Neuroendoscopic biopsy and the treatment of tumor-associated hydrocephalus of the ventricular and paraventricular region in pediatric patients: a nationwide study in Japan.
Neuroendoscopic biopsy and the treatment of tumor-associated hydrocephalus of the ventricular and paraventricular region in pediatric patients: a nationwide study in Japan.
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神经内窥镜活检和儿科患者脑室和室旁区肿瘤相关脑积水的治疗：日本的一项全国性研究。
DOI：
10.1007/s10143-015-0629-z
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Ohira T.
中科院分区：
文献类型：
--
作者：
Miwa T;Hayashi N;Endo S;Ohira T.
神经内窥镜活检是一种微创且有用的手术，可用于肿瘤相关脑积水的诊断和初步治疗。我们描述了全国范围内儿童脑室内和脑室旁肿瘤神经内镜活检现状的调查，以及儿科患者肿瘤相关脑积水的治疗。主要检查项目包括患者年龄、性别、肿瘤部位、病理诊断、并发症、肿瘤相关性脑积水的治疗及疗效、术后病程中的播散情况。来自 67 个机构的 221 名儿科患者（平均 8.6 岁）进行了登记。 206 名患者 (93.2%) 进行了内镜肿瘤活检，这 206 名患者中的 195 名患者 (94.7%) 可以进行组织病理学诊断。最常见的组织病理学诊断肿瘤是生殖细胞肿瘤（41.5%），其次是星形细胞肿瘤（24.1%）和囊性病变（15.9%）。在 177 名患者 (80.1%) 中观察到相关脑积水，其中 101 名患者接受了内镜下第三脑室造口术 (ETV)。 ETV围手术期有效率99.0%，远期有效率90.1%。 24 名患者 (10.9%) 发现除发热以外的围手术期并发症。在统计分析中，儿童对 ETV 的长期缓解率 (p= 0.025) 显示出儿童患者的结果明显优于成人患者 (p< 0.05)。涉及儿童脑室内和脑室旁肿瘤的神经内窥镜手术被认为非常有用，并发症发生率较低，并且安全性较高。
A neuroendoscopic biopsy is a minimally invasive and useful procedure for the diagnosis and initial management of tumor-associated hydrocephalus. We describe the nationwide investigation of the current status of neuroendoscopic biopsy for intra- and paraventricular tumors in children, as well as the treatment of tumor-associated hydrocephalus in pediatric patients. The main items examined included the patient’s age and sex, location of the tumor, pathological diagnosis, complications, treatment and efficacy of treatment of the tumor-associated hydrocephalus, and the dissemination during the postoperative course. Two hundred twenty-one pediatric patients (mean 8.6 years) from 67 institutions were registered. Endoscopic tumor biopsies were performed in 206 patients (93.2 %), and a histopathological diagnosis could be performed in 195 of these 206 patients (94.7 %). The most frequently histopathologically diagnosed tumor was a germ cell tumor (41.5 %), followed by astrocytic tumors (24.1 %) and cystic lesions (15.9 %). Associated hydrocephalus was observed in 177 patients (80.1 %), 101 of whom underwent endoscopic third ventriculostomy (ETV). The efficacy rate of the ETV in the perioperative period was 99.0 %, and the long-term response rate was 90.1 %. Perioperative complications other than fever were found in 24 patients (10.9 %). In the statistical analysis, pediatric long-term response rate to ETV (p= 0.025) showed significantly more favorable results for pediatric than adult patients (p< 0.05). Neuroendoscopic procedures involving pediatric intra- and paraventricular tumors were considered to be very useful, with a low incidence of complication, and were associated with higher safety.