Abstract：
During the last 30 years, the neurosurgeons have witnessed a revolution in the practice of interventricular surgery. The advent of neuroendoscopy at the end of the 1980s has allowed a minimally invasive management of a very large series of pathologies in pediatric neurosurgery ranging from hydrocephalus to arachnoid cyst to intraventricular tumors. The progresses in the management of hydrocephalus, intracranial cyst, and the fluid filled collection nevertheless has been more rapid and radical due to the simpler equipment that is necessary to perform this kind of surgery. The intraventricular tumors instead have been addressed in a slower way, and for many years, the only endoscopic procedure that was allowed on interventricular tumors was a biopsy associated with the management of hydrocephalus. Only very small tumors have been considered operable for complete removal during many years due to the limitations of the neuroendoscopic equipment and to the small calibers of the working channel. More recently, the advent of new devices and new surgical techniques are offering new perspectives on the possibility of intraventricular tumor surgery in children. In this review, we describe the historical perspective of the learning curve of intraventricular tumor surgery under neuroendoscopic control and try to offer a view of the future perspective in the removal of larger intraventricular tumors, analyzing the main indications for intraventricular endoscopic tumor surgery. We offer as well an historical perspective of the evolution of skull base surgery and endonasal transsphenoidal approach for skull-based tumors in children. This kind of surgery that has acquired widespread acceptance for many pathologies in adult age has diffused more slowly in pediatric neurosurgery due to the anatomical limitation observed in these age range. Also in this field, the slow evolution of the technique and of the technology available to neurosurgeons has allowed a very significant expansion of indication for the minimally invasive removal of skull base tumors in children.
摘要：
在过去的30年里,神经外科医生见证了室间手术实践的革命。1980年代末神经内窥镜检查的出现允许对小儿神经外科手术中的大量病理进行微创治疗，从脑积水到蛛网膜囊肿到脑室内肿瘤。脑积水的治疗进展,颅内囊肿,然而，由于执行这种手术所需的更简单的设备，填充流体的收集更加快速和激进。相反，脑室内肿瘤的治疗速度较慢，多年来,室间肿瘤唯一允许的内镜手术是与脑积水治疗相关的活检.由于神经内窥镜设备的限制和工作通道的小口径，多年来认为只有非常小的肿瘤可完全切除。最近,新设备和新手术技术的出现为儿童脑室内肿瘤手术的可能性提供了新的视角。在这次审查中,我们描述了在神经内镜控制下进行脑室内肿瘤手术的学习曲线的历史观点，并试图提供对切除更大的脑室内肿瘤的未来观点的看法。分析脑室内内镜下肿瘤手术的主要适应证。我们还提供了颅底手术和经鼻蝶入路治疗儿童颅底肿瘤的历史观点。由于在这些年龄范围内观察到的解剖学限制，这种在成人年龄的许多病理中已获得广泛接受的手术在小儿神经外科中的扩散较慢。同样在这个领域，这项技术和神经外科医生可利用的技术的缓慢发展使得儿童颅底肿瘤微创切除的适应症有了非常显著的扩大.
