脳幹部・脳幹部周辺病変

Brain Stem and Para-Brain Stem Lesions

Point

・脳幹や脳幹近傍の手術は術野が狭く深い上，脳幹や脳神経に可動性が乏しいため，アプローチが手術の成否を決めやすい．

・この部位の手術は一般に症例数が少ないと思われるが，術前シミュレーションは手術経験の不足を補う効果がある．

・細い脳神経や血管の描出，脳幹との癒着度などの予測には限界があることを知り，シミュレーションと術中に得られる情報を統合して判断する．

＊本論文中、［Video］マークのある図につきましては、関連する動画を見ることができます（公開期間：2027年4月まで）。

　Surgeries for brainstem lesions and adjacent areas needs meticulous manipulation in the profoundly deep surgical field. Moreover, it is associated with a high risk of complications pertinent to resection. The opportunity for a surgeon to amass extensive surgical experience in these lesions is limited. Additionally, the reduced tissue mobility in the brainstem, compared to other lesions, makes selecting the optimal surgical approach critical. Preoperative simulation is pivotal in surmounting these challenges. However, the limitations of preoperative simulations should be recognized in accurately depicting diminutive vessels and cranial nerves around the brainstem. Incorporating intraoperative anatomical observations and data from intraoperative monitoring into a surgical strategy is imperative. Here, we present three cases in which we believe preoperative simulation was effective; a cavernous hemangioma of the brainstem, trochlear schwannoma, and diffuse midline glioma in the pons.