Neuroendoscopic approach to intraventricular lesions.
Neuroendoscopic approach to intraventricular lesions.
复制标题
神经内窥镜方法治疗脑室内病变。
DOI：
10.3171/foc.1999.6.4.8
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发表时间：
1999
影响因子：
4.1
通讯作者：
H. Schroeder
中科院分区：
文献类型：
--
作者：
M. Gaab;H. Schroeder
目的。本研究的目的是确定内镜治疗脑室内肿瘤患者的疗效。方法。报道了 30 名接受内窥镜治疗的脑室内病变患者的一系列病例。病变包括7个胶样囊肿、6个星形细胞瘤、3个室管膜下瘤、2个室管膜瘤以及以下各1个：松果体母细胞瘤、松果体细胞瘤/松果体母细胞瘤（中间型）、表皮样囊肿、松果体囊肿、髓母细胞瘤、动静脉血管瘤、海绵体瘤、脉络丛乳头状瘤、垂体腺瘤、颅咽管瘤、黑色素瘤和生殖细胞瘤。进行了肿瘤全切除、部分切除、活组织检查、支架植入、隔膜造口术和第三脑室造口术。在两例（两个室管膜下瘤直径> 2厘米）中，由于肿瘤非常坚固，内镜下分段切除术无效。因此，停止内窥镜手术并通过显微外科手术切除肿瘤。其余案件均按计划完成。即使存在定向不良或大量出血等困难，也没有必要放弃内窥镜手术。总共进行了28次严格内镜干预，平均持续时间为85分钟（范围35-170分钟）。所有胶样囊肿和表皮样病变均被完全清空，包膜被广泛切除。五例实体瘤被完全切除，而大多数星形细胞瘤被部分切除。 22 名脑脊液通路阻塞患者的脑积水相关症状全部消失。没有发生与内窥镜检查相关的死亡。有两例发生大出血，并通过内镜控制得到控制。作者观察到 1 例脑膜炎、1 例沉默症、2 例因穹窿损伤导致的记忆丧失、1 例在获得导水管肿瘤活检标本后出现短暂性滑车麻痹，以及 1 例在获得生殖细胞瘤活检标本后出现短暂性混乱。结论。根据作者的初步经验，内窥镜方法被认为是安全有效的。在这个系列中，通过使用内窥镜技术，可以实现非交通性脑积水的缓解、肿瘤切除，甚至完全切除肿瘤。根据结果，作者认为，在治疗选定的脑室内病变时应考虑使用内窥镜技术。
Object. The purpose of this study was to determine the efficacy of endoscopic treatment in patients with intraventricular tumors. Methods. A series of 30 patients with endoscopically treated intraventricular lesions is reported. The lesions included seven colloid cysts, six astrocytomas, three subependymomas, two ependymomas, and one each of the following: pineoblastoma, pineocytoma/pineoblastoma (intermediate type), epidermoid cyst, pineal cyst, medulloblastoma, arteriovenous hemangioma, cavernoma, choroid plexus papilloma, pituitary adenoma, craniopharyngioma, melanoma, and germinoma. Total tumor resections, partial resections, biopsies, stent implantations, septostomies, and third ventriculostomies were performed. In two cases (two subependymomas > 2 cm in diameter), piecemeal endoscopic resection was ineffective because of the very firm consistency of the tumors. Therefore the endoscopic procedure was discontinued and the tumors were removed microsurgically. In the remaining cases the procedures were completed as planned. Even in the presence of difficulties such as poor orientation or significant bleeding, there was no need to abandon the endoscopic procedure. A total of 28 strictly endoscopic interventions were performed, in which the average duration was 85 minutes (range 35-170 minutes). All colloid cysts and the epidermoid lesion were completely evacuated and the capsules were widely resected. Total extirpation of solid tumors was achieved in five cases, whereas most astrocytomas were partially resected. The hydrocephalus-related symptoms resolved in all of the 22 patients with cerebrospinal fluid pathway obstruction. There were no endoscopy-related deaths. In two cases, major bleeding occurred and was controlled endoscopically. The authors observed one case of meningitis, one of mutism, two of memory loss attributed to forniceal injury, one of transient trochlear palsy after a biopsy specimen of an aqueductal tumor was obtained, and one of transient confusion after a biopsy specimen of a germinoma was obtained. Conclusions. In the authors' preliminary experience, the endoscopic approach was found to be safe and effective. In this series, it was possible to achieve relief of noncommunicating hydrocephalus, tumor resections, and even complete tumor removals by using endoscopic techniques. Based on the results, the authors believe that endoscopic techniques should be considered in the treatment of selected intraventricular lesions.