Neuroendoscopic approach to tectal tumors: a consecutive series.
Neuroendoscopic approach to tectal tumors: a consecutive series.
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顶盖肿瘤的神经内窥镜方法：连续系列。
DOI：
10.3171/foc.1999.6.4.17
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发表时间：
1999
影响因子：
4.1
通讯作者：
Susumu Yoshioka
中科院分区：
文献类型：
--
作者：
Kazunari Oka;Yoshiaki Kin;Yoshinori Go;Katsuyuki Hirakawa;Masamichi Tomonaga;Tohru Inoue;Susumu Yoshioka
作者报告了一个连续系列的10例患者谁提出的体征和症状引起的顶盖肿瘤。临床表现，影像学特征，神经内镜治疗策略，和组织学检查结果的报告和讨论。自1990年1月以来，在10名患有顶盖肿瘤的患者中进行了11次神经内窥镜手术。患者平均随访5年（范围2个月至12年），并进行了回顾性研究，其中评估了病例记录、放射学检查结果、手术记录和组织病理学检查结果。进行磁共振（MR）成像，并使用图像将患者分为三组：T1加权图像上出现等信号的顶盖肥大（第1组）; T1加权图像上出现信号降低且钆给药后无增强的顶盖肿瘤占据脑导水管（第2组）;顶盖肿瘤T1加权像呈混杂信号，增强明显（第3组）。组织学检查结果与MRI特征一致：第1组为胶质组织或胶质增生;第2组为良性星形细胞瘤;第3组为恶性星形细胞瘤。脑脊液分流术是唯一能缓解梗阻性脑积水的手术治疗方法。第3组1例患者接受放疗，随后在神经内镜引导下部分切除肿瘤。此后，肿瘤一直在下降。所有患者在接受神经内窥镜手术后智力状态正常。神经内窥镜手术可以提供组织学诊断，确定肿瘤-中脑的相互关系，并且在治疗阻塞性脑积水和切除顶盖肿瘤方面非常有效。该术式可作为顶盖胶质瘤的一种新的治疗策略，值得临床应用。
The authors report a consecutive series of 10 patients who presented with signs and symptoms caused by tectal tumors. Clinical findings, radiographic features, neuroendoscopic management strategies, and histological findings are reported and discussed. Since January 1990, 11 neuroendoscopic procedures were performed in 10 patients who harbored tectal tumors. The patients were followed for an average of 5 years (range 2 months to 12 years), and a retrospective study was conducted in which case notes, radiological findings, operative notes, and histopathological findings were assessed. Magnetic resonance (MR) imaging was performed, and the images were used to classify patients into three groups: those with hypertrophy of the tectum in whom isointensity appeared on T1-weighted images (Group 1); those with a tectal tumor occupying the cerebral aqueduct in whom decreased signal intensity appeared on T1-weighted images, as well as no enhancement after gadolinium administration (Group 2); and those with a tectal tumor in whom mixed signal intensity appeared on T1-weighted images and conspicuous evidence of contrast enhancement (Group 3). The results of histological examination were consistent with MR imaging features: in Group 1, glial tissue or gliosis; in Group 2, benign astrocytoma; and in Group 3, malignant astrocytoma. Cerebrospinal fluid diversion was the only surgical treatment that provided relief from obstructive hydrocephalus. One patient in Group 3 underwent radiotherapy and subsequent partial tumor removal under neuroendoscopic guidance. Thereafter, the tumor remained in decline. All patients had normal intellectual status after undergoing surgery in which a neuroendoscope was used. Neuroendoscopic procedures can provide histological diagnosis, define the tumor-midbrain interrelationship, and be highly effective in treating obstructive hydrocephalus and in removing tectal tumors. This procedure may receive clinical application as a new management strategy for tectal glioma.