这项研究没有得到任何资助。

伊斯坦布尔医学院机构审查委员会批准了该研究方案。在研究开始之前，要求患者签署一份知情同意书，概述其数据的使用目的和发布。
1. 术前程序
<ol><li>在全身麻醉下进行手术。在手术室准备内窥镜和光学设备。</li>
	<li>在开始程序之前检查仪器（图 1 和 表 1）。</li>
</ol>2. 手术技术（图 2）
<ol><li>在全身麻醉下将患者置于仰卧位。用柔软的头部支撑患者头部，并将其弯曲 10° 角。</li>
	<li>触诊冠状缝合线。Kocher 点位于冠状缝合线的正前方，中线右侧约 2.5 cm。</li>
	<li>按照常规无菌和消毒规则开始手术。<ol><li>使用 #5 刀片在右侧额部区域（包括 Kocher 点）做一个 20 厘米的曲线切口。</li>
		<li>通过双极烧灼术确保止血，并解剖皮肤和皮下组织。</li>
		<li>放置自动皮肤牵开器。</li>
		<li>使用 Adson 骨膜电梯刮擦骨膜。</li>
		<li>使用高速钻头和穿孔器在前部区域钻一个毛刺孔。</li>
		<li>用 #11 刀片打开十字形的硬脑膜，并用双极烧灼凝固下面的软脑膜。</li>
		<li>将内窥镜鞘插入垂直于钻孔的脑实质中，并在握住内窥镜鞘的同时取下闭孔。进入侧脑室后，可以看到脑脊液从内窥镜鞘中流出。 注：检查脑脊液 （CSF） 样本中的肿瘤标志物，如 α-胎蛋白和 B-Hcg，可提高组织学检查的准确性。</li>
		<li>将 6.1 mm 宽的内窥镜插入内窥镜护套。可视化脑室侧腔。<ol><li>识别侧脑室中的间隔静脉和丘脑纹静脉。</li>
			<li>识别脉络丛。向前跟随脉络丛直至第三脑室，穿过门罗孔 （FOM）。</li>
		</ol></li>
		<li>将心室镜穿过 FOM 以进入第三脑室。</li>
		<li>找到第三脑室的底部，由于脑积水，它通常很薄。<ol><li>识别第三脑室的体和漏斗部隐窝。</li>
			<li>确保第三脑室底部的孔位于漏斗部隐窝和乳体之间最半透明的点。</li>
		</ol></li>
		<li>找到基底动脉并在动脉复合体前方穿刺，以防止手术过程中的损伤和出血。</li>
		<li>使用 4F Fogarty 导管的尖端刺穿第三脑室的底部。然后，反复给导管的球囊充气和放气，以扩大开口。观察导管球囊放气时脑脊液的射流。</li>
		<li>如果在手术过程中发生出血，请用大量温水冲洗，直到所有出血明显停止并且脑脊液清除。 注意：文献中关于用于管理出血的液体存在不同的看法。但是，我们在诊所使用正常体温的乳酸林格氏液。</li>
		<li>将内窥镜移至松果体肿瘤所在的第三脑室后部区域。 注意：内窥镜的入口点和角度在进入这两个位于不同位置的结构中起着关键作用。这对于避免损坏穹窿和关键血管结构至关重要。</li>
		<li>识别中间马萨并进行解剖，以便更好地观察后第三脑室。</li>
		<li>识别肿瘤并检查生长模式。使用双极烧灼术小心凝固肿瘤表面。</li>
		<li>肿瘤表面完全凝固后，使用活检钳进行活检。将活检送至病理科进行冷冻分析，并根据组织病理学诊断切除肿瘤。</li>
		<li>通过冲洗和双极烧灼来控制局部出血。</li>
		<li>拆下内窥镜系统。</li>
		<li>用缝合线缝合伤口，不要引流管。</li>
	</ol></li>
</ol>3. 术后操作
<ol><li>住院时间最短。手术后第二天动员患者。</li>
	<li>进行头颅 CT 平扫和脑脊液流式 MRI 检查，以评估第三脑室造瘘术的通畅性，并排除出血。</li>
	<li>如果没有主诉，第二天让患者出院。</li>
	<li>要求患者遵循病理结果，并在第 10 天和第一个月末到门诊就诊。</li>
</ol>

Kocher 的内窥镜检查

<ol>
	<li>Favero, G., Bonomini, F., Rezzani, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pineal+gland+tumors:+A+review.">Pineal gland tumors: A review.</a> Cancers (Basel). 13 (7), 1547 (2021).</li><li>Nagasawa, D. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pineal+germ+cell+tumors:+Two+cases+with+review+of+histopathologies+and+biomarkers).">Pineal germ cell tumors: Two cases with review of histopathologies and biomarkers).</a> J Clin Neurosci. 38, 23-31 (2017).</li><li>Tamrazi, B., Nelson, M., Bl&#252;ml, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pineal+region+masses+in+pediatric+patients.">Pineal region masses in pediatric patients.</a> Neuroimaging Clin N Am. 27 (1), 85-97 (2017).</li><li>Carr, C., O'Neill, B. E., Hochhalter, C. B., Strong, M. J., Ware, M. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Biomarkers+of+pineal+region+tumors:+A+review.">Biomarkers of pineal region tumors: A review.</a> Ochsner J. 19 (1), 26-31 (2019).</li><li>Iorio-Morin, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Histology-stratified+tumor+control+and+patient+survival+after+stereotactic+radiosurgery+for+pineal+region+tumors:+A+report+from+the+international+gamma+knife+research+foundation.">Histology-stratified tumor control and patient survival after stereotactic radiosurgery for pineal region tumors: A report from the international gamma knife research foundation.</a> World Neurosurg. 107, 974-982 (2017).</li><li>Liu, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simultaneous+single-trajectory+endoscopic+biopsy+and+third+ventriculostomy+in+pediatric+pineal+region+tumors.">Simultaneous single-trajectory endoscopic biopsy and third ventriculostomy in pediatric pineal region tumors.</a> Acta Neurol Belg. 121 (6), 1535-1542 (2021).</li><li>Attri, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+third+ventriculostomy+and+simultaneous+tumor+biopsy+in+pineal+region+tumors+using+the+&amp;#34;single+burr+hole&amp;#34;+technique:+An+analysis+of+34+cases.">Endoscopic third ventriculostomy and simultaneous tumor biopsy in pineal region tumors using the &amp;#34;single burr hole&amp;#34; technique: An analysis of 34 cases.</a> Asian J Neurosurg. 15 (4), 976-982 (2020).</li><li>Abbassy, M., Aref, K., Farhoud, A., Hekal, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Outcome+of+single-trajectory+rigid+endoscopic+third+ventriculostomy+and+biopsy+in+the+management+algorithm+of+pineal+region+tumors:+A+case+series+and+review+of+the+literature.">Outcome of single-trajectory rigid endoscopic third ventriculostomy and biopsy in the management algorithm of pineal region tumors: A case series and review of the literature.</a> Childs Nerv Syst. 34 (7), 1335-1344 (2018).</li><li>Fukushima, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+biopsy+of+intraventricular+tumors+with+the+use+of+a+ventriculofiberscope.">Endoscopic biopsy of intraventricular tumors with the use of a ventriculofiberscope.</a> Neurosurgery. 2 (2), 110-113 (1978).</li><li>Kawsar, K. A., Haque, M. R., Chowdhury, F. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Avoidance+and+management+of+perioperative+complications+of+endoscopic+third+ventriculostomy:+The+Dhaka+experience.">Avoidance and management of perioperative complications of endoscopic third ventriculostomy: The Dhaka experience.</a> J Neurosurg. 123 (6), 1414-1419 (2015).</li><li>Yang, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+third+ventriculostomy+and+biopsy+of+a+tectal+lesion+using+flexible+neuroendoscopy+and+urological+cup+forceps:+Illustrative+case.">Endoscopic third ventriculostomy and biopsy of a tectal lesion using flexible neuroendoscopy and urological cup forceps: Illustrative case.</a> J Neurosurg Case Lessons. 5 (16), (2023).</li><li>Revuelta Barbero, J. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combined+microsurgical-endoscopic+paramedian+supracerebellar-infratentorial+approach+for+resection+of+a+pineal+low-grade+glioma.">Combined microsurgical-endoscopic paramedian supracerebellar-infratentorial approach for resection of a pineal low-grade glioma.</a> Neurosurg Focus Video. 5 (1), 9 (2021).</li><li>Al-Saiari, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simultaneous+biportal+endoscopic+management+of+pineal+region+tumors+in+patients+with+obstructive+hydrocephalus:+Technical+notes.">Simultaneous biportal endoscopic management of pineal region tumors in patients with obstructive hydrocephalus: Technical notes.</a> Chin Neurosurg J. 9 (1), 1 (2023).</li><li>Birski, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+versus+stereotactic+biopsies+of+intracranial+lesions+involving+the+ventricles.">Endoscopic versus stereotactic biopsies of intracranial lesions involving the ventricles.</a> Neurosurg Rev. 44 (3), 1721-1727 (2021).</li><li>Gurusamy, S. M., Yaakub, A., Wan Hitam, W. H., Ahmad Maulana, S. A., Wan Ibrahim, W. Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pineal+gland+tumour+with+drop+metastases:+A+case+report.">Pineal gland tumour with drop metastases: A case report.</a> Cureus. 14 (10), e29855 (2022).</li><li>Panyaping, T., Tritanon, O., Wisetsathon, P., Chansakul, T., Pongpitcha, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accuracy+of+apparent+diffusion+coefficient+values+for+distinguishing+between+pineal+germ+cell+tumour+and+pineoblastoma.">Accuracy of apparent diffusion coefficient values for distinguishing between pineal germ cell tumour and pineoblastoma.</a> Clin Radiol. 78 (7), e494-e501 (2023).</li><li>Leone, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=single+burr+hole+endoscopic+third+ventriculostomy+and+tumor+biopsy+for+pineal+lesions:+Feasibility,+safety,+and+benefits.">single burr hole endoscopic third ventriculostomy and tumor biopsy for pineal lesions: Feasibility, safety, and benefits.</a> World Neurosurg. 173, 5-11 (2023).</li><li>Morgenstern, P. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pineal+region+tumors:+An+optimal+approach+for+simultaneous+endoscopic+third+ventriculostomy+and+biopsy.">Pineal region tumors: An optimal approach for simultaneous endoscopic third ventriculostomy and biopsy.</a> Neurosurg Focus. 30 (4), 3 (2011).</li><li>Zhang, Z., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+hydrocephalus+secondary+to+pineal+region+tumors.">Management of hydrocephalus secondary to pineal region tumors.</a> Clin Neurol Neurosurg. 115 (9), 1809-1813 (2013).</li><li>Xin, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic-assisted+surgery+versus+microsurgery+for+pineal+region+tumors:+A+single-center+retrospective+study.">Endoscopic-assisted surgery versus microsurgery for pineal region tumors: A single-center retrospective study.</a> Neurosurg Rev. 44 (2), 1017-1022 (2021).</li><li>Choque-Velasquez, J., Resendiz-Nieves, J., Colasanti, R., Hernesniemi, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+obstructive+hydrocephalus+associated+with+pineal+region+cysts+and+tumors+and+its+implication+in+long-term+outcome.">Management of obstructive hydrocephalus associated with pineal region cysts and tumors and its implication in long-term outcome.</a> World Neurosurg. 149, e913-e923 (2021).</li><li>Chibbaro, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neuroendoscopic+management+of+posterior+third+ventricle+and+pineal+region+tumors:+Technique,+limitation,+and+possible+complication+avoidance.">Neuroendoscopic management of posterior third ventricle and pineal region tumors: Technique, limitation, and possible complication avoidance.</a> Neurosurg Rev. 35 (3), 331-338 (2012).</li><li>Ahmed, A. I., Zaben, M. J., Mathad, N. V., Sparrow, O. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+biopsy+and+third+ventriculostomy+for+the+management+of+pineal+region+tumors.">Endoscopic biopsy and third ventriculostomy for the management of pineal region tumors.</a> World Neurosurg. 83 (4), 543-547 (2015).</li></ol>

作者声明他们没有利益冲突。

松果体瘤的 ETV 和活检的描述最早是在 1970 年代描述的。从历史上看，对失控出血的恐惧一直存在。然而，由于内窥镜手术技术的进步，出血控制现在并不是经验丰富的外科医生的主要并发症 9,10。根据文献中的几个案例，已发现内窥镜管理作为表现为脑积水的松果体区域肿瘤的第一步是有效的。内窥镜管理的主要目标是 CSF 引流和组织诊断，以便进一?...

松果体是位于上丘脑的神经内分泌腺，负责调节脊椎动物的生物节律。其解剖边界包括形成腺体底部的第三脑室壁的后表面、上部的胼胝体脾和围绕两侧的丘脑。它呈松果状，在四叉心池 1,2 中向后和向下延伸。
松果体肿瘤是相对罕见的肿瘤，主要是儿童恶性肿瘤，占所有儿童脑肿瘤的 3-11%，而成人脑肿瘤的 <1% 1,3,4。年龄、性别和种族可以改变松果体肿瘤的相对发病率5。松果体瘤分为三种类型：生殖细胞瘤、松果体实质肿瘤和起源于邻近解剖区域的肿瘤。生殖细胞瘤是最常见的松果体瘤，占欧洲松果体瘤的 50% 1,3。
松果体肿瘤的病理学多种多样，其最佳管理仍存在争议6。神经内窥镜检查的进步为松果体区肿瘤的治疗做出了重大贡献。神经内窥镜技术在治疗这些肿瘤方面是微创、有效且安全的。使用这种技术，可以治疗脑积水并同时进行活检7。在大多数情况下，由于放疗和化疗对大多数组织病理学亚型有效，同时内镜下第三脑室造瘘术 （ETV） 和肿瘤活检是松果体区肿瘤的首选手术方法。已经描述了同时进行 ETV 和活检的各种技术，目前没有执行该程序的标准技术8。

<table><tbody><tr><td>Adson periosteal elevator</td><td>Ruggles-Redmond</td><td>RO263</td><td>Semi-sharp, 5 mm, curved 6-3/8, length 164 mm</td></tr><tr><td>Automatic skin retractors&amp;nbsp;</td><td>Integra</td><td>3,72,245</td><td>Heiss Automatic Skin Retractor Length - Overall (mm): 102&lt;br/&gt; Length 1 - Tip/Jaw (mm): 8</td></tr><tr><td>Balloon catheter&amp;nbsp;</td><td>Edwards Fogarty</td><td>120804FP</td><td>Length (cm): 80, Catheter size (F): 4,&amp;nbsp; Inflated balloon diameter (mm): 9</td></tr><tr><td>Biopsy Forceps</td><td>Karl Storz LOTTA CLICKLINE Grasping Forceps</td><td>28164 LE</td><td>Rotating, dismantling, single action jaws, diameter 2.7 mm, working length 30 cm</td></tr><tr><td>Bipolar coagulation electrode</td><td>Karl Storz LOTTA</td><td>28161 SF</td><td>Diameter 1.3 mm, working length 30 cm</td></tr><tr><td>Bisture</td><td>Beybi</td><td>24,02,502</td><td>Beybi Bisture Tip. No: 20 and No: 11</td></tr><tr><td>High-speed drill</td><td>Medtronic Midas Rex MR8</td><td>MR8&amp;trade; Electric Plus EM850</td><td>Perforator tip used</td></tr><tr><td>Obturator</td><td>Karl Storz LOTTA</td><td>28164 LLO</td><td>Use with Operating Sheaths for ventricular puncture</td></tr><tr><td>Operating sheath</td><td>Karl Storz LOTTA</td><td>28164 LSB</td><td>Graduated, rotating, outer diameter 6.8 mm, working length 13 cm</td></tr><tr><td>Ventriculoscope</td><td>Karl Storz LOTTA Ventriculoscope with HOPKINS</td><td>28164 LAB</td><td>Wide angle telescope 30&amp;deg;, angled eyepiece, outer diameter 6.1 mm, length 18 cm, working channel diameter 2.9 mm, irrigation/suction channel diameter 1.6 mm</td></tr></tbody></table>

endoscopic third ventriculostomy and pineal biopsy from a single entry point

松果体肿瘤对儿童有重大影响，尽管它们相对少见。它们约占所有儿童脑肿瘤的 3-11%，远高于成人脑肿瘤的 <1%。这些肿瘤可分为三大类：生殖细胞肿瘤、实质松果体肿瘤和由相关解剖结构引起的肿瘤。获得准确的微创组织诊断对于为松果体肿瘤患者选择最合适的治疗方案至关重要。这是由于可用的治疗方案多种多样，以及与完全切除相关的潜在风险。如果患者出现由松果体肿瘤引起的急性梗阻性脑积水，则必须立即治疗脑积水。这种紧迫性源于脑积水的潜在并发症，包括颅内压升高和神经功能缺损。为了应对这些挑战，微创内窥镜方法提供了一个宝贵的机会。该技术使临床医生能够及时缓解脑积水并同时获得组织学诊断。这种双重好处使患者能够更全面地了解肿瘤，并有助于确定对患者最有效的治疗策略。

术前磁共振成像 （MRI） 显示松果体瘤和三心室脑积水。手术前，我们确保检查了我们的内窥镜装置、4F Fogarty 球囊导管 （见 图 1）和所有必需的材料 （见表 1）。 松果体肿瘤的大小最初测量为 30 mm x 15 mm x 20 mm。然而，在术后 MRI 扫描中，观察到肿瘤大小增加到 35 mm x 52 mm x 45 mm，表明肿瘤具有进行性。幸运的是，在接受化疗后，对治疗有积极的反?...

作者聚焦：用于第三脑室造口术和松果体活检的单入口内窥镜脑室内入路

松果体肿瘤经常引起梗阻性脑积水，需要组织病理学诊断来决定治疗方案。他们可能会根据病理诊断通过手术切除或放化疗进行治疗。作为一种微创初始治疗，Kocher 点的内窥镜方法可实现第三脑室造瘘术和活检。

内窥镜下第三脑室造口术和松果体活检从单一入口点

Pineal neoplasms have a significant impact on children although they are relatively uncommon. They account for approximately 3-11% of all childhood brain ...

endoscopic-third-ventriculostomy-pineal-biopsy-from-single-entry

Research

JoVE Journal

Medicine

Endoscopic Third Ventriculostomy and Pineal Biopsy from a Single Entry Point

472 次观看.  Istanbul University Faculty of Medicine. 内窥镜脑室内入路广泛用于神经外科。在这里，我们描述了从单个入口点对因松果体病变患有梗阻性脑积水的患者进行第三脑室造口术和松果体活检的完整内窥镜技术。所以内窥镜系统包含一个通道和一个冲洗通道。双极凝血、神经球囊和微镊子足以进行手术。先进技术的优势使在内窥镜手术中能够采集高清 HDI 4K 质量的图像。倾斜和柔性内窥?...

视频: 作者聚焦：用于第三脑室造口术和松果体活检的单入口内窥镜脑室内入路

Microvascular Decompression: Salient Surgical Principles and Technical Nuances

Trigeminal neuralgia is a disorder associated with severe episodes of lancinating pain in the distribution of the trigeminal nerve. Previous reports indicate that 80-90% of cases are related to compression of the trigeminal nerve by an adjacent vessel. The majority of patients with trigeminal neuralgia eventually require surgical management in order to achieve remission of symptoms. Surgical options for management include ablative procedures (e.g., radiosurgery, percutaneous radiofrequency lesioning, balloon compression, glycerol rhizolysis, etc.) and microvascular decompression. Ablative procedures fail to address the root cause of the disorder and are less effective at preventing recurrence of symptoms over the long term than microvascular decompression. However, microvascular decompression is inherently more invasive than ablative procedures and is associated with increased surgical risks. Previous studies have demonstrated a correlation between surgeon experience and patient outcome in microvascular decompression. In this series of 59 patients operated on by two neurosurgeons (JSN and PEK) since 2006, 93% of patients demonstrated substantial improvement in their trigeminal neuralgia following the procedure&#x2014;with follow-up ranging from 6 weeks to 2 years. Moreover, 41 of 66 patients (approximately 64%) have been entirely pain-free following the operation.
In this publication, video format is utilized to review the microsurgical pathology of this disorder. Steps of the operative procedure are reviewed and salient principles and technical nuances useful in minimizing complications and maximizing efficacy are discussed.

There are many available options for management of the patient with trigeminal neuralgia. Microvascular decompression, while the most invasive of all options, is also the most effective at achieving long term remission of symptoms. Video instruction on how to maximize efficacy and minimize complications with this procedure is described.

微血管减压:突出的手术原则和技术的细微差别

Trigeminal neuralgia is a disorder associated with severe episodes of lancinating pain in the distribution of the trigeminal nerve. Previous reports ...

科研

医学

Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms

Less invasive surgical approaches for intracranial aneurysm clipping may reduce length of hospital stay, surgical morbidity, treatment cost, and improve patient outcomes. We present our experience with a minimally invasive pterional approach for anterior circulation aneurysms performed in a major tertiary cerebrovascular center and compare the results with an aged matched dataset from the Nationwide Inpatient Sample (NIS). From August 2008 to December 2012, 22 elective aneurysm clippings on patients &#8804;55 years of age were performed by the same dual fellowship-trained cerebrovascular/endovascular neurosurgeon. One patient (4.5%) experienced transient post-operative complications. 18 of 22 patients returned for follow-up imaging and there were no recurrences through an average duration of 22 months. A search in the NIS database from 2008 to 2010, also for patients aged &#8804;55 years of age, yielded 1,341 hospitalizations for surgical clip ligation of unruptured cerebral aneurysms. Inpatient length of stay and hospital charges at our institution using the minimally invasive thumb-sized pterional technique were nearly half that of NIS (length of stay: 3.2 vs 5.7 days; hospital charges: $52,779 vs. $101,882). The minimally invasive thumb-sized pterional craniotomy allows good exposure of unruptured small and medium-sized supraclinoid anterior circulation aneurysms. Cerebrospinal fluid drainage from key subarachnoid cisterns and constant bimanual microsurgical techniques avoid the need for retractors which can cause contusions, localized venous infarctions, and post-operative cerebral edema at the retractor sites. Utilizing this set of techniques has afforded our patients with a shorter hospital stay at a lower cost compared to the national average.

Minimally invasive thumb-sized pterional craniotomy for aneurysm clipping has afforded our patients with a shorter hospital stay at a lower cost compared to the national average.

微创拇指大小翼点入开颅未破裂前循环动脉瘤的手术夹子结扎

Less invasive surgical approaches for intracranial aneurysm clipping may reduce length of hospital stay, surgical morbidity, treatment cost, and improve ...

Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations

Arteriovenious malformations (AVMs) are associated with significant morbidity and mortality, and have a rupture risk of ~3% per year. Treatment of AVMs must be tailored specifically to the lesion, with surgical resection being the gold standard for small, accessible lesions. Pre-operative embolization of AVMs can reduce nidal blood flow and remove high-risk AVM features such as intranidal or venous aneurysms, thereby simplifying a challenging neurosurgical procedure. Herein, we describe our approach for the staged endovascular embolization and open resection of AVMs, and highlight the advantages of having a comprehensively trained neurovascular surgeon leading a multi-disciplinary clinical team. This includes planning the craniotomy and resection to immediately follow the final embolization stage, thereby using a single session of anesthesia for aggressive embolization, and rapid resection. Finally, we provide a representative case of a 22-year-old female with an unruptured right frontal AVM diagnosed during a seizure workup, who was successfully treated via staged embolizations followed by open surgical resection.

Surgery is the gold standard for accessible arteriovenious malformations (AVMs), and pre-operative embolization can simplify this procedure. We describe our approach for staged endovascular embolization and open resection of AVMs, and provide a representative clinical example highlighting the advantages of a comprehensively trained neurovascular surgeon leading a multi-disciplinary clinical team.

脑动静脉畸形的综合血管内和开放性手术治疗

Arteriovenious malformations (AVMs) are associated with significant morbidity and mortality, and have a rupture risk of ~3% per year. Treatment of AVMs ...

神经科学

Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control seizures. However, a significant minority of patients continues to exhibit post-operative seizures, even in those cases in which the suspected source of seizures has been correctly localized and resected. The protocol presented here combines a clinical procedure routinely employed during the pre-operative evaluation of temporal lobe epilepsy (TLE) patients with a novel technique for network analysis. The method allows for the evaluation of the temporal evolution of mesial network parameters. The bilateral insertion of foramen ovale electrodes (FOE) into the ambient cistern simultaneously records electrocortical activity at several mesial areas in the temporal lobe. Furthermore, network methodology applied to the recorded time series tracks the temporal evolution of the mesial networks both interictally and during the seizures. In this way, the presented protocol offers a unique way to visualize and quantify measures that considers the relationships between several mesial areas instead of a single area.

This protocol describes a procedure to track the evolution of mesial network measures in temporal lobe epilepsy (TLE) patients. It is based on the combination of intracranial recordings with a novel numerical technique for data analysis. Specifically, we present a protocol for network analyses of foramen ovale recordings.

在耐药性颞叶癫痫患者卵圆孔电极记录的网络分析

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control ...

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

Endoscopic endonasal trans-sphenoidal surgery has become the gold standard for the surgical treatment of pituitary adenomas and many other pituitary lesions. Refinements in surgical techniques, technological advancements, and incorporation of neuronavigation have rendered this surgery minimally invasive. The complication rates of this surgery are very low while excellent results are consistently obtained through this approach.
This paper focuses on the step-by-step surgical approach to pituitary adenomas, which is based on personal experience, and details the results obtained with this minimally invasive surgery.

The aim of this paper is to describe the different steps of the endoscopic endonasal approach to the sella turcica.

内镜下鼻跨蝶入路: 垂体腺瘤的微创手术

Endoscopic endonasal trans-sphenoidal surgery has become the gold standard for the surgical treatment of pituitary adenomas and many other pituitary ...

An Endoscopic Transcanal Transpromontorial Approach for Vestibular Schwannomas using a Computer-Based Three-Dimensional Imaging System

A 2D monocular endoscope has been used in transcanal transpromontory vestibular schwannoma surgery instead of craniotomy. However, the absence of depth perception is the limitation of this approach. With the loss of depth perception, the surgeon will be not able to perform delicate and particularly complicated surgery. A binocular endoscope has been developed to provide stereoscopic vision with better depth perception for complicated anatomic structures and has been applied in some endoscopic surgeries. However, the diameter of the endoscope is a limitation in the performance of transcanal otologic surgeries. A small diameter endoscope facilitates easier surgery in a restricted space. A computer-based 3D imaging system can obtain 3D images in real-time using a small monocular endoscope. In this study, to evaluate the feasibility of a computer-based 3D imaging system for endoscopic lateral skull base surgery, we applied this 3D imaging system in a transcanal transpromontorial approach in two patients with vestibular schwannomas. The surgical procedure was completed without complication in these two cases. There was no mortality, perioperative complications, nor notable postoperative complications. Using this computer-based 3D imaging system, a better depth perception and stereoscopic vision was observed compared to a conventional 2D endoscope. The improvement in depth perception offers superior management of the complicated surgical anatomy.

Here, we present a transcanal transpromontorial approach for vestibular schwannomas using a computer-based three-dimensional (3D) imaging system combined with a two-dimensional (2D) endoscope. This system provided stereoscopic vision, better depth perception and reduced visual fatigue. This 3D imaging system enabled the application of 3D vision technology in endoscopic lateral skull base surgery.

A 2D monocular endoscope has been used in transcanal transpromontory vestibular schwannoma surgery instead of craniotomy. However, the absence of depth ...

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery

Endoscopic endonasal surgery has gained a prominent role in the management of complex skull base tumors. It allows the resection of a large group of benign and malignant lesions through a natural anatomical extra-cranial pathway, represented by the nasal cavities, avoiding brain retraction and neurovascular manipulation. This is reflected by the patients' prompt clinical recovery and the low risk of permanent neurological sequelae, representing the main caveat of conventional skull base surgery. This surgery must be tailored to each specific case, considering its features and relationship with surrounding neural structures, mostly based on preoperative neuroimaging. Advanced MRI techniques, such as tractography, have been rarely adopted in skull base surgery due to technical issues: lengthy and complicated processes to generate reliable reconstructions for inclusion in the neuronavigation system. 
This paper aims to present the protocol implemented in the institution and highlights the synergistic collaboration and teamwork between neurosurgeons and the neuroimaging team (neurologists, neuroradiologists, neuropsychologists, physicists, and bioengineers) with the final goal of selecting the optimal treatment for each patient, improving the surgical results and pursuing the advancement of personalized medicine in this field.

We present a protocol to integrate diffusion MRI tractography in patient work-up to endoscopic endonasal surgery for a skull base tumor. The methods for adopting these neuroimaging studies in the pre- and intra-operative phases are described.

扩散MRI造影术在内窥镜内窥镜颅骨基础外科中的作用

Endoscopic endonasal surgery has gained a prominent role in the management of complex skull base tumors. It allows the resection of a large group of ...

Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus

Hydrocephalus is a common adult neurosurgical condition typically requiring treatment with a cerebrospinal fluid (CSF) shunt, of which the ventriculoperitoneal (VP) shunt is the most common type. Unfortunately, the failure rates of VP shunts are alarmingly high, with up to 50% of patients requiring revision surgery within 2 years. VP shunt failure may occur due to infection, or catheter mispositioning, migration, and occlusion. We undertook a joint neurosurgery and general surgery collaboration in a 7-year prospective non-randomized consecutive quality improvement cohort study to reduce the rates of ventriculoperitoneal (VP) shunt failures in 224 adult patients at a tertiary care institution. The initiative combined the use of electromagnetic stereotactic neuronavigation to guide the placement of the proximal catheter and laparoscopy to place the distal catheter under direct visualization. With laparoscopic assistance, the distal catheter was anchored through a small hole created in the falciform ligament and placed into the right retrohepatic space, free from the omentum, adhesions, or bowel that might obstruct the catheter tip. The surgeries were performed using a shunt infection prevention protocol to reduce the risk of shunt infections. Here, we present an intraoperative video of the surgical procedure. Compliance with shunt infection reduction strategies and the combined utilization of neuronavigation and laparoscopy techniques in adult VP shunt surgery resulted in a 44% reduction in the risk of overall shunt failure. The significant positive impact with regard to shunt-failure-free patient outcomes among patients who underwent VP shunt surgery using this strategy underscores the value associated with the use of these modern intraoperative techniques and cross-specialty collaboration during VP shunt surgery.

Patient outcomes of ventriculoperitoneal (VP) shunt surgery, the mainstay treatment for hydrocephalus in adults, are poor due to high shunt failure rates. We present intraoperative footage of VP shunt insertion using neuronavigation and laparoscopy guidance, with the goal to reduce the risks of proximal and distal shunt catheter failures, respectively.

神经导航和腹腔镜引导脑室腹腔分流插入治疗脑积水

Hydrocephalus is a common adult neurosurgical condition typically requiring treatment with a cerebrospinal fluid (CSF) shunt, of which the ...

一种有效的高速气动钻头开颅术以进入猪脑

Accessing the Porcine Brain via High-Speed Pneumatic Drill Craniectomy

The use of pigs as an experimental animal model is especially relevant in neuroscience research, as the porcine and human central nervous systems (CNS) share many important functional and architectural properties. Consequently, pigs are expected to have an increasingly important role in future research on various neurological diseases. Here, a method to perform an anterior craniectomy through the porcine frontal bone is described. After a midline incision and subsequent exposure of the porcine frontal bone, anatomical landmarks are used to ensure the optimal location of the craniectomy. By careful and gradual thinning of the frontal bone with a rounded drill, a rectangular opening to the dura mater and underlying cerebral hemispheres is achieved. The presented method requires certain surgical materials, including a pneumatic high-speed drill, and some degree of surgical experience. Potential complications include unintended lesions of the dura mater or dorsal sagittal sinus. However, the method is simple, time-efficient, and offers a high degree of reproducibility for researchers. If performed correctly, the technique exposes a large portion of the unaffected pig brain for various neuromonitoring or analyses.

作者聚焦：一种通过颅骨切除术进入猪脑的可重复且有效的方法

This protocol describes performing a craniectomy using a high-speed pneumatic drill on a 3-month-old Danish Landrace pig. The access is made through the frontal bone and reveals the ventral dura mater and underlying cerebral hemispheres. This procedure allows for access to a large portion of the pig brain.

通过高速气动钻头开颅术进入猪脑

The use of pigs as an experimental animal model is especially relevant in neuroscience research, as the porcine and human central nervous systems (CNS) ...

内窥镜下第三脑室造口术和松果体活检从单一入口点

副本

摘要

探索更多视频

此视频中的章节

微血管减压:突出的手术原则和技术的细微差别

微创拇指大小翼点入开颅未破裂前循环动脉瘤的手术夹子结扎

脑动静脉畸形的综合血管内和开放性手术治疗

在耐药性颞叶癫痫患者卵圆孔电极记录的网络分析

内镜下鼻跨蝶入路: 垂体腺瘤的微创手术

An Endoscopic Transcanal Transpromontorial Approach for Vestibular Schwannomas using a Computer-Based Three-Dimensional Imaging System

扩散MRI造影术在内窥镜内窥镜颅骨基础外科中的作用

神经导航和腹腔镜引导脑室腹腔分流插入治疗脑积水

通过高速气动钻头开颅术进入猪脑

通过高速气动钻头开颅术进入猪脑