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首页> 外文期刊>Neurosurgery >Endoscope-assisted supraorbital craniotomy for lesions of the interpeduncular fossa.
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Endoscope-assisted supraorbital craniotomy for lesions of the interpeduncular fossa.

机译：内窥镜辅助眶上颅骨切开术治疗椎间孔窝病变。

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OBJECTIVE: The supraorbital approach is well accepted for lesions in the anterior fossa, the sellar region, and the anterior circle of Willis. However, the usefulness of this approach has not yet been elucidated for lesions in the interpeduncular fossa. The technique of an endoscope-assisted, ipsi- and contralateral supraorbital approach to lesions within the interpeduncular fossa is described, and the initial results are reported. METHODS: A small supraorbital craniotomy, using an eyebrow incision, was performed in each of seven patients who were operated on for different types of lesions in the interpeduncular fossa, including a neuromuscular choristoma of the oculomotor nerve, a retrosellar epidermoid tumor, and five aneurysms (two of the basilar artery tip, two at the offspring of the superior cerebellar artery, and one fusiform arterial widening of the basilar artery apex). The surgical approach, its indications and limitations, and the additional value of an endoscope are outlined. RESULTS: All lesions could be easily reached and well visualized through this approach by using an endoscope as an adjunct to the operating microscope. The saccular aneurysms all could be clipped successfully, the fusiform widening was wrapped, the epidermoid tumor was removed completely, and the choristoma was removed only partially because of brain stem invasion. The patient with the neuromuscular choristoma had persistent diabetes insipidus postoperatively, most probably caused by stretching the pituitary stalk with the endoscope. The patient with the epidermoid tumor showed a postoperative transient partial oculomotor nerve paresis at the side of the approach. The cosmetic results of the eyebrow incisions for this approach were excellent in all patients. CONCLUSION: Lesions in the interpeduncular fossa can be effectively treated using a supraorbital approach, which can be ipsi- or contralateral to the side of the lesion, depending on the exact location of the lesion. The use of an endoscope is essential to visualize these lesions that lie in the shadow of the sellar and parasellar anatomic structures. The major advantage over other approaches are a nearly perpendicular surgical route (although the distance is longer, which is, on the other hand, not a disadvantage), a minimized amount of dissection and brain retraction by using an endoscope through anatomic gateways, and a small surgical incision with excellent cosmetic results.
机译：目的：眶上入路可广泛用于威利斯前窝，鞍区和前环的病变。但是，这种方法的有效性尚未阐明，用于椎间孔窝病变。介绍了一种内窥镜辅助，同侧同侧和对侧眶上入路治疗椎间孔窝内病变的技术，并报道了初步结果。方法：对7例因椎间窝窝不同类型病变进行手术的患者进行了小切口眶上颅骨开颅手术，其中包括动眼神经神经肌性胆管瘤，后巩膜上皮样肿瘤和五个动脉瘤（两个基底动脉尖端，两个在小脑上动脉的后代，另一个在基底动脉顶点的梭形动脉变宽）。概述了外科手术方法，其适应症和局限性以及内窥镜的附加价值。结果：通过使用内窥镜作为手术显微镜的附件，通过这种方法可以轻松到达所有病变并对其进行良好可视化。囊状动脉瘤全部可以成功切除，梭形变宽被包裹，表皮样肿瘤被完全清除，而由于脑干的侵袭，胆囊瘤仅被部分清除。神经肌肉型胆管瘤患者术后持续尿崩症，很可能是由于用内窥镜拉长垂体柄所致。患有表皮样肿瘤的患者在入路一侧出现术后短暂性部分动眼神经麻痹。在所有患者中，采用这种方法进行眉毛切口的美容效果都非常好。结论：可以使用眶上方法有效治疗椎间窝窝的病变，视病变的确切位置而定，病变可以位于病变侧同侧或对侧。内窥镜的使用对于可视化位于蝶鞍和鞍旁解剖结构阴影中的这些病变至关重要。与其他方法相比，主要优点是手术路径几乎垂直（尽管距离较长，但从另一方面来说，这不是缺点），使用内窥镜通过解剖通道使解剖和脑内回缩量最小化，以及小手术切口，具有出色的美容效果。

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