脑室内腔隙畸形的神经内窥镜手术：适应症和手术注意事项综述。

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-10-28 DOI:10.1016/j.wneu.2024.10.002

Bianca Bossi, Luca Ferlendis, Désirée Dallago, Immacolata Mazzetto, Marco Scarlino, Antonio Tabano, Davide Locatelli

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引用次数: 0

摘要

背景：脑室内海绵畸形（IVC）是中枢神经系统罕见的血管病变。手术切除仍是一项具有挑战性的工作，传统的显微外科技术因直接操作脑组织而导致发病率高。神经内镜方法提供了一种微创替代方案，但其治疗 IVC 的有效性和安全性仍未得到充分探索：方法：我们进行了一项叙述性综述，分析了所有记录在案的完全采用内窥镜经脑室方法（ETVA）治疗 IVC 的病例。研究纳入了1990年至2024年5月发表的综述、原始研究论文和病例报告。结果：结果：共发现17例IVC主要位于门罗孔的患者。IVC 的平均大小为 17 毫米（范围为 7-29 毫米）。神经内镜手术实现了所有病例的大体全切除，从而缓解了临床症状。除一名患者术后出现记忆障碍外，未发现持续性神经功能障碍。术中出血是 IVC 切除术中的一大难题，通过持续温水冲洗和专用凝血器械进行了处理。此外，还报告了6例神经内镜手术，如内镜下第三脑室造口术（ETV）和室间隔切开术，用于治疗脑积水（HCP）：结论：神经内镜手术在治疗脑积水方面具有多项优势，包括微创入路、精确观察和减少脑组织操作。我们的研究结果支持 ETVA 的有效性和安全性，强调了其作为一种治疗特定 IVC 的重要策略的潜力。

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Neuroendoscopic Surgery for Intraventricular Cavernous Malformations: A Review on Indications and Surgical Considerations

Background

Intraventricular cavernous malformations (IVCs) are rare vascular lesions of the central nervous system. Surgical resection remains a challenging endeavor, with conventional microsurgical techniques associated with morbidity due to direct brain tissue manipulation. Neuroendoscopic approaches offer a minimally invasive alternative, though their efficacy and safety in treating IVCs remain underexplored.

Methods

A narrative review was conducted to analyze all documented cases of IVCs treated exclusively with endoscopic transventricular approaches. Reviews, original research papers, and case reports published from 1990 to May 2024 were included. When available, surgical videos were also reviewed.

Results

Seventeen patients with IVCs primarily located in the foramen of Monro were identified. The mean size of the IVCs was 17 mm (range: 7–29 mm). Neuroendoscopic procedures achieved gross total resection in all cases, leading to the resolution of clinical symptoms. Except for one patient who experienced memory impairment postsurgery, no persistent neurological dysfunctions were observed. Intraoperative bleeding, a significant challenge in IVC resection, was managed with continuous warm irrigation and dedicated coagulation instruments. Additionally, 6 cases of neuroendoscopic procedures such as endoscopic third ventriculostomy and septum pellucidotomy were reported for managing hydrocephalus.

Conclusions

Neuroendoscopic surgery offers several advantages in treating IVCs, including minimally invasive access, precise visualization, and reduced brain tissue manipulation. Our findings support the efficacy and safety of endoscopic transventricular approaches, underscoring its potential as a valuable therapeutic strategy for selected IVCs.

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.