Pure endoscopic resection of pineal region tumors through supracerebellar infratentorial approach with ‘head-up’ park-bench position

Neuroendoscopic resection <i>via</i> supracerebellar infratentorial (SCIT) approach is adequate for some indicated pineal region tumors with the natural infratentorial corridor. We described this full endoscopic approach through a modified ‘head-up’ park-bench position to facilitate the procedure. We reviewed the clinical and radiological data of four patients with pineal region lesions who underwent pure endoscopic tumor resection through the SCIT approach with this modified position. The related literature concerning fully endoscopic pineal region tumor resection was also reviewed. This cohort included four patients with pineal region tumors. External ventricular drainage (Ommaya reservoir) was performed in three patients with hydrocephalus in advance. The average tumor volume was 19.2 ± 17.2 cm³. Pathological examination confirmed two mixed germinomas, one glioblastoma multiforme, and one hemangioblastoma. Gross total resection (GTR) was achieved in all patients, and all patients recovered well without neurological deficits or surgical complications. Hydrocephalus was relieved among all patients. The pure endoscopic SCIT approach could enable safe and effective resection of pineal region tumors, even for relatively large lesions. The endoscope could provide a panoramic view and illumination of the deep-seated structures. Compared with the sitting position, this modified ergonomic position could be implemented easily.

经小脑上幕下（supracerebellar infratentorial, SCIT）入路行神经内镜切除术，对于存在自然幕下通道且符合手术适应证的部分松果体区肿瘤而言，是切实可行的手术方案。本研究详述了一种经改良“头高脚低”公园长椅体位实施的全内镜手术方法，以优化手术操作流程。我们回顾了4例采用该改良体位行经SCIT入路纯内镜肿瘤切除术的松果体区病变患者的临床及影像学资料，并复习了有关全内镜松果体区肿瘤切除术的相关文献。本队列共纳入4例松果体区肿瘤患者，其中3例合并脑积水的患者术前接受了脑室外引流（奥玛亚储液囊，Ommaya reservoir）置入术。患者的平均肿瘤体积为19.2±17.2 cm³。病理检查结果证实，2例为混合性生殖细胞瘤，1例为多形性胶质母细胞瘤，1例为血管母细胞瘤。所有患者均实现了肿瘤全切术（gross total resection, GTR），术后均恢复良好，未出现神经功能缺损或手术相关并发症，且脑积水均得到缓解。研究表明，纯内镜SCIT入路可安全、有效地实现松果体区肿瘤的切除，即使对于体积相对较大的病变亦适用。内镜可提供深部结构的全景视野与照明，相较于传统坐位，该改良的符合人体工学的体位更易于实施。