Background Keyhole surgery has developed since the 1990s as a less invasive therapeutic strategy for intracranial lesions, initially for the treatment of intracranial aneurysms. The purpose of this study was to descri...Background Keyhole surgery has developed since the 1990s as a less invasive therapeutic strategy for intracranial lesions, initially for the treatment of intracranial aneurysms. The purpose of this study was to describe and evaluate the results of surgical treatment of lesions in the anterior fossa and sellar region via a supraorbital keyhole approach using eyebrow incisions. Methods Between April 1994 and July 2003, 54 patients with lesions in the anterior fossa and sellar region were operated on via the supraorbital keyhole approach. The surgical results were studied retrospectively and compared with that of patients with lesions at the same locations but treated via a conventional subfrontal approach.Results No significant difference in curative effect was found between the conventional subfrontal approach and the supraorbital keyhole approach. However, the supraorbital approach required a much smaller skin incision, causing less surgical trauma, while achieving excellent surgical exposure and good recovery. Conclusion The supraorbital keyhole approach using an eyebrow incision is safe, effective, and both suitable and convenient for treating lesions in the anterior fossa and sellar region, with almost no adverse consequences on the facial features of patients.展开更多
Objective To design a paramedian supracerebelalr infratentorial keyhole approach by applying the keyhole conception and explore its feasibility. The keyhole approach is imitated and microanatomical structures are obse...Objective To design a paramedian supracerebelalr infratentorial keyhole approach by applying the keyhole conception and explore its feasibility. The keyhole approach is imitated and microanatomical structures are observed,which could be reference of this approach in clinical use. Methods The paramedian展开更多
Background:Meningiomas are rather uncommon tumors in the pediatric population,differing significantly from those found in adults by their atypical location,higher rate of more malignant types,consequently higher risk ...Background:Meningiomas are rather uncommon tumors in the pediatric population,differing significantly from those found in adults by their atypical location,higher rate of more malignant types,consequently higher risk of recurrence and a less favorable outcome.Even in children,suprasellar meningiomas without dural matrix are rare findings mimicking more common suprasellar lesions.Case presentation:Here we describe a case of a 12-year-old girl who presented with a rapidly progressing chiasmal syndrome and was diagnosed by MRI with an unusual suprasellar tumor that could not fit the diagnoses expected in a case of a parasellar mass in a child,similar to a craniopharyngioma or optic pathway glioma.After multiple clinical investigations,the tumor etiology was still unclear,so the preferred option of treatment was surgical resection.An endoscope-assisted gross total resection through a supraorbital keyhole approach was performed uneventfully,with total vision recovery in a short time.Benign meningiomas located in the skull base without dural attachment appear to be rare,even in pediatric patients.Conclusion:Differential diagnoses of suprasellar and para sellar tumor lesions in pediatric patients can be confusing.There are peculiar features of pediatric tumor diseases that should be considered while working out the management strategy.The main principle of meningioma treatment is the highest possible extent of resection minimally affecting the quality of life.展开更多
Background In China, the feasibility of keyhole approach in surgical treatment of petroclival meningioma has not been well evaluated. This report summarized our experience in 25 patients with petroclival meningioma wh...Background In China, the feasibility of keyhole approach in surgical treatment of petroclival meningioma has not been well evaluated. This report summarized our experience in 25 patients with petroclival meningioma who had been treated with keyhole approach surgery. Methods From July 2000 to July 2005, 25 patients with petroclival meningioma were subjected to resection via subtemporal, retrosigmoid or combined keyhole approaches. The extent of tumor resection was evaluated by MRI 3 months after surgery, and postoperative complications were investigated. Results The maximum diameter of tumors ranged from 2 to 7 cm （mean, 4.5 cm）. Gross total resection （GTR） was achieved in 14 patients, giving a GTR rate of 56%. Subtotal resection （STR） was carried out in 8 patients and partial resection in 3. Thirteen patients kept normal neurological status, whereas others suffered from cranial nerve deficits （Ⅶ, Ⅶ, Ⅲ and lower CN）. One patient died in the postoperative period. Conclusions Keyhole approach surgery, especially the combined keyhole approach is suitable for the treatment of petroclival meningioma. It provides easy and quick access to the supra- and infratentorial juxta-clival region without drilling of the petrous bone. Complications related to the approach can be minimized.展开更多
Background Image-guided neurosurgery, endoscopic-assisted neurosurgery and the keyhole approach are three important parts of minimally invasive neurosurgery and have played a significant role in treating skull base le...Background Image-guided neurosurgery, endoscopic-assisted neurosurgery and the keyhole approach are three important parts of minimally invasive neurosurgery and have played a significant role in treating skull base lesions. This study aimed to investigate the potential usefulness of coupling of the endoscope with the far lateral keyhole approach and image guidance at the ventral craniocervical junction in a cadaver model. Methods We simulated far lateral keyhole approach bilaterally in five cadaveric head specimens （10 cranial hemispheres）. Computed tomography-based image guidance was used for intraoperative navigation and for quantitative measurements. Skull base structures were observed using both an operating microscope and a rigid endoscope. The jugular tubercle and one-third of the occipital condyle were then drilled, and all specimens were observed under the microscope again. We measured and compared the exposure of the petroclivus area provided by the endoscope and by the operating microscope. Statistical analysis was performed by analysis of variance followed by the Student-Newman-Keuls test. Results With endoscope assistance and image guidance, it was possible to observe the deep ventral craniocervical junction structures through three nerve gaps （among facial-acoustical nerves and the lower cranial nerves） and structures normally obstructed by the jugular tubercle and occipital condyle in the far lateral keyhole approach. The surgical area exposed in the petroclival region was significantly improved using the 0° endoscope （1147.80 mm2） compared with the operating microscope （（756.28±50.73） mm2）. The far lateral retrocondylar keyhole approach, using both 0° and 30° endoscopes, provided an exposure area （（1147.80±159.57） mm2 and （1409.94±155.18） mm2, respectively） greater than that of the far lateral transcondylar transtubercular keyhole approach （（1066.26±165.06） mm2） （P 〈0.05）. Conclusions With the aid of the endoscope and image guidance, it is possible to approach the ventral craniocervical junction with the far lateral keyhole approach. The use of an angled-lens endoscope can significantly improve the exposure of the petroclival region without drilling the jugular tubercle and occipital condyle.展开更多
Background In recent years, keyhole microsurgery has become an important subject of modern minimally invasive neurosurgery. In this study, minimally invasive techniques avoiding unnecessary tissue injuries were applie...Background In recent years, keyhole microsurgery has become an important subject of modern minimally invasive neurosurgery. In this study, minimally invasive techniques avoiding unnecessary tissue injuries were applied to refine traditional approaches for the removal of third ventricular tumors within a limited operative filed. Methods Individualized keyhole approaches were designed according to the characteristics of third ventricular tumors and their growth patterns. A series of keyhole approaches such as supraorbital subfrontal approach, infratentorial supracerebellar approach, interhemispheric transcallosal approach, pterional approach were taken to enter the third ventricle anteriorly, posteriorly, superiorly or laterally, respectively. A total of 34 removed tumors in or extended into the third ventricle included 11 craniopharyngiomas, 10 pituitary adenomas, 2 pinealomas, 1 cholesteatoma, 3 germinomas, and 7 gliomas. Results Total tumor resection was done in 27 （79.4%） of the patients, and subtotal resection in 7 patients （20.6%）. Residual tumor was due to tight adherence of germinoma to the vein of Galen （1 patient）, craniopharyngioma to the pituitary stalk （3）, supratentorial extension of pineal region gliomas （1）, suprasellar extension of gliomas （1） and giant pituitary adenoma （1）. Complications such as brain contusion, postoperative hemorrhage and infection were not associated with keyhole approaches. Extended incision or enlarged bone flap was not made because of episode during operation or inadequate exposure. Conclusions Keyhole approaches are safe, effective and minimally invasive in the surgical treatment of tumors deeply seated in the third ventricle. Individualized keyhole approach ensures a successful treatment. Tumors in the upper middle part of the third ventricle can be exposed by the interhemispheric transcallosal keyhole approach. Tumors of the posterior third ventricle may be well exposed by the infratentorial supracerebellar keyhole approach. Tumors of the anterior third ventricle can be entered by either a supraorbital subfrontal keyhole approach or a pterional keyhole approach.展开更多
Background Despite the presigmoid transpetrosal approach has been used by different researchers in various ways, the surgical injury rate remains high. Applying a minimally invasive keyhole idea, we devised a presigmo...Background Despite the presigmoid transpetrosal approach has been used by different researchers in various ways, the surgical injury rate remains high. Applying a minimally invasive keyhole idea, we devised a presigmoid transpetrosal keyhole approach （PTKA）, classified and quantitatively assessed their approach to the petroclival area on a cadaver model by using a neuronavigation system. Methods The presigmoid transpetrosal keyhole approach was divided into four increasingly morbidity-producing steps： retrolabyrinthine, partial labyrinthectomy with petrous apicectomy, translabyrinthine and transcochlear keyhole approaches. Six latex-injected cadaveric heads （twelve sides） underwent dissection in which a neuronavigation system was used. An area of exposure 10 cm superficial to a central target （working area） was calculated. The area of clival exposure with each subsequent dissection was also calculated. Results The retrolabyrinthine keyhole approach （RLK） spares hearing and facial function in theory but provides for only a small window of upper clival exposure. The view afforded by partial labyrinthectomy with petrous apicectomy keyhole approach （PLPAK） provides for up to four times this exposure. The translabyrinthine keyhole approach （TLK） and transcochlear keyhole approach （TCK）, although producing more morbidity, add little in terms of a larger petroclival window. However, with each step, the surgical freedom for manipulation of instruments increases. Conclusions The presigmoid transpetrosal keyhole approach to the petroclival area is feasible and useful. The RLK has relatively limited utility. For lesions without bone invasion, the PLPAK provides a much more versatile exposure with an excellent chance of hearing and facial nerve preservation. The TLK provides for greater versatility in treating lesions but clival exposure is not greatly enhanced. The TCK adds little in terms of intradural exposure but should be reserved for cases in which access to the petrous carotid artery is necessary.展开更多
Background:The Middle cerebral artery (MCA) aneurysm is a common type of craniocerebral aneurysm that is prone to rupture and high mortality. The classic surgical approaches are the Pterional approach and the Lateral ...Background:The Middle cerebral artery (MCA) aneurysm is a common type of craniocerebral aneurysm that is prone to rupture and high mortality. The classic surgical approaches are the Pterional approach and the Lateral Supraorbital (LSO) approach, but there are shortcomings. Methods:This study retrospectively analyzed clinical and imaging data from 181 patients with MCA aneurysm clipping in the Department of Neurosurgery, First Affiliated Hospital of Soochow University between 2011 and 2017. Statistical analysis using parametric and nonparametric tests showed that P values below 0.05 were considered statistically significant. Results: The preoperative GCS score (P=0.003), Hunt-Hess scale (P < 0.001) and the operating habits of the surgeon (P < 0.001) affected the surgeon to choose a surgical approach. The choice of two surgical methods on the operation time (P < 0.001), skin incision (P < 0.001), complications (P=0.026), tracheotomy (P=0.014), prognosis (P=0.002) were significantly different. Different surgical approaches (P=0.002), Hunt-Hess scale (P <0.001), GCS scale (P < 0.001), GCS sorse (P < 0.001), skin incision (P=0.031) and complications (P < 0.001) are closely related to the prognosis of patients. Conclusions: Modified LSO approach provides another surgical approach for MCA aneurysm clipping, while avoiding the drawbacks of the LSO approach in the clipping of MCA distal aneurysm.展开更多
Background: Craniopharyngioma is a kind of intracranial benign tumor that is primarily treated with surgery. At present, a variety of surgical approaches are used for tumor resection. We have conducted a comparative a...Background: Craniopharyngioma is a kind of intracranial benign tumor that is primarily treated with surgery. At present, a variety of surgical approaches are used for tumor resection. We have conducted a comparative analysis of the two approaches most used in our department. Methods: The study retrospectively analyzed the clinical data from 65 patients with craniopharyngioma surgically treated by the two approaches mentioned above. Among these patients, 24 were treated by lateral supraorbital (LSO) approach and 41 by standard pterional approach. Indicators including, but not limited to, length of incision, operation time, postoperative pituitary function, urine volume, visual function improvement, and hospitalization were used to compare these two groups of patients. Results: The data shows that there was no significant difference in total tumor resection rate (P=0.54), postoperative visual field improvement (P=0.68) and postoperative function of endocrine. However, the LSO approach significantly reduced the operative incision (P=0.001), shortened the operation time (P=0.001) and operative complexity, while reducing the incidence of postoperative complications (P=0.04). Conclusions: In surgical treatment of craniopharyngioma, LSO approach has similar surgical effect with standard pterional approach, but it can significantly shorten the operation time, reduce surgical trauma and the incidence of complications. Therefore, LSO provides another alternative to surgical approach for microsurgical removal of craniopharyngioma.展开更多
Background: The eyebrow supraorbital keyhole approach could be considered a modified minimally invasive model for the classic pterional subfrontal approach in which an eyebrow incision and supraorbital mini craniotomy...Background: The eyebrow supraorbital keyhole approach could be considered a modified minimally invasive model for the classic pterional subfrontal approach in which an eyebrow incision and supraorbital mini craniotomy are performed for exposure of the anterior cranial fossa corridor. Methods: This study was retrospectively conducted on twenty four patients, age ranging from 20 to 65 years old, with anterior cranial fossa lesions who were meeting the eligibility criteria for eyebrow craniotomy in the period from August 2019 to January 2023. These patients were operated through eyebrow supraorbital approach in which microscopic endoscopic assisted technique were used. Extent of resection, clinical and cosmetic outcomes and complication incidence were assessed. Results: We included the twenty four patients who met inclusion criteria (17 females and 7 males) their ages ranged from 20 to 65 years. The most common pathology was meningioma in 19 patients. Two patients experienced supraorbital loss of sensation and only one patient experienced palsy of frontalis branch of facial nerve. Frontal sinus was breached in 3 patients with no patient experienced postoperative CSF leak. Total excision was accomplished for 23 patients. Four patients who had preoperative visual compromise, improvement of visual acuity and field defects was observed in 3 patients. No major intraoperative complications occurred. All patients filled cosmetic satisfaction questionnaire during their outpatient visits. For the eyebrow supraorbital approach, no incision related intolerable pain, no craniotomy defects or irregularities, no cosmetic complaints nor limitation of jaw opening were reported, and only minor symptoms in the form of limited eyebrow elevation, swelling and numbness in the forehead. Conclusions: The eyebrow craniotomy could be used safely as a more cosmetic and minimally invasive approach for a variety of anterior cranial fossa lesions. Endoscopic assistance has been found very useful for deeply seated lesions and hidden residuals with minimal brain retraction which couldn’t be accessed easily through microscopic field solely. Endoscopic assisted eyebrow supraorbital keyhole approach could be performed on a wider scale with great results but requires good selection of cases and more practice to expertise the needed skills.展开更多
目的比较神经内镜下经眶上锁孔入路与显微镜下经侧裂岛叶入路治疗高血压性基底节区脑出血的临床效果。方法选取52例进行手术治疗的高血压性基底节区脑出血患者进行回顾性分析,根据手术方式不同分为内镜组(28例,采用神经内镜下经眶上锁...目的比较神经内镜下经眶上锁孔入路与显微镜下经侧裂岛叶入路治疗高血压性基底节区脑出血的临床效果。方法选取52例进行手术治疗的高血压性基底节区脑出血患者进行回顾性分析,根据手术方式不同分为内镜组(28例,采用神经内镜下经眶上锁孔入路治疗)和显微镜组(24例,采用显微镜下经侧裂岛叶入路治疗)。比较两组患者手术时间、术中出血量、血肿清除率、住院时间、术后7 d格拉斯哥昏迷评分法(GCS)评分、神经功能缺损程度、术后并发症发生情况、颅内再出血情况及预后情况。结果内镜组手术时间(82.35±15.26)min、住院时间(11.58±2.09)d短于显微镜组的(162.47±20.43)min、(14.67±2.11)d,术中出血量(109.58±20.45)ml少于显微镜组的(161.67±38.78)ml,血肿清除率(88.24±8.68)%、术后7 d GCS评分(12.88±1.56)分高于显微镜组的(83.07±7.81)%、(11.16±1.24)分,差异有统计学意义(P<0.05)。两组术前美国国立卫生研究院卒中量表(NIHSS)评分比较差异无统计学意义(P>0.05);内镜组术后1周NIHSS评分(7.86±1.56)分低于显微镜组的(11.12±1.83)分,差异有统计学意义(P<0.05)。两组颅内感染、脑脊液漏、继发性脑梗发生率及颅内再出血发生率比较,差异均无统计学意义(P>0.05)。两组格拉斯哥预后评分法(GOS)评分比较,差异无统计学意义(P>0.05)。结论神经内镜下经眶上锁孔入路可以有效治疗高血压性基底节区脑出血,能明显减少术中出血量,提高血肿清除率、术后GCS评分,缩短手术时间和住院时间,且安全性和预后与显微镜下经侧裂岛叶入路手术无明显差异。展开更多
文摘Background Keyhole surgery has developed since the 1990s as a less invasive therapeutic strategy for intracranial lesions, initially for the treatment of intracranial aneurysms. The purpose of this study was to describe and evaluate the results of surgical treatment of lesions in the anterior fossa and sellar region via a supraorbital keyhole approach using eyebrow incisions. Methods Between April 1994 and July 2003, 54 patients with lesions in the anterior fossa and sellar region were operated on via the supraorbital keyhole approach. The surgical results were studied retrospectively and compared with that of patients with lesions at the same locations but treated via a conventional subfrontal approach.Results No significant difference in curative effect was found between the conventional subfrontal approach and the supraorbital keyhole approach. However, the supraorbital approach required a much smaller skin incision, causing less surgical trauma, while achieving excellent surgical exposure and good recovery. Conclusion The supraorbital keyhole approach using an eyebrow incision is safe, effective, and both suitable and convenient for treating lesions in the anterior fossa and sellar region, with almost no adverse consequences on the facial features of patients.
文摘Objective To design a paramedian supracerebelalr infratentorial keyhole approach by applying the keyhole conception and explore its feasibility. The keyhole approach is imitated and microanatomical structures are observed,which could be reference of this approach in clinical use. Methods The paramedian
文摘Background:Meningiomas are rather uncommon tumors in the pediatric population,differing significantly from those found in adults by their atypical location,higher rate of more malignant types,consequently higher risk of recurrence and a less favorable outcome.Even in children,suprasellar meningiomas without dural matrix are rare findings mimicking more common suprasellar lesions.Case presentation:Here we describe a case of a 12-year-old girl who presented with a rapidly progressing chiasmal syndrome and was diagnosed by MRI with an unusual suprasellar tumor that could not fit the diagnoses expected in a case of a parasellar mass in a child,similar to a craniopharyngioma or optic pathway glioma.After multiple clinical investigations,the tumor etiology was still unclear,so the preferred option of treatment was surgical resection.An endoscope-assisted gross total resection through a supraorbital keyhole approach was performed uneventfully,with total vision recovery in a short time.Benign meningiomas located in the skull base without dural attachment appear to be rare,even in pediatric patients.Conclusion:Differential diagnoses of suprasellar and para sellar tumor lesions in pediatric patients can be confusing.There are peculiar features of pediatric tumor diseases that should be considered while working out the management strategy.The main principle of meningioma treatment is the highest possible extent of resection minimally affecting the quality of life.
文摘Background In China, the feasibility of keyhole approach in surgical treatment of petroclival meningioma has not been well evaluated. This report summarized our experience in 25 patients with petroclival meningioma who had been treated with keyhole approach surgery. Methods From July 2000 to July 2005, 25 patients with petroclival meningioma were subjected to resection via subtemporal, retrosigmoid or combined keyhole approaches. The extent of tumor resection was evaluated by MRI 3 months after surgery, and postoperative complications were investigated. Results The maximum diameter of tumors ranged from 2 to 7 cm （mean, 4.5 cm）. Gross total resection （GTR） was achieved in 14 patients, giving a GTR rate of 56%. Subtotal resection （STR） was carried out in 8 patients and partial resection in 3. Thirteen patients kept normal neurological status, whereas others suffered from cranial nerve deficits （Ⅶ, Ⅶ, Ⅲ and lower CN）. One patient died in the postoperative period. Conclusions Keyhole approach surgery, especially the combined keyhole approach is suitable for the treatment of petroclival meningioma. It provides easy and quick access to the supra- and infratentorial juxta-clival region without drilling of the petrous bone. Complications related to the approach can be minimized.
文摘Background Image-guided neurosurgery, endoscopic-assisted neurosurgery and the keyhole approach are three important parts of minimally invasive neurosurgery and have played a significant role in treating skull base lesions. This study aimed to investigate the potential usefulness of coupling of the endoscope with the far lateral keyhole approach and image guidance at the ventral craniocervical junction in a cadaver model. Methods We simulated far lateral keyhole approach bilaterally in five cadaveric head specimens （10 cranial hemispheres）. Computed tomography-based image guidance was used for intraoperative navigation and for quantitative measurements. Skull base structures were observed using both an operating microscope and a rigid endoscope. The jugular tubercle and one-third of the occipital condyle were then drilled, and all specimens were observed under the microscope again. We measured and compared the exposure of the petroclivus area provided by the endoscope and by the operating microscope. Statistical analysis was performed by analysis of variance followed by the Student-Newman-Keuls test. Results With endoscope assistance and image guidance, it was possible to observe the deep ventral craniocervical junction structures through three nerve gaps （among facial-acoustical nerves and the lower cranial nerves） and structures normally obstructed by the jugular tubercle and occipital condyle in the far lateral keyhole approach. The surgical area exposed in the petroclival region was significantly improved using the 0° endoscope （1147.80 mm2） compared with the operating microscope （（756.28±50.73） mm2）. The far lateral retrocondylar keyhole approach, using both 0° and 30° endoscopes, provided an exposure area （（1147.80±159.57） mm2 and （1409.94±155.18） mm2, respectively） greater than that of the far lateral transcondylar transtubercular keyhole approach （（1066.26±165.06） mm2） （P 〈0.05）. Conclusions With the aid of the endoscope and image guidance, it is possible to approach the ventral craniocervical junction with the far lateral keyhole approach. The use of an angled-lens endoscope can significantly improve the exposure of the petroclival region without drilling the jugular tubercle and occipital condyle.
文摘Background In recent years, keyhole microsurgery has become an important subject of modern minimally invasive neurosurgery. In this study, minimally invasive techniques avoiding unnecessary tissue injuries were applied to refine traditional approaches for the removal of third ventricular tumors within a limited operative filed. Methods Individualized keyhole approaches were designed according to the characteristics of third ventricular tumors and their growth patterns. A series of keyhole approaches such as supraorbital subfrontal approach, infratentorial supracerebellar approach, interhemispheric transcallosal approach, pterional approach were taken to enter the third ventricle anteriorly, posteriorly, superiorly or laterally, respectively. A total of 34 removed tumors in or extended into the third ventricle included 11 craniopharyngiomas, 10 pituitary adenomas, 2 pinealomas, 1 cholesteatoma, 3 germinomas, and 7 gliomas. Results Total tumor resection was done in 27 （79.4%） of the patients, and subtotal resection in 7 patients （20.6%）. Residual tumor was due to tight adherence of germinoma to the vein of Galen （1 patient）, craniopharyngioma to the pituitary stalk （3）, supratentorial extension of pineal region gliomas （1）, suprasellar extension of gliomas （1） and giant pituitary adenoma （1）. Complications such as brain contusion, postoperative hemorrhage and infection were not associated with keyhole approaches. Extended incision or enlarged bone flap was not made because of episode during operation or inadequate exposure. Conclusions Keyhole approaches are safe, effective and minimally invasive in the surgical treatment of tumors deeply seated in the third ventricle. Individualized keyhole approach ensures a successful treatment. Tumors in the upper middle part of the third ventricle can be exposed by the interhemispheric transcallosal keyhole approach. Tumors of the posterior third ventricle may be well exposed by the infratentorial supracerebellar keyhole approach. Tumors of the anterior third ventricle can be entered by either a supraorbital subfrontal keyhole approach or a pterional keyhole approach.
文摘Background Despite the presigmoid transpetrosal approach has been used by different researchers in various ways, the surgical injury rate remains high. Applying a minimally invasive keyhole idea, we devised a presigmoid transpetrosal keyhole approach （PTKA）, classified and quantitatively assessed their approach to the petroclival area on a cadaver model by using a neuronavigation system. Methods The presigmoid transpetrosal keyhole approach was divided into four increasingly morbidity-producing steps： retrolabyrinthine, partial labyrinthectomy with petrous apicectomy, translabyrinthine and transcochlear keyhole approaches. Six latex-injected cadaveric heads （twelve sides） underwent dissection in which a neuronavigation system was used. An area of exposure 10 cm superficial to a central target （working area） was calculated. The area of clival exposure with each subsequent dissection was also calculated. Results The retrolabyrinthine keyhole approach （RLK） spares hearing and facial function in theory but provides for only a small window of upper clival exposure. The view afforded by partial labyrinthectomy with petrous apicectomy keyhole approach （PLPAK） provides for up to four times this exposure. The translabyrinthine keyhole approach （TLK） and transcochlear keyhole approach （TCK）, although producing more morbidity, add little in terms of a larger petroclival window. However, with each step, the surgical freedom for manipulation of instruments increases. Conclusions The presigmoid transpetrosal keyhole approach to the petroclival area is feasible and useful. The RLK has relatively limited utility. For lesions without bone invasion, the PLPAK provides a much more versatile exposure with an excellent chance of hearing and facial nerve preservation. The TLK provides for greater versatility in treating lesions but clival exposure is not greatly enhanced. The TCK adds little in terms of intradural exposure but should be reserved for cases in which access to the petrous carotid artery is necessary.
文摘Background:The Middle cerebral artery (MCA) aneurysm is a common type of craniocerebral aneurysm that is prone to rupture and high mortality. The classic surgical approaches are the Pterional approach and the Lateral Supraorbital (LSO) approach, but there are shortcomings. Methods:This study retrospectively analyzed clinical and imaging data from 181 patients with MCA aneurysm clipping in the Department of Neurosurgery, First Affiliated Hospital of Soochow University between 2011 and 2017. Statistical analysis using parametric and nonparametric tests showed that P values below 0.05 were considered statistically significant. Results: The preoperative GCS score (P=0.003), Hunt-Hess scale (P < 0.001) and the operating habits of the surgeon (P < 0.001) affected the surgeon to choose a surgical approach. The choice of two surgical methods on the operation time (P < 0.001), skin incision (P < 0.001), complications (P=0.026), tracheotomy (P=0.014), prognosis (P=0.002) were significantly different. Different surgical approaches (P=0.002), Hunt-Hess scale (P <0.001), GCS scale (P < 0.001), GCS sorse (P < 0.001), skin incision (P=0.031) and complications (P < 0.001) are closely related to the prognosis of patients. Conclusions: Modified LSO approach provides another surgical approach for MCA aneurysm clipping, while avoiding the drawbacks of the LSO approach in the clipping of MCA distal aneurysm.
文摘Background: Craniopharyngioma is a kind of intracranial benign tumor that is primarily treated with surgery. At present, a variety of surgical approaches are used for tumor resection. We have conducted a comparative analysis of the two approaches most used in our department. Methods: The study retrospectively analyzed the clinical data from 65 patients with craniopharyngioma surgically treated by the two approaches mentioned above. Among these patients, 24 were treated by lateral supraorbital (LSO) approach and 41 by standard pterional approach. Indicators including, but not limited to, length of incision, operation time, postoperative pituitary function, urine volume, visual function improvement, and hospitalization were used to compare these two groups of patients. Results: The data shows that there was no significant difference in total tumor resection rate (P=0.54), postoperative visual field improvement (P=0.68) and postoperative function of endocrine. However, the LSO approach significantly reduced the operative incision (P=0.001), shortened the operation time (P=0.001) and operative complexity, while reducing the incidence of postoperative complications (P=0.04). Conclusions: In surgical treatment of craniopharyngioma, LSO approach has similar surgical effect with standard pterional approach, but it can significantly shorten the operation time, reduce surgical trauma and the incidence of complications. Therefore, LSO provides another alternative to surgical approach for microsurgical removal of craniopharyngioma.
文摘Background: The eyebrow supraorbital keyhole approach could be considered a modified minimally invasive model for the classic pterional subfrontal approach in which an eyebrow incision and supraorbital mini craniotomy are performed for exposure of the anterior cranial fossa corridor. Methods: This study was retrospectively conducted on twenty four patients, age ranging from 20 to 65 years old, with anterior cranial fossa lesions who were meeting the eligibility criteria for eyebrow craniotomy in the period from August 2019 to January 2023. These patients were operated through eyebrow supraorbital approach in which microscopic endoscopic assisted technique were used. Extent of resection, clinical and cosmetic outcomes and complication incidence were assessed. Results: We included the twenty four patients who met inclusion criteria (17 females and 7 males) their ages ranged from 20 to 65 years. The most common pathology was meningioma in 19 patients. Two patients experienced supraorbital loss of sensation and only one patient experienced palsy of frontalis branch of facial nerve. Frontal sinus was breached in 3 patients with no patient experienced postoperative CSF leak. Total excision was accomplished for 23 patients. Four patients who had preoperative visual compromise, improvement of visual acuity and field defects was observed in 3 patients. No major intraoperative complications occurred. All patients filled cosmetic satisfaction questionnaire during their outpatient visits. For the eyebrow supraorbital approach, no incision related intolerable pain, no craniotomy defects or irregularities, no cosmetic complaints nor limitation of jaw opening were reported, and only minor symptoms in the form of limited eyebrow elevation, swelling and numbness in the forehead. Conclusions: The eyebrow craniotomy could be used safely as a more cosmetic and minimally invasive approach for a variety of anterior cranial fossa lesions. Endoscopic assistance has been found very useful for deeply seated lesions and hidden residuals with minimal brain retraction which couldn’t be accessed easily through microscopic field solely. Endoscopic assisted eyebrow supraorbital keyhole approach could be performed on a wider scale with great results but requires good selection of cases and more practice to expertise the needed skills.
文摘目的比较神经内镜下经眶上锁孔入路与显微镜下经侧裂岛叶入路治疗高血压性基底节区脑出血的临床效果。方法选取52例进行手术治疗的高血压性基底节区脑出血患者进行回顾性分析,根据手术方式不同分为内镜组(28例,采用神经内镜下经眶上锁孔入路治疗)和显微镜组(24例,采用显微镜下经侧裂岛叶入路治疗)。比较两组患者手术时间、术中出血量、血肿清除率、住院时间、术后7 d格拉斯哥昏迷评分法(GCS)评分、神经功能缺损程度、术后并发症发生情况、颅内再出血情况及预后情况。结果内镜组手术时间(82.35±15.26)min、住院时间(11.58±2.09)d短于显微镜组的(162.47±20.43)min、(14.67±2.11)d,术中出血量(109.58±20.45)ml少于显微镜组的(161.67±38.78)ml,血肿清除率(88.24±8.68)%、术后7 d GCS评分(12.88±1.56)分高于显微镜组的(83.07±7.81)%、(11.16±1.24)分,差异有统计学意义(P<0.05)。两组术前美国国立卫生研究院卒中量表(NIHSS)评分比较差异无统计学意义(P>0.05);内镜组术后1周NIHSS评分(7.86±1.56)分低于显微镜组的(11.12±1.83)分,差异有统计学意义(P<0.05)。两组颅内感染、脑脊液漏、继发性脑梗发生率及颅内再出血发生率比较,差异均无统计学意义(P>0.05)。两组格拉斯哥预后评分法(GOS)评分比较,差异无统计学意义(P>0.05)。结论神经内镜下经眶上锁孔入路可以有效治疗高血压性基底节区脑出血,能明显减少术中出血量,提高血肿清除率、术后GCS评分,缩短手术时间和住院时间,且安全性和预后与显微镜下经侧裂岛叶入路手术无明显差异。
