Delitala Alberto, Brunori Andrea, Chiappetta Francesco
U.O. di Neurochirurgia, Dipartimento di Neuroscienze G.M. Lancisi, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy.
Childs Nerv Syst. 2004 Nov;20(11-12):858-62. doi: 10.1007/s00381-004-0943-1. Epub 2004 Aug 19.
This paper reports our series of cystic craniopharyngiomas treated using a purely neuroendoscopic approach.
Drainage and wide marsupialization into CSF spaces (cysto-ventriculo-cisternostomy) were achieved to ensure mass effect control, continuous dilution, and reabsorption of the cyst's fluid. A steerable, flexible neuroendoscope and a pre-coronal approach were used in 7 patients harboring intra/paraventricular cysts (4 primary and 3 recurrent).
These surgical goals were achieved in all but one case and no procedure-related complications were observed. During the follow-up period (range 6-72 months; average 38.3 months) one recurrence and one progression of undrained pouch were observed at 25 and 30 months. Both patients underwent successful repeat neuroendoscopy.
In our hands, this technique has proven minimally invasive, safe, and effective; although oncologically palliative it can be implemented with other therapeutic modalities. Our preliminary experience should stimulate the recruitment of larger groups of patients in order to define the role of neuroendoscopy in the multimodal treatment of craniopharyngiomas.
本文报告了我们采用单纯神经内镜方法治疗的一系列囊性颅咽管瘤病例。
通过将囊肿引流并广泛敞开至脑脊液间隙（囊肿 - 脑室 - 脑池造瘘术），以确保控制占位效应、持续稀释并吸收囊肿液。7例患有脑室内/脑室旁囊肿的患者（4例初发，3例复发）采用了可操纵的软性神经内镜及冠状缝前入路。
除1例患者外，所有患者均实现了手术目标，且未观察到与手术相关的并发症。在随访期（6 - 72个月，平均38.3个月）内，分别在25个月和30个月时观察到1例未引流囊袋复发及1例进展。这两名患者均成功接受了再次神经内镜手术。
在我们的经验中，该技术已被证明具有微创、安全且有效的特点；尽管从肿瘤学角度而言是姑息性的，但可与其他治疗方式联合应用。我们的初步经验应促使招募更多患者群体，以明确神经内镜在颅咽管瘤多模式治疗中的作用。
