ABSTRACT

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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俯卧位仰卧位松果体和第三脑室后部病变的内窥镜小脑幕下入路：技术说明。

摘要

客观的

小脑幕下 (SCIT) 入路常用于治疗松果体和第三脑室后区的病变，可以坐位或俯卧位进行。我们描述了我们使用纯内窥镜 SCIT 方法的经验，使用俯卧位，颈部伸展和头部旋转。

方法

我们使用纯内窥镜 SCIT 方法分析了 2013 年 7 月至 2018 年 1 月期间手术的所有儿童和成人患者。

外科手术是通过旁正中斜下锁孔枕下开颅术进行的。助手拿着内窥镜，外科医生使用细长的长轴器械进行双手肿瘤解剖。头部后屈的俯卧位允许重力辅助扩大小脑幕和小脑之间的解剖手术通道并增强静脉血引流，类似于坐位或半坐位，但空气栓塞的风险降低。

结果

该方法允许完全去除位于松果体区和第三脑室后部的病变。已经有七名患者使用这种方法进行了手术。他们都完全切除了肿瘤。没有观察到永久性神经功能缺损。

结论

内窥镜 SCIT 方法能够有效和安全地切除松果体和第三脑室后部病变，即使是中等尺寸（最大 3 厘米）。内窥镜保证了深层结构的详细视图和照明。可以通过双手使用显微外科器械进行肿瘤切除。