Shoap Wesley, Goldschmidt Ezequiel, Rodriguez Rubio Roberto
Department of Neurological Surgery, LSU Health Sciences Center, New Orleans, Louisiana, USA; Department of Neurological Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.
Department of Neurological Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.
World Neurosurg. 2025 Aug;200:124188. doi: 10.1016/j.wneu.2025.124188. Epub 2025 Jun 18.
The posterior incisura is a deep and surgically challenging area with complex neurovasculature. Endoscopic paramedian supracerebellar infratentorial approaches (EPSCITAs) have improved access and visualization of this region. However, endoscope and instrument conflict within this deep and narrow corridor remains a key limitation. This study evaluates the feasibility of a combined EPSCITA and endoscopic occipital interhemispheric transtentorial approach (EOIHTTA) with the aim of improving surgical freedom and visualization in this region.
Five embalmed and latex-injected cadaveric donors were dissected bilaterally (10 sides total). Measurements were taken at the EPSCITA port and then were repeated after addition of the EOIHTTA port. Measurements of surgical freedom at 3 anatomic targets, area of exposure, distance to the pineal gland, and angle at approach port, were obtained using stereotactic navigation. Statistical analyses were performed using 2-sample t-tests.
Addition of the EOIHTTA port improved the vertical angle of approach from 15.07° to 58.96°, P < 0.0001, and horizontal angle of approach from 28.1° to 50.02°, P < 0.0001. The area of surgical freedom at each anatomic target increased notably, with the area at the pineal gland expanding from 663 mm to 1042 mm, P < 0.005, the superior colliculus from 806 mm to 1090 mm, P < 0.005, and the splenium from 415 mm to 902 mm, P < 0.005.
This dual-port approach enhances access to the posterior incisura, providing improved surgical exposure and maneuverability while reducing instrument conflict. This technique is an effective minimally invasive approach to this deep-seated region, addressing the limitations of traditional single-port techniques.
后切迹是一个深部且手术难度大的区域，其神经血管结构复杂。内镜经小脑幕上小脑幕下旁正中入路（EPSCITA）改善了对该区域的显露和视野。然而，在这个深部且狭窄的通道内，内镜和器械冲突仍然是一个关键限制。本研究评估联合EPSCITA和内镜枕部半球间经小脑幕入路（EOIHTTA）的可行性，目的是提高该区域的手术自由度和视野。
对5具防腐并注入乳胶的尸体供体进行双侧解剖（共10侧）。在EPSCITA入路端口进行测量，然后在增加EOIHTTA入路端口后重复测量。使用立体定向导航获取3个解剖靶点的手术自由度、暴露面积、到松果体的距离以及入路端口角度的测量值。采用两样本t检验进行统计分析。
增加EOIHTTA入路端口后，入路的垂直角度从15.07°提高到58.96°，P < 0.0001，水平角度从28.1°提高到50.02°，P < 0.0001。每个解剖靶点的手术自由度面积显著增加，松果体区域从663平方毫米扩大到1042平方毫米，P < 0.005，上丘从806平方毫米扩大到1090平方毫米，P < 0.005，胼胝体压部从415平方毫米扩大到902平方毫米，P < 0.005。
这种双端口入路增强了对后切迹的显露，在减少器械冲突的同时，提供了更好的手术暴露和可操作性。该技术是针对这个深部区域的一种有效的微创方法，解决了传统单端口技术的局限性。
