Biportal endoscopic management of third ventricle tumors in patients with occlusive hydrocephalus: technical note.
Biportal endoscopic management of third ventricle tumors in patients with occlusive hydrocephalus: technical note.
复制标题
闭塞性脑积水患者第三脑室肿瘤的双孔内镜治疗：技术说明。
作者：
F. Vetõ;Z. Horváth;T. Dóczi
客观化
目的探讨双门静脉内窥镜下治疗后第三脑室肿瘤的可行性和优越性。由于神经内窥镜的最新发展，经典的第三脑室造口术已经成为治疗闭塞性脑积水的标准单孔手术和分流术的真正替代方法。在第三脑室肿瘤阻塞导水管的患者中，脑积水的急性发展往往先于衰弱的局灶性症状和体征。其中40%的肿瘤对辐射敏感，因此没有必要开颅手术。初级治疗的目标是减轻升高的颅内压，并确定肿瘤的组织学性质。脑脊液分流和计算机断层扫描或磁共振成像引导的活检通常被认为是选择的方法。
方法
对3例后第三脑室肿瘤合并急性脑积水的患者，在CT引导下一次行三脑室造瘘术，并在两个硬质脑室镜下进行肿瘤活检。
结果
3例患者进行了脑室造口术，2例患者进行了肿瘤活检。最长40分钟的手术没有涉及死亡或发病率。所有患者的组织学结果均已确定。2例恶性浸润性肿瘤患者术后放疗，1例小海绵状肿瘤患者未采取进一步治疗措施。在6个月的随访中，血流敏感磁共振成像证实所有患者脑室造口通畅。
结论
在肿瘤活检和第三脑室底开窗手术中，双门静脉内窥镜手术入路可实现两种手术的独立视觉控制、脑室镜经Monro狭窄孔的安全通道，以及通过可用的四个灌流通道方便地控制脑室内的颅内压。在选定的浸润性后第三脑室肿瘤患者中，这种手术和术后放疗可能是直接手术或分流和影像引导活检的替代方案。
OBJECTIVE
To present the feasibility and advantages of the biportal endoscopic management of posterior third ventricle tumors. As a result of recent developments in neuroendoscopy, classical third ventriculostomy has become a standard single burr hole procedure and a real alternative to shunting in the treatment of occlusive hydrocephalus. In patients with third ventricle tumors occluding the aqueduct, the acute development of hydrocephalus may often precede debilitating focal symptoms and signs. Forty percent of those tumors are radiosensitive, rendering craniotomy unnecessary. The goal of primary management is the alleviation of raised intracranial pressure and determination of the histological nature of the tumor. Cerebrospinal fluid shunting and the performance of a computed tomography- or magnetic resonance imaging-guided biopsy are generally suggested as the methods of choice.
METHODS
Three patients with posterior third ventricle tumors and acute hydrocephalus were treated in one session by computed tomography-guided endoscopic third ventriculostomy and endoscopic tumor biopsy was performed by means of two rigid ventriculoscopes.
RESULTS
Ventriculostomy was performed in three patients, and tumor biopsy was performed in two patients. The maximum 40-minute operation did not involve mortality or morbidity. Histological findings were established in all patients. In two patients with malignant infiltrative tumors, postoperative radiotherapy was used; in one patient with a small cavernoma, no further measures were taken. At the 6-month follow-up, flow-sensitive magnetic resonance imaging confirmed ventriculostomy patency in all patients.
CONCLUSION
The biportal endoscopic approach allowed independent visual control of both procedures, safe passages of the ventriculoscopes via the narrow foramen of Monro, and facile control of the intracranial pressure in the ventricles via the available four irrigation channels during the performance of tumor biopsy and fenestration of the floor of the third ventricle. In selected patients with infiltrating posterior third ventricle tumors, this procedure and postoperative radiotherapy may be an alternative to direct surgery or to shunting and performance of image-guided biopsy.