背景：儿童松果体区病变是异质性病变，通常是由于闭塞性脑积水和颅内压（ICP）升高所致。用于评估脑积水的MRI衍生参数是视神经鞘直径（ONSD）作为ICP的替代指标和额枕角比（FOHR）。代表心室体积。由于ICP升高可能并不总是与临床症状相关，ONSD辅助治疗有助于接受治疗的患者做出决策.这项研究的目的是评估接受手术治疗的松果体区病变患者的术前和术后ONSD和FOHR作为脑积水指标的磁共振成像（MRI）。
方法：对2010年至2023年在三级护理中心接受松果体区病变手术的所有患者进行了回顾性数据分析。仅选择术前和术后进行MRI检查的患者。多个时间点的临床数据和ONSD，以及FOHR进行了分析。影像学参数变化与手术治疗前后的临床体征相关。
结果：33例患者，40例手术病例符合纳入标准。诊断年龄为10.9±4.6岁（1-17岁）。术前80％的手术病例可见脑积水（n=32/40）。脑积水的存在与术前ONSD的显着升高相关（p=0.006）。术后即刻（p<0.001）和术后3个月（p<0.001）的ONSD显着降低。FOHR显示出较不明显的下降（立即p=0.006，3个月p=0.003）。在没有脑积水的患者中，未观察到ONSD的显著变化(p=0.369)。在6/6临床治疗失败的脑积水患者中，ONSD增加，但在3/6ONSD是唯一可识别的MRI变化，FOHR不变。
结论：ONSD测量可用于评估松果体区肿瘤患者脑积水引起的颅内高压。ONSD变化似乎对评估脑积水治疗失败具有价值。
BACKGROUND: Pineal region lesions in children are heterogenous pathologies often symptomatic due to occlusive hydrocephalus and thus elevated intracranial pressure (ICP). MRI-derived parameters to assess hydrocephalus are the optic nerve sheath diameter (ONSD) as a surrogate for ICP and the frontal occipital horn ratio (FOHR), representing ventricle volume. As elevated ICP may not always be associated with clinical signs, the adjunct of ONSD could help decision making in patients undergoing treatment. The goal of this study is to assess the available magnetic resonance imaging (MRI) of patients with pineal region lesions undergoing surgical treatment with respect to pre- and postoperative ONSD and FOHR as an indicator for hydrocephalus.
METHODS: Retrospective data analysis was performed in all patients operated for pineal region lesions at a tertiary care center between 2010 and 2023. Only patients with pre- and postoperative MRI were selected for inclusion. Clinical data and ONSD at multiple time points, as well as FOHR were analyzed. Imaging parameter changes were correlated with clinical signs of hydrocephalus before and after surgical treatment.
RESULTS: Thirty-three patients with forty operative cases met the inclusion criteria. Age at diagnosis was 10.9 ± 4.6 years (1-17 years). Hydrocephalus was seen in 80% of operative cases preoperatively (n = 32/40). Presence of hydrocephalus was associated with significantly elevated preoperative ONSD (p = 0.006). There was a significant decrease in ONSD immediately (p < 0.001) and at 3 months (p < 0.001) postoperatively. FOHR showed a slightly less pronounced decrease (immediately p = 0.006, 3 months p = 0.003). In patients without hydrocephalus, no significant changes in ONSD were observed (p = 0.369). In 6/6 patients with clinical hydrocephalus treatment failure, ONSD increased, but in 3/6 ONSD was the only discernible MRI change with unchanged FOHR.
CONCLUSIONS: ONSD measurements may have utility in evaluating intracranial hypertension due to hydrocephalus in patients with pineal region tumors. ONSD changes appear to have value in assessing hydrocephalus treatment failure.
