A restricted neuroendoscopic approach for pathological diagnosis of intraventricular and paraventricular tumours
A restricted neuroendoscopic approach for pathological diagnosis of intraventricular and paraventricular tumours
复制标题
限制性神经内窥镜方法用于脑室内和脑室旁肿瘤的病理诊断
作者：
A. Fiorindi;P. Longatti
背景人们对神经内窥镜技术在神经肿瘤学中的应用越来越感兴趣。我们报告了对脑室内和脑室旁脑肿瘤患者进行内镜活检的经验，以确定使用该技术的标准。方法我们确定了 23 名患者（年龄 7-78 岁），他们因脑室内或脑室旁病变接受了内窥镜活检，这些病变被认为不适合手术切除且对于立体定向方法风险太大。所有活组织检查均通过徒手技术通过柔性内窥镜获得。结果 16 名患者的标本充足并得出了诊断；在三名患者中，它们提供了信息，但不能完全诊断； 4 名患者无法获得病理诊断。在 13 名因病变导致导水管阻塞的患者中，在同一手术中进行了第三次脑室造口术；在一名病变阻塞门罗孔的患者中，进行了隔膜造口术，而在另一例患者中则需要进行多次膀胱造口术。临床或放射学上均未观察到具体并发症，特别是没有发生大出血。结论根据我们的经验，内镜活检可以为 23 名患者中的 19 名提供病理诊断。对于难以接近的选定病变，应将内窥镜活检取样足够的组织视为首选。
BackgroundThere is increasing interest in the use of neuroendoscopic techniques in neuro-oncology. We report our experience of endoscopic biopsy in patients harbouring intraventricular and paraventricular brain tumours in order to define criteria for the use of this technique.MethodsWe identified 23 patients (aged 7–78 years) who underwent endoscopic biopsy for intraventricular or paraventricular lesions considered not suitable for surgical removal and too risky for a stereotactical approach. All of the biopsies were obtained with a flexible endoscope using a free-hand technique.FindingsIn 16 patients specimens were adequate and led to a diagnosis; in three patients they were informative but not completely diagnostic; a pathological diagnosis was unavailable in four patients. In 13 patients with a lesion causing an obstruction of the aqueduct, a third ventriculostomy was performed during the same procedure; in one patient with a lesion occluding the Monro foramen, a septostomy was done, while in another case multiple cystostomies were required. No specific complications were observed, either clinically or radiologically, in particular no major bleeding occurred.ConclusionsIn our experience, endoscopic biopsy could provide a pathological diagnosis in 19 of 23 patients. Endoscopic biopsy sampling sufficient tissue should be considered as the first choice in selected lesions that are otherwise difficult to approach.