論文

国際誌
2023年3月13日

Endoscopic Evacuation of Putaminal Hemorrhage Using the Trans-Middle Temporal Gyrus Approach: Technical Notes and Case Presentations.

Journal of neurological surgery. Part A, Central European neurosurgery
  • Ken Yamazaki
  • ,
  • Toshihiro Ogiwara
  • ,
  • Satoshi Kitamura
  • ,
  • Yu Fujii
  • ,
  • Daisuke Yamazaki
  • ,
  • Haruki Kuwabara
  • ,
  • Kohei Funato
  • ,
  • Yoshiki Hanaoka
  • ,
  • Tetsuyoshi Horiuchi

記述言語
英語
掲載種別
研究論文(学術雑誌)
DOI
10.1055/a-2053-2999

BACKGROUND AND STUDY AIMS: The development of minimally invasive endoscopic neurosurgery has enabled widespread application of endoscopic surgery via the ipsilateral transfrontal approach for putaminal hematoma evacuation. However, this approach is unsuitable for putaminal hematomas that extend into the temporal lobe. We adopted the endoscopic trans-middle temporal gyrus approach, instead of the conventional surgical approach, for the management of these complicated cases and determined its safety and feasibility. PATIENTS AND METHODS: Twenty patients with putaminal hemorrhage underwent surgical treatment at the Shinshu University Hospital between January 2016 and May 2021. Of these, two patients with left putaminal hemorrhage that extended into the temporal lobe underwent surgical treatment using the endoscopic trans-middle temporal gyrus approach. The procedure entailed the use of a thinner transparent sheath to reduce the technique's invasiveness, a navigation system to determine the location of the middle temporal gyrus and the sheath's trajectory, and an endoscope with a 4K camera for higher image quality and utility. The Sylvian fissure was compressed superiorly using our novel "port retraction technique" (i.e., by tilting the transparent sheath superiorly) to avoid damage to the middle cerebral artery and the Wernicke's area. RESULTS: The endoscopic trans-middle temporal gyrus approach allowed sufficient hematoma evacuation and hemostasis under endoscopic observation without any surgical complexities or complications. The postoperative course was uneventful in both patients. CONCLUSION: The endoscopic trans-middle temporal gyrus approach for putaminal hematoma evacuation helps avoid damage to normal brain tissue, which could result from the wide range of motion of the conventional technique, particularly when the hemorrhage extends to the temporal lobe.

リンク情報
DOI
https://doi.org/10.1055/a-2053-2999
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/36914159
ID情報
  • DOI : 10.1055/a-2053-2999
  • PubMed ID : 36914159

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