Subarachnoid dissemination of intraventricular tumors following simultaneous endoscopic biopsy and third ventriculostomy.
Subarachnoid dissemination of intraventricular tumors following simultaneous endoscopic biopsy and third ventriculostomy.
复制标题
同时进行内窥镜活检和第三脑室造口术后脑室内肿瘤的蛛网膜下腔播散。
DOI：
10.3171/2009.7.peds0971
复制
发表时间：
2010
期刊：
影响因子：
--
通讯作者：
M. Souweidane
中科院分区：
文献类型：
--
作者：
N. Luther;W. Stetler;I. Dunkel;P. Christos;J. Wellons;M. Souweidane
对象
对于松果体区或后第三脑室肿瘤引起的非交通性脑积水的患者，内窥镜活检联合第三脑室吻合术(ETV)是一种公认的诊断和治疗方法。理论上，第三脑室底部开窗为脑室内肿瘤的蛛网膜下腔扩散提供了一条管道。这项研究的目的是确定手术后软脑膜播散率。
方法
作者回顾了1995至2008年间在他们的机构接受过ETV和同时内窥镜活检或肿瘤切除的所有患者。根据病理将患者分为高危或低危两组。所有可用的术后临床和放射学数据，包括脑和脊髓的磁共振成像，以及脑脊液样本，如果有的话，都进行了评估。然后对文献进行回顾，以确定远距离软脑膜播散率，以便进行比较。
结果
32名患者符合纳入研究的标准。病理检查显示22例有软脑膜扩散的高风险。2例患者出现新的软脑膜病变，其中卵黄囊瘤1例，松果体母细胞瘤1例。中位临床随访时间为34个月(2-103个月)，脑部磁共振成像随访时间为38个月(1-94个月)。12例患者进行了脊柱MRI随访(中位数为术后7个月)，15例患者进行了脑脊液分析(中位数为术后1个月)。Kaplan-Meier生存分析预测，高危患者两年无转移生存率为94.7%。根据一项文献综述，对于各种高危疾病，未进行ETV时的基线传播率一般在8%至24%之间。
结论
在这项活检和ETV研究中，肿瘤的软脑膜转移率与文献中大系列研究的转移率相比没有增加。
OBJECT
Endoscopic biopsy with concomitant third ventriculostomy (ETV) is a well-established diagnostic and therapeutic maneuver in patients presenting with noncommunicating hydrocephalus resulting from a tumor of the pineal region or posterior third ventricle. Fenestration of the floor of the third ventricle theoretically provides a conduit for the subarachnoid dissemination of an intraventricular tumor. The aim of this study was to ascertain the rate of leptomeningeal dissemination following this surgical procedure.
METHODS
The authors conducted a review of all patients for whom an ETV and simultaneous endoscopic biopsy procedure or tumor resection had been performed at their institutions between 1995 and 2008. Patients were divided into high or low risk groups by leptomeningeal metastatic potential based on pathology. All available postoperative clinical and radiographic data, including MR imaging of the brain and spinal cord, as well as CSF sampling were evaluated when available. A review of the literature was then conducted to establish rates of distant leptomeningeal dissemination for comparative purposes.
RESULTS
Thirty-two patients satisfied the criteria for study inclusion. Pathology revealed that 22 had a high risk for leptomeningeal dissemination. New leptomeningeal disease (1 yolk sac tumor and 1 pineoblastoma) occurred in 2 patients. The median clinical and brain MR imaging follow-ups overall were 34 (range 2-103 months) and 38 months (range 1-94 months), respectively. Follow-up MR imaging of the spine was performed in 12 patients (median 7 months postoperation), and CSF was analyzed in 15 patients (median 1 month postoperation). A Kaplan-Meier survival analysis predicted a 2-year metastasis-free survival of 94.7% for high-risk patients. Baseline rates of dissemination when ETV was not performed were in general between 8 and 24% for various high-risk pathologies according to a literature review.
CONCLUSIONS
The rate of leptomeningeal metastasis of tumors in this biopsy and ETV study was not increased when compared with rates from large series in the literature.