| Objective: To observe the anatomic characteristics of pineal region and its adjacent structures by simulating midline and paramedian SCIT approach under neuroendoscope,so as to provide anatomic basis for endoscopic treatment of lesions in this area.Methods: Five adult cadaveric heads fixed with formalin were selected to simulate the midline and paramedian SCIT approach under neuroendoscope.The structure of pineal region was observed and measured,and the exposure of the two surgical approaches was compared.Results: The midline SCIT approach approach could clearly reveal the anatomic structure of the pineal region,but the bridging veins were densely distributed and needed to be severed.The paramedian SCIT approach exposed the pineal gland,and increased the exposure of the arteriovenous structure of the lateral course.The distance from the dura mater to the cerebellar fissure vein was 58.14±1.62 mm and 76.51±2.25 mm,and the relative degree of freedom was 0.09±0.01,0.05±0.01.The relative degrees of freedom of pineal gland were 0.47±0.01 and 0.35±0.09,and the superior colliculus were 0.26±0.05 and 0.40±0.07.The left and right angles of the pineal gland were 14.85±0.35 and 17.86±1.03 degrees,respectively,and the anterior and posterior angles were 21.40±1.41 and 15.00±3.06 degrees.The left and right angles of the corpus callosum were 14.55±0.07 and 17.04±1.57 degrees,and the anterior and posterior angles were 14.60±0.71 and 18.76±2.83 degrees.The left andright angles of the ipsilateral superior colliculus were 15.63±5.08 and 21.42±1.42 degrees,and the anterior and posterior angles were 12.73±4.87 and 21.24±4.23 degrees.The difference was statistically significant(p < 0.05).Conclusion: The better approach to reveal the pineal region is the midline SCIT approach,and the surgical space of the approach is large,but part of the infratentorial bridging veins need to be resected,and the paramedian SCIT approach provides more sufficient operating space for the operation.The pineal gland can also be effectively exposed under the premise of retaining the cerebellar fissure vein and infratentorial bridging veins.The surgical approach should be selected according to the specific location of the lesion.Objective: To explore the choice of surgical approach for pineal region tumors by SCIT approach under neuroendoscope combined with endoscopic anatomy and to observe the clinical effect of neuroendoscopic transtentorial SCIT approach in the treatment of pineal region tumors.Methods: The clinical data of 4 patients with pineal region tumors resected by SCIT approach under neuroendoscope from December 2017 to March 2019 were analyzed retrospectively.All the patients underwent MRI plain and enhanced scan,HCG and AFP examination before operation.The tumors were resected by SCIT approach under general anesthesia in lateral subduction position.The patients were followed up for 1-6 months and the head MRI was reexamined.Results: The tumors were completely resected in 4 patients,and the patients recovered well after operation.Two patients were confirmed to be a mixed germ cell tumor by postoperative pathology.One case was treated with whole brain and spinal cord radiotherapy.After 4 months,the original lesion recurred and systemic chemotherapy has been given.The other case was signed out of hospital after surgery.Conclusion: Endoscopic supratentorial cerebellar approach for pineal region tumor resection with less trauma,fewer complications,safe and effective.If the blood supply of tumors in pineal region is abundant,the midline SCIT approach can be preferred.For tumors at the level of tentorial notch,the paramedian SCIT approach can achieve satisfactory results.ETV is the best method to deal with obstructive hydrocephalus caused by pineal region tumors. |
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