松果体区肿瘤内镜手术进展
Progress in endoscopic surgery for pineal region tumors
张晓彪1
作者信息
- 1. 复旦大学附属中山医院神经外科 上海 200032
- 折叠
摘要
松果体区肿瘤位于颅脑中心,因解剖位置深、周边神经血管结构复杂,是神经外科手术的难点.内镜技术的成熟弥补了传统显微手术在视野暴露、解剖识别和安全性上的局限.本文就内镜技术在松果体区肿瘤手术中的应用创新与进展作如下评述,重点探讨了幕下小脑上入路(supracerebellarinfratentorial approach,SCITA,中线与中线旁方式)及经枕天幕入路(occipital-transtentorial approach,OTTA)等手术路径的选择,并强调了对大脑内静脉等关键结构的精准保护.文章同时分析了肿瘤切除策略:针对不同病理类型,提出整块切除或保留部分病灶的个体化策略,结合术后化放疗提升疗效.此外内镜技术在梗阻性脑积水处理(如内镜下第三脑室底造瘘术)与组织活检中展现出独特的优势.3D内镜技术的应用进一步强化了深部结构的立体感知,大幅提升了手术认知和操作安全性.未来内镜技术的创新将有望推动松果体区肿瘤手术向更加微创、精准、安全的方向发展.
Abstract
Located at the center of the brain,pineal region tumors are challenging for neurosurgical procedures due to their deep anatomical position and the complex surrounding neurovascular structures.The maturity of endoscopic techniques has compensated for the limitations of traditional microscopic surgery in terms of field exposure,anatomical identification,and surgical safety.This article systematically reviews the progress in the application of endoscopic techniques in pineal region tumor surgery,focusing on the selection of surgical approaches such as the supracerebellar infratentorial approach(SCITA,midline and paramedian methods)and the occipital transtentorial approach(OTTA),and emphasizes the precise protection of key structures like the internal cerebral veins.By analyzing tumor resection strategies for different pathological types,this article proposes individualized strategies for en bloc resection or partial lesion preservation,combined with postoperative chemotherapy and radiotherapy to improve therapeutic outcomes.Furthermore,endoscopic techniques have demonstrated unique advantages in the management of obstructive hydrocephalus(such as endoscopic third ventriculostomy)and tissue biopsy.The application of 3D endoscopic technology has further enhanced the stereoscopic perception of deep structures,significantly improving surgical cognition and operational safety.Future innovations in endoscopic technology are expected to promote the development of pineal region tumor surgery towards minimally invasive,precise,and safe directions.
关键词
松果体区肿瘤/内镜技术/手术入路/肿瘤切除策略/脑积水Key words
Pineal region tumors/Endoscopic techniques/Surgical approaches/Tumor resection strategies/Hydrocephalus引用本文复制引用
出版年
2025
NETL
NSTL
万方数据