Neurofiberscopic Biopsy of Tumors of the Pineal Region and Posterior Third Ventricle: Indications, Technique, Complications, and Results
Neurofiberscopic Biopsy of Tumors of the Pineal Region and Posterior Third Ventricle: Indications, Technique, Complications, and Results
复制标题
松果体区和第三脑室后部肿瘤的神经纤维镜活检：适应症、技术、并发症和结果
作者：
M. Chernov;S. Kamikawa;F. Yamane;S. Ishihara;O. Kubo;T. Hori
目的：评价松果体区和第三脑室后区肿瘤的神经纤维镜活检结果。方法：从2001年至2004年，23例（平均年龄30.6岁）位于松果体区或后三脑室的肿瘤患者接受了神经纤维镜活检，同时进行第三脑室造瘘术。该手术适用于验证肿瘤的组织学诊断，计划通过放疗和/或化疗进行治疗，而无需开放手术（8例），建立病理诊断，为进一步选择最合适的治疗策略（11例），复发肿瘤和放射性坏死的分化（2例患者），以及大肿瘤相关囊肿减压术（2例患者）。在6例以前分流的患者中，在第三脑室造口上进行了脑室腹膜分流术的替代。结果：无术后死亡或永久性发病。在所有情况下，获得的组织样本足以进行病理诊断。一过性术后并发症包括发热（15例）、恶心和呕吐（3例）和复视（1例）。在长期随访中，发现1例患者因肿瘤再生长和瘢痕形成导致迟发性第三脑室吻合口失败，另1例患者发现恶性胶质瘤通过蛛网膜下腔播散。结论：神经纤维镜活检是一种有用的方法，用于松果体区和后三脑室肿瘤的取样，可以有效地用于以前分流和分流患者。
OBJECTIVE:Evaluation of results of the neurofiberscopic biopsy of tumors of the pineal region and posterior third ventricle. METHODS:From 2001 to 2004, 23 patients (mean age, 30.6 yr) with tumors located in the pineal region or posterior third ventricle underwent neurofiberscopic biopsy with simultaneous third ventriculostomy. The procedure was indicated for verification of the histological diagnosis of the neoplasm, which was planned to be treated by radiotherapy and/or chemotherapy without open surgery (eight patients), establishment of the pathological diagnosis for further choice of the most appropriate treatment strategy (11 patients), differentiation of the recurrent neoplasm and radiation necrosis (two patients), and decompression of the large tumor-associated cyst (two patients). In six previously shunted patients, substitution of the ventriculoperitoneal shunt on the third ventricle stoma was performed. RESULTS:There was no postoperative mortality or permanent morbidity. In all cases, the obtained tissue sample was sufficient for pathological diagnosis. Transient postoperative complications included fever (15 patients), nausea and vomiting (three patients), and diplopia (one patient). On the long-term follow-up, delayed third ventricular stoma failure caused by tumor regrowth and scar formation was found in one patient, and dissemination of the malignant glioma through the subarachnoid space was found in another patient. CONCLUSION:Neurofiberscopic biopsy represents a useful method for sampling of tumors of the pineal region and posterior third ventricle, which can be effectively used in both previously shunted and shunt-free patients.