Objective

The supracerebellar infratentorial (SCIT) approach is frequently used for the treatment of lesions in the pineal and posterior third ventricle region and can be performed in a sitting or prone position. We describe our experience with the purely endoscopic SCIT approach, using a prone position, with neck extension and head rotation.

Methods

We analysed all paediatric and adult patients operated on between July 2013 and January 2018 using the purely endoscopic SCIT approach.

The surgical procedure was conducted through a paramedian subtorcular key-hole suboccipital craniotomy. The assistant held the endoscope and the surgeon used fine, long shaft instruments for bimanual tumour dissection. The prone position with head retroflexion allowed a gravity-aided enlargement of the anatomical surgical corridor between tentorium and cerebellum and enhanced venous blood drainage, similarly to the sitting or semi-sitting position, but with a decreased risk of air embolism.

Results

The approach allowed a complete removal of lesions located in the pineal region and in the posterior part of the third ventricle. Seven patients have been operated with this approach. All of them had the tumour completely removed. No permanent neurological deficits have been observed.

Conclusions

The endoscopic SCIT approach enables effective and safe removal of pineal and posterior third ventricle lesions, even of moderate dimensions (up to 3 cm). The endoscope guarantees a detailed view and illumination of the deep-seated structures. The tumour resection can be performed with bimanual use of microsurgical instruments.

中文翻译：

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内镜下小脑腓肠肌入路法治疗松果体和松散位的松果体和后第三脑室病变：技术说明

目的

小脑上膀胱下肌（SCIT）方法通常用于治疗松果体和第三脑室后部区域的病变，可以坐下或俯卧。我们用俯卧位，颈部延伸和头部旋转的纯内镜SCIT方法描述我们的经验。

方法

我们使用纯内窥镜SCIT方法分析了2013年7月至2018年1月之间手术的所有儿科和成年患者。

手术过程通过中上眼睑下锁孔下枕下开颅手术进行。助手拿着内窥镜，外科医生使用精细的长柄器械进行双手肿瘤解剖。与头坐位或半坐位相似，俯卧位使头部向后弯曲，可在重力帮助下扩大ten肌和小脑之间的解剖外科手术通道，并增强静脉血液排出，但降低了空气栓塞的风险。

结果

该方法可以完全清除位于松果体区域和第三脑室后部的病变。该方法已手术治疗了七名患者。他们所有人都完全切除了肿瘤。没有观察到永久性神经功能缺损。

结论

内窥镜SCIT方法能够有效，安全地去除甚至是中等尺寸（最大3厘米）的松果体和第三脑室后部病变。内窥镜可确保深层结构的详细视图和照明。肿瘤切除可以通过双手使用显微外科手术器械来进行。