Mandat Tomasz, Roszkowski Marcin, Barszcz Sławomir, Podgórski Jan Krzysztof, Jurkiewicz Elzbieta
Kliniki Neurochirurgii Centralnego Szpitala Klinicznego Wojskowej Akademii Medycznej.
Neurol Neurochir Pol. 2002 Jul-Aug;36(4):711-22.
The aim of the study was to evaluate the effectiveness of endoscopic third ventriculostomy (ETV) in non-communicating hydrocephalus secondary to tumour of the posterior part of the third ventricle tumours in children.
The study group consisted of 32 patients (13 girls and 19 boys) treated at the Department of Neurosurgery Children's Memorial Health Institute in Warsaw in the years 1996-2000. In 22 cases benign tectal mass (BTM) and 10 malignant neoplasms (including 9 germ cell tumours and 1 ependymoma) were diagnosed. The follow-up period after ETV ranged from 5 months to 4 years (mean 21 months). The retrospective analysis of medical reports and control CTs, MRs, and PC MR-cine studies was performed.
In all the patients the early (up to 3 months postop) outcomes were good. 8 patients with malignant neoplasms after initial chemotherapy underwent residual tumor excision (more than 3 months after ETVs) and in two of them the CFS meningeal tumor spreads were detected. In 26 (81%) of the patients permanent control of hydrocephalus was achieved. The recurrence of active hydrocephalus was observed in 6 cases (19%). 3 of them were children with benign tectal masses and 3 with malignant tumours. The reason of failure in 2 cases was associated with meningeal tumor dissemination, and in one with postoperative bleeding after surgical tumor excision (communicating hydrocephalus). In 2 cases with benign tumours reasons of failures were not clear (patent stomies on PC MR-cine) and in 1 case late stomy occlusion on PC-MR flow study was diagnosed. Five out of 6 patients underwent shunt placements and in 1 case with late ventriculostomy occlusion another endoscopic procedure (after 26 months) was successfully performed.
The endoscopic third ventriculostomy was an efficient method to control non-communicating hydrocephalus in children with posterior part of the third ventricle brain tumours. The PC MR flow study was a useful diagnostic tool in the stomy patency evaluation and in further treatment planning in cases of failures. It seems that recurrence of active hydrocephalus can be successfully treated with repeated ETV when the stomy occlusion is detected on MR flow studies. Other cases of failures ought to be treated by shunt implantations.
本研究旨在评估内镜下第三脑室造瘘术（ETV）治疗儿童第三脑室后部肿瘤继发非交通性脑积水的有效性。
研究组由1996年至2000年在华沙儿童纪念健康研究所神经外科接受治疗的32例患者（13名女孩和19名男孩）组成。其中22例诊断为良性顶盖肿物（BTM），10例为恶性肿瘤（包括9例生殖细胞瘤和1例室管膜瘤）。ETV术后随访时间为5个月至4年（平均21个月）。对病历报告以及对照CT、MR和PC MR电影成像研究进行回顾性分析。
所有患者早期（术后3个月内）预后良好。8例恶性肿瘤患者在初始化疗后接受了残留肿瘤切除（ETV术后3个月以上），其中2例检测到脑脊液脑膜肿瘤播散。26例（81%）患者实现了脑积水的永久性控制。6例（19%）观察到活动性脑积水复发。其中3例为良性顶盖肿物患儿，3例为恶性肿瘤患儿。2例失败原因与脑膜肿瘤播散有关，1例与手术切除肿瘤后术后出血（交通性脑积水）有关。2例良性肿瘤患者失败原因不明（PC MR电影成像显示造瘘口通畅），1例经PC-MR血流研究诊断为晚期造瘘口闭塞。6例患者中有5例行分流术，1例晚期脑室造瘘口闭塞患者成功进行了另一次内镜手术（26个月后）。
内镜下第三脑室造瘘术是控制儿童第三脑室后部脑肿瘤继发非交通性脑积水的有效方法。PC MR血流研究是评估造瘘口通畅情况以及失败病例进一步治疗计划的有用诊断工具。当MR血流研究检测到造瘘口闭塞时，似乎重复进行ETV可以成功治疗活动性脑积水复发。其他失败病例应通过分流植入治疗。
