumors: complication avoidance.岛叶原发性肿瘤的手术切除：避免并发症
J Neurosurg. 2001 Oct;95(4):638-50. doi: 10.3171/jns.2001.95.4.0638.
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Perforating branches of the middle cerebral artery. Microsurgical anatomy of their extracerebral segments.大脑中动脉穿支。其脑外段的显微外科解剖学
J Neurosurg. 1985 Aug;63(2):266-71. doi: 10.3171/jns.1985.63.2.0266.