Transendplate approach for craniopharyngioma resection

Treatment of diseases: craniopharyngioma Indication Endoscopic approach for craniopharyngioma resection is applicable to: 1. The ventricle type on the cystic saddle behind the optic chiasm (frontal optic chiasm) or the ventricle type of craniopharyngioma after the optic chiasm. 2. Intraventricular craniopharyngioma located at the bottom of the third ventricle is not obstructed. Preoperative preparation 1. There must be a correct positioning diagnosis before surgery. The relationship between the location of the lesion and the surrounding structure should be analyzed before surgery in order to select the appropriate surgical approach, to obtain the best exposure, avoid the important structure of the skull as much as possible, increase the safety of the operation and strive for good Effect. 2. Skin preparation, wash the head with soap and water 1 day before the operation, shave the hair on the morning of the operation. You can also shave your head on the eve of surgery. 3. Fasting the morning of surgery. It can be enema in the evening before surgery, but when the intracranial pressure is increased, the enema should be removed to avoid sudden deterioration of the condition. 4. Give phenobarbital 0.1g orally before surgery to ensure a quiet rest. One hour before the operation, 0.1 g of phenobarbital, 0.4 mg of atropine or 0.3 mg of scopolamine were intramuscularly injected. Surgical procedure Anesthesia and position Surgery is usually performed under general anesthesia. In the supine position, the upper body is slightly raised by 15° to 30°, and the specific head position is often slightly different with the transcranial approach. Generally, the head is slightly biased to the opposite side by 15° to 30°. The head is about 15° lower to facilitate lifting the frontal lobe and exposing the saddle. Surgical procedure 1. Do a right forehead craniotomy (if the surgeon is used to the left hand, you can also do the left side). Some neurosurgeons tend to choose to perform surgery on the heavier side or on the side of the tumor that is more pronounced to the side of the saddle. Scalp incision: The scalp incision varies according to individual habits, but the Frazier incision is used more. In recent years, due to the purpose of beauty, more authors advocate the use of a coronal incision in the hairline to avoid leaving scars on the face. Open the bone flap and cut the dura mater: the bone flap of the forehead should be as low as possible, straight to the leading edge of the anterior cranial fossa, but the bone flap should be designed according to the frontal sinus size shown by the X-ray, try to avoid the sawing amount. Sinus, if the frontal sinus is accidentally sawn, it should be properly handled as usual. The dural incision is parallel to the upper edge of the iliac crest, and the inner and outer ends are cut forward and rearward to form two auxiliary incisions to form an "H" shape. The dura mater in front of the incision is sutured on the periosteum. 2. It has been diagnosed as a craniopharyngioma after optic chiasm, or it is found as a anterior type of optic chiasm through the subfrontal approach, but no tumor is required to explore the posterior chiasm, and can be separated along the top of the visual cross; or along the neck The proximal part of the anterior cerebral artery is exposed to the bifurcation of the artery, and the first segment of the anterior cerebral artery is exposed to the distal end of the artery, and then the separation can be achieved after a slight separation. At this point, the thinned end plate is visible, the color becomes black and bulges forward. 3. After the tumor is removed and the bulged endplate is found, the needle can be used for puncture. If the cystic fluid is taken out, if it is determined to be a craniopharyngioma, the endplate and a very thin third ventricle wall are cut. Incision of the tumor sac, the inner wall is very smooth, and a white calcified tumor knot is often seen. There is a thin layer of glial reaction layer between the outer wall of the tumor sac and the surrounding brain tissue, but the surrounding brain tissue is the bottom of the third ventricle, which has important physiological functions, and can affect life if damaged. Therefore, care should be taken when removing, if the capsule boundary is unclear, do not force separation, so as not to cause serious consequences. After completely separating or excising the tumor wall, if the ventricle type of craniopharyngioma is seen, the ipsilateral oculomotor nerve and posterior communicating artery can be seen. complication 1. Visual impairment. 2. Diabetes insipidus. 3. Pituitary dysfunction. 4. Symptoms of hypothalamic damage.

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