Donati P, Sardo L, Sanzo M
Pediatric Neurosurgical Center, Children's Hospital A. Meyer, Florence, Italy.
Minim Invasive Neurosurg. 2003 Jun;46(3):177-81. doi: 10.1055/s-2003-40732.
The authors report a case study of a giant cyst of the cavum septi pellucidi, cavum Vergae and veli interpositi spreading to the posterior fossa, and initially treated elsewhere by ventriculoperitoneal shunt, with no resolution of the symptomatology. A few months later the patient was successfully treated by fenestration into the ventricular system through a neuroendoscopic technique, at the Pediatric Neurosurgical Center of the Meyer Children's Hospital in Florence. Symptomatic midline cysts are quite rare and different techniques have been proposed for their treatment, i. e., direct craniotomy, conventional shunting, stereotactic approaches as well as endoscopic fenestration. In such cases neuroendoscopy obtains a good symptom resolution level, avoiding at the same time the risks of damage to endoventricular structures and often eliminates the need for a definitive ventriculoperitoneal shunt. In the present research the authors analyze the anatomy of the midline cavities and the mechanism through which a cyst may become symptomatic. The surgical endoscopic technique and the clinical and radiological assessments which confirmed the patency of the fenestration are also discussed. The authors conclude that endoscopic ventricular fenestration may represent the treatment of choice for this pathology.
作者报告了一例透明隔腔、Vergae腔和中间帆腔巨大囊肿蔓延至后颅窝的病例研究，该患者最初在其他地方接受了脑室腹腔分流术，但症状未得到缓解。几个月后，患者在佛罗伦萨迈耶儿童医院的儿科神经外科中心通过神经内镜技术成功进行了脑室系统开窗术治疗。有症状的中线囊肿相当罕见，针对其治疗已提出了不同的技术，即直接开颅术、传统分流术、立体定向方法以及内镜开窗术。在这种情况下，神经内镜可获得良好的症状缓解水平，同时避免了损伤脑室内结构的风险，并且常常无需进行永久性脑室腹腔分流术。在本研究中，作者分析了中线腔的解剖结构以及囊肿产生症状的机制。还讨论了手术内镜技术以及证实开窗术通畅的临床和影像学评估。作者得出结论，内镜下脑室开窗术可能是这种病症的首选治疗方法。
