背景:松果体区肿瘤对神经外科医生具有挑战性,可导致继发性脑积水。出镜的出现为松果体区肿瘤手术提供了具有高图像质量和人体工程学系统的临床干预措施。在这项研究中,我们描述了用于促进松果体区肿瘤的手术切除和缓解脑积水的切除方法。
方法:在这项回顾性队列研究中,我们连续回顾了25例松果体区病变患者的临床和影像学资料,这些患者在单中心接受了三维肿瘤切除术。
结果:患者队列包括16名男性和9名女性,平均年龄为34.6岁(范围,6-62岁;≤18岁8例)。病理检查证实8个松果体肿瘤,四个胶质瘤,九种生殖细胞肿瘤,两个室管膜瘤,和两个转移性肿瘤。23例术前存在脑积水。在肿瘤切除之前,对17例患者进行了Ommaya储集层植入的体外脑室引流(EVD).两名患者接受了术前内镜下第三脑室造瘘术(ETV),五名患者接受了脑室-腹膜(VP)分流术,包括接受这两种程序的人。19例患者(76%)在“平视”平台位置使用外镜进行了总切除。8例(31.6%)侵犯第三脑室的患者接受了次全切除,主要在神经胶质瘤病例中,高于没有入侵的(0%),但无统计学意义(P=0.278,Fisher精确检验)。术后未观察到新的神经功能障碍。2例患者(8%)发生颅内和肺部感染,两名患者(8%)患有气胸。所有患者术后脑积水明显缓解,4例复发性脑积水患者在长期随访中治愈。术后辅助管理推荐用于指定患者,平均随访24.8±14.3个月,结果令人满意。
结论:外镜是松果体区肿瘤切除和脑积水缓解的有用工具,特别是第三脑室后侵犯,因为完全切除可以实现,没有明显的并发症。应强调出镜对指示的松果体区肿瘤的特殊优越性。
BACKGROUND: The pineal region tumors are challenging for neurosurgeons and can lead to secondary hydrocephalus. The introduction of the exoscope has provided clinical interventions with high image quality and an ergonomic system for pineal region tumor operations. In this
study, the authors describe the exoscopic approach used to facilitate the surgical resection of pineal region tumors and relieve hydrocephalus.
METHODS: In this retrospective cohort
study, we consecutively reviewed the clinical and radiological data of 25 patients with pineal region lesions who underwent three-dimensional exoscopic tumor resection at a single center.
RESULTS: The patient cohort consisted of 16 males and 9 females, with an average age of 34.6 years (range, 6-62 years; 8 cases aged ≤18). Pathological examination confirmed eight pineal gland tumors, four gliomas, nine germ cell neoplasms, two ependymomas, and two metastatic tumors. Preoperative hydrocephalus was present in 23 patients. Prior to tumor resection, external ventricular drainage (EVD) with Ommaya reservoir implantation was performed in 17 patients. Two patients received preoperative endoscopic third ventriculostomy (ETV), and five patients received a ventriculoperitoneal (VP) shunt, including one who received both procedures. Gross total resection was achieved in 19 patients (76%) in the \'head-up\' park bench position using the exoscope. Eight patients (31.6%) with third ventricle invasion received subtotal resection, mainly in glioma cases, which was higher than those without invasion (0%), but not statistically significant ( P =0.278, Fisher\'s exact test). No new neurological dysfunction was observed after surgery. Two patients (8%) developed intracranial and pulmonary infections, and two patients (8%) suffered from pneumothorax. Hydrocephalus was significantly relieved in all patients postoperatively, and four patients with relapse hydrocephalus were cured during the long-term follow-up. Postoperative adjuvant management was recommended for indicated patients, and a mean follow-up of 24.8±14.3 months showed a satisfied outcome.
CONCLUSIONS: The exoscope is a useful tool for pineal region tumor resection and hydrocephalus relief, particularly with posterior third ventricle invasion, as total resection could be achieved without obvious complication. The special superiority of the exoscope for the indicated pineal region tumors should be highlighted.