Microsurgical and neuro endoscopic anatomy for frontolateral keyhole approach / 中华显微外科杂志

Objective To explore and compare the relevant regional anatomies as they relate the fron- tolateral keyhole approach under microscopy and neuroendoscopy for operations in anterior cranial base and sellar region.Methods Fifteen silieone-injected cadaveric heads were dissected to reveal and compare the extent of expesure through the transfrontolateral keyhole approach under neuroendoscopy and microscopy. Results Portions in the areas of olfactory groove,sellar region and sylvian tissure were blind under micro- scope.Endoscope could allow observation of areas considered blind under the microscope.It could increase light intensity during the approach to objects,extend viewing angles,clear depiction of details in close-up po- sitions and inspect hidden structures.But images of endoscope were two dimensional,lack of view depth.Mi- croscopy and neuroendoscopy could help each other to recuperate deficiency.Conclusion Endoscope-assis- ted neuromicrosurgery is helpful,safe and minimally invasive to treat deepseated lesions in anterior cranial base,sellar region by transfrontolateral keyhole approach.

Transcaliosum interfornix approach to microsurgically remove the tumors of the third ventricle / 中华显微外科杂志

Objevtive To explore the microsurgical methods for resecting the tumors of the third ven- tricle and discuss the anatomic foundation of mircrosurgical methods.Methods Twelve patients with tumors of third ventricle were operated on via approach of transcallosum interfornix.Pathologic diagnoses included eight craniopharyngiomas intruding the third ventricle,two gliomas in medial thalamus,one ependymoma and one teratoma.Results Total removal in microscope of the tumors were achieved in 10 cases and subtotal re- moval in 2 cases.The percentage of total resections achieved to 83.3%.Seven of eight craniopharyngiomas were totally resected and the postoperative MR indicated no remanent or recurrent tumors.No death occurred in all cases and the recent complications which were disappeared after one or two weeks' management mostly included polydipsia,diuresis and electrolyte disturbances.Long termed complications included two hydren- cephalus and two spontaneously absorbed subdural fluidifies ventricle-abodminal shunt was performed in one case.The time of follow-up continued were between two months to two and a half years.One subtotal resected craniopharyngiomas was relapesed in eight months,one glioma in thalamus was relapesed in one year and in the remanent ten cases nine can live normally and one can live with self-care.Conclusion Transcallosum interfornix approach for microsurgically removing the third ventricle tumors reached the third ventricle through the rudimental tissue space of embryonic tissue.It can provide a slight trauma,a quite large operative field, euthyhoria for operating.We can use this appoach to resect the tumors located in all directions in the third ven- tricle.The percentage of total resection was large and few complications occurred.