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Anatomical study of endoscope-assisted far lateral keyhole approach to the ventral craniocervical region with neuronavigational guidance

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Chinese Medical Journal 2013年第9期126卷 1707-1713页

作者： GUAN Min-wu WANG Jia-yin FENG Dong-xia Paul Fu CHEN Li-hua LI Ming-chu ZHANG Qiu-hang Amir Samii Madjid Samii KONG Feng ZHANG Zhi-ping CHEN Ling Department of Neurosurgery Xuanwu Hospital Capital Medical University China International Neuroscience Institute Beijing 100053 China Beijing Geriatric Medical Research Center Beijing 100053 China Department of Neurosurgery University of Arkansas for Medical Science Little rock Arkansas 72205 USA Department of Neurosurgery Wayne State University School of Medicine Detroit Michigan 48236 USA Department of Neurosurgery International Neuroscience Institute Hannover 30625 Germany

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

关键词： far lateral approach neuroendoscope neuronavigation keyhole approach ventral craniocervicaljunction

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Classification and microsurgical treatment of foramen magnum meningioma

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Chinese Neurosurgical Journal 2023年第2期9卷 114-126页

作者： Pengfei Wu Yanlei Guan Minghao Wang Luyang Zhang Dan Zhao Xiao Cui Jiyuan Liu Bo Qiu Jun Tao Yunjie Wang Shaowu Ou Department of Neurosurgery the First Affiliated HospitalChina Medical University155 Nanjing StreetHeping DistrictShenyang 110001LiaoningChina

Background To investigate the classification and microsurgical treatment of foramen magnum meningioma(FMM).Methods We retrospectively analyzed 76 patients with FMM and classified them into two classifications,classification ABS according to the relationship between the FMM and the brainstem and classification SIM according to the relationship between the FMM and the vertebral artery(VA).All patients underwent either the far lateral approach(54 cases)or the suboccipital midline approach(22 cases).Results Of the 76 cases,47 cases were located ahead of the brainstem(A),16 cases at the back of the brainstem(B),and 13 cases were located laterally to the brainstem(S).There were 15 cases located superior to the VA(S),49 cases were inferior(I),and 12 cases were mixed type(M).Among 76 cases,71 cases were resected with Simpson grade 2(93.42%),3 with Simpson grade 3(3.95%),and 2 with Simpson grade 4(2.63%).We summarized four anatomical triangles:triangles SOT,VOT,JVV,and *** mean postoperative Karnofsky performance score was improved in all patients(papproach and predicting the difficulty of FMMs,and it is of great importance to master the content,position relationship with the tumor,and variable anatomical structures in the four"triangles"for the success of the operation.

关键词： Classification Anatomical triangles Foramen magnum meningioma Microsurgical treatment far lateral approach

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