Efficacy and safety of the endoscopic “wet-field” technique for removal of supratentorial cavernous malformations

Objective Cerebral cavernous malformations (CMs) presenting with focal neurological symptoms or mass effects require surgical removal. In recent years, cylindrical retractors have been widely utilized for the removal of deep-seated lesions during both microscopic and endoscopic surgery. In the present study, we evaluated the efficacy and safety of endoscopic transcylinder removal of CMs using a novel wet-field technique. Methods We included 13 patients with supratentorial CMs who had undergone endoscopic transcylinder surgery between April 2013 and March 2022. One patient experienced recurrence of the CM and underwent a second endoscopic transcylinder surgery. Therefore, we retrospectively evaluated 14 procedures. The surgical field was continuously irrigated with artificial cerebrospinal fluid to maintain expansion and visualization of the tumor bed. We termed this method as the “wet-field technique.” Patient characteristics, symptoms, and pre- and postoperative magnetic resonance imaging results were obtained from medical records. Results The average maximum CM diameter was 35.3 mm (range: 10–65 mm). Cylinder diameters were 6 mm in eight procedures, 10 mm in four procedures, and 17 mm in one procedure. Wet-field technique was applied in all cases. The endoscope provided a bright field of view even under water. Continuous water irrigation made it easier to observe the entire tumor bed which naturally expanded by water pressure. Gross total resection was achieved in 13 procedures, while subtotal resection was achieved in one procedure. No surgical complications were observed. Conclusions The endoscopic transcylinder removal using wet-field technique is safe and effective for the removal of symptomatic intracranial supratentorial CMs..

Medienart:

E-Artikel

Erscheinungsjahr:

2022

Erschienen:

2022

Enthalten in:

Zur Gesamtaufnahme - volume:164

Enthalten in:

Acta neurochirurgica - 164(2022), 10 vom: 22. Juni, Seite 2587-2594

Sprache:

Englisch

Beteiligte Personen:

Takeuchi, Kazuhito [VerfasserIn]
Nagata, Yuichi [VerfasserIn]
Tanahashi, Kuniaki [VerfasserIn]
Araki, Yoshio [VerfasserIn]
Mizuno, Akihiro [VerfasserIn]
Sasaki, Hiroo [VerfasserIn]
Harada, Hideyuki [VerfasserIn]
Ito, Keishi [VerfasserIn]
Saito, Ryuta [VerfasserIn]

Links:

Volltext [lizenzpflichtig]

Themen:

Cavernous angioma
Endoscopy
Navigation system
Port surgery

RVK:

RVK Klassifikation

Anmerkungen:

© The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature 2022

doi:

10.1007/s00701-022-05273-z

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2132200726

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