脳梁離断術を神経ナビゲーション付きオートフォーカス顕微鏡で最適化し、脳室内病変に対する脳梁間経脳梁アプローチを行う
Luca Campagnaro1, Camilla Bonaudo2, Shani Don Enderage1
1Neurosurgical Clinic, Department of Neuroscience, Psychology, Pharmacology and Child Health - Careggi University Hospital, Florence, Italy.
Background And Objectives:
The interhemispheric transcallosal rout (IHTCR) is often chosen to approach intraventricular lesions, despite being associated with specific morbidity, such as disconnection syndrome; thus, some key points include minimizing the size of callosotomy and possibly avoiding the incision of the middle/posterior third of the body of corpus callosum (CC) that might be associated to severe morbidity. Despite this need, reports on the use of neuronavigation for a tailored IHTCR are scarce in the literature. The present study describes the technical nuances of our neuronavigated autofocus microscope (NAM)-guided strategy and reports our results about the size of the callosotomy.
Materials And Methods:
We retrospectively reviewed data from eight consecutive patients who recently underwent resection of intraventricular lesions via the IHTCR, guided by a NAM, at our institute from May 2024 to March 2025. We report detailed technical notes on the surgical planning and intraoperative neuronavigated images.
Results:
In all patients the callosal section was located in the anterior third of the body of the CC. Callosotomy was smaller than 8 mm in six patients with small lesions and smaller than 20 mm in two patients with large lesions. In almost all cases, the size of the callosotomy was smaller than half of the main diameter of the tumor. At follow-up, all patients experienced improvement in preoperative symptoms, and none showed signs of disconnection syndrome.
Conclusion:
Our NAM -guided strategy to tailored IHTRC enable us to design a customized approach for the single patient, facilitating surgical procedures and achieving a small callosotomy size in relation to the dimensions of the tumor.
