|
1
|
Tosi U, Guadix SW, Souweidane MM. Neuroendoscopy: The State of the Art. World Neurosurg 2023; 178:305-310. [PMID: 37803686 DOI: 10.1016/j.wneu.2023.07.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 10/08/2023]
Abstract
Over the past century, neuroendoscopy developed into a mainstay of neurosurgical practice, allowing for minimally invasive approaches to the ventricles, skull base, and spine. Its development, however, is far from over. Current challenges are inherent in the very feature that renders neuroendoscopy appealing-the small channels of the modern endoscope allow surgery to be performed with minimal tissue retraction, but they also make hemostasis and resection of large masses difficult. New optics allow for significantly improved image quality; yet open craniotomy often allows for 3-dimensional visualization and bimanual dissection and is part of everyday neurosurgical training. Finally, the utilization of neuroendoscopy remains limited, presenting ongoing challenges for neurosurgical teaching and achievement of technical mastery.
Collapse
Affiliation(s)
- Umberto Tosi
- Department of Neurological Surgery, NewYork-Presbyterian Weill Cornell Medicine, New York, New York, USA
| | - Sergio W Guadix
- Department of Neurological Surgery, NewYork-Presbyterian Weill Cornell Medicine, New York, New York, USA
| | - Mark M Souweidane
- Department of Neurological Surgery, NewYork-Presbyterian Weill Cornell Medicine, New York, New York, USA.
| |
Collapse
|
|
2
|
Liu P, Wang X, Liu Y, Cai J, Yang Z, Quan K, Zhu W, Song J. Surgical Management of Falcotentorial Junction Tumors: A Case Series Report. Front Oncol 2022; 12:866225. [PMID: 35619919 PMCID: PMC9128551 DOI: 10.3389/fonc.2022.866225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The surgical strategy for falcotentorial junction tumors remains complex. Different approaches are selected according to the location and growth pattern of the tumor and the operator's experience. This report reviews our single-institution experience in the surgical management of falcotentorial junction tumors. Methods We retrospectively reviewed the clinical and imaging data, surgical strategy, and follow-up outcomes of 49 patients treated from 2007 to 2020. Result All 49 patients (12 male, 37 female, mean age: 56.3 ± 11.3 years) underwent safe tumor resection. The most common complaints were headache (43%), dizziness (39%), and unstable gait (16%). Thirty percent of the tumors showed calcification, and the computed tomography scans revealed hydrocephalus in 36% of the patients. On magnetic resonance imaging, 43% of the tumors were unilateral. According to the Asari classification, the tumors were divided into inferior (16%), superior (29%), anterior (22%), and posterior (33%) types. The occipital interhemispheric approach (88%) and supracerebellar-infratentorial approach (10%) were primarily used to reach the tumors. The pathology examination results revealed that 85.7% of the tumors were meningioma and 14.3% were hemangiopericytoma. Of the 49 patients, 15 achieved a Simpson grade I resection, and 29 achieved a Simpson grade II resection. The follow-up rate was 77.6% (38/45); 94.7% of patients (36/38) achieved a favorable outcome, and 9 experienced tumor recurrences. Conclusion Surgical approach selection depends on the growth characteristics of the tumor and the degree of venous or sinus involvement. The occipital interhemispheric approach is the most commonly used and safest approach for falcotentorial junction tumors with multiple brain pressure control assistance techniques.
Collapse
Affiliation(s)
- Peixi Liu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Fudan University, Shanghai, China.,Neurosurgical Institute, Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Fudan University, Shanghai, China
| | - Xiaowen Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Fudan University, Shanghai, China.,Neurosurgical Institute, Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Fudan University, Shanghai, China
| | - Yingjun Liu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Fudan University, Shanghai, China.,Neurosurgical Institute, Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Fudan University, Shanghai, China
| | - Jiajun Cai
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Fudan University, Shanghai, China.,Neurosurgical Institute, Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Fudan University, Shanghai, China
| | - Zixiao Yang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Fudan University, Shanghai, China.,Neurosurgical Institute, Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Fudan University, Shanghai, China
| | - Kai Quan
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Fudan University, Shanghai, China.,Neurosurgical Institute, Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Fudan University, Shanghai, China
| | - Wei Zhu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Fudan University, Shanghai, China.,Neurosurgical Institute, Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Fudan University, Shanghai, China
| | - Jianping Song
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Fudan University, Shanghai, China.,Neurosurgical Institute, Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Fudan University, Shanghai, China
| |
Collapse
|
|
3
|
Gu Y, Zhou Q, Zhu W, Wu Q, Xie T, Wu S, Hu F, Yu Y, Sun C, Li C, Zhang B, Zhan L, Zhang X. The Purely Endoscopic Supracerebellar Infratentorial Approach for Resecting Pineal Region Tumors with Preservation of Cerebellomesencephalic Vein: Technical Note and Preliminary Clinical Outcomes. World Neurosurg 2019; 128:e334-e339. [PMID: 31028986 DOI: 10.1016/j.wneu.2019.04.146] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/08/2019] [Accepted: 04/16/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The cerebellomesencephalic vein (CMV) was frequently sacrificed in surgery approached via the supracerebellar infratentorial (SCIT) route for resecting pineal region tumors, which resulted in potential risk of neurologic deficit. Preserving the CMV in the SCIT approach could enhance the safety and effectiveness of this natural corridor surgery. The aim of this article was to identify the probability and safety of preserving the CMV through the application of neuroendoscopy in the SCIT approach. METHODS Clinical data of patients who underwent pineal region tumor resection through a purely endoscopic SCIT approach were retrospectively analyzed, focusing on surgical techniques and clinical outcomes. RESULTS The study included 8 patients with pineal region tumors. The CMV was preserved intact in all patients. Total tumor removal was achieved in 7 of 8 patients. In 1 patient with 2 tumors in the pineal region and roof of the third ventricle, the tumor in the pineal region was resected completely, followed by subsequent chemotherapy combined with radiotherapy, after which the other tumor disappeared totally. All patients recovered normally with uneventful postoperative outcomes. CONCLUSIONS The advantage of close observation and panoramic view provided by neuroendoscopy combined with meticulous manipulation improved the ability to preserve the CMV in resecting pineal region tumors via the SCIT approach. The neuroendoscopic technique enhances the safety and efficacy of the SCIT approach.
Collapse
Affiliation(s)
- Ye Gu
- Department of Neurosurgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China; Shanghai Key Laboratory of Medical Image Computing and Computer Assisted Intervention, Shanghai Medical College, Fudan University, Shanghai, China
| | - Quan Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wei Zhu
- Department of Neurosurgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Qi Wu
- Department of Neurosurgery, Zhenjiang First People's Hospital, Zhenjiang, China
| | - Tao Xie
- Department of Neurosurgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Silin Wu
- Department of Neurosurgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Fan Hu
- Department of Neurosurgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China; Shanghai Key Laboratory of Medical Image Computing and Computer Assisted Intervention, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yong Yu
- Department of Neurosurgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Chongjing Sun
- Department of Neurosurgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Chen Li
- Department of Neurosurgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Bo Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Guiyang College of Traditional Chinese Medicine, Guiyang, China
| | - Liping Zhan
- Department of Neurosurgery, Zhenjiang First People's Hospital, Zhenjiang, China
| | - Xiaobiao Zhang
- Department of Neurosurgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China; Shanghai Key Laboratory of Medical Image Computing and Computer Assisted Intervention, Shanghai Medical College, Fudan University, Shanghai, China.
| |
Collapse
|