Li Khan W, Roonprapunt Chanland, Lawson Herman C, Abbott I Rick, Wisoff Jeffrey, Epstein Fred, Jallo George I
Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA.
Neurosurg Focus. 2005 Jun 15;18(6A):E2.
Tectal gliomas are a distinct form of pediatric brainstem tumor that present in patients with symptoms related to increased intracranial pressure due to obstructive hydrocephalus. The natural history of these lesions is often uniquely indolent. Thus, initial surgical therapies are directed at treatment of hydrocephalus, usually with ventricular shunt placement. Recently, third ventriculostomy has been used in patients with tectal gliomas, both as an initial procedure and after shunt failures. In this report the authors review their experience with the treatment of hydrocephalus in patients with tectal gliomas.
The authors reviewed 31 consecutive cases of tectal gliomas and compared the success rates of ventricular shunt placement with the success rates of endoscopic third ventriculostomy (ETV). Shunt placement procedures were associated with a significant number of malfunctions, and most patients required shunt revisions. The ETV procedure was attempted both as an initial treatment and after shunt malfunction. Overall, ETV was attempted in 18 patients and was performed successfully in all cases. At the time of follow-up evaluation, 16 patients (89%) were shunt free.
The authors found that ETV could be performed with good long-term success both as an initial treatment and after shunt failure. Overall, ETV was found to be superior to ventricular shunt placement in the management of hydrocephalus associated with tectal gliomas.
顶盖胶质瘤是小儿脑干肿瘤的一种特殊类型，患者因梗阻性脑积水出现与颅内压升高相关的症状。这些病变的自然病程通常极为缓慢。因此，初始手术治疗旨在治疗脑积水，通常采用脑室分流术。近来，第三脑室造瘘术已用于顶盖胶质瘤患者，既作为初始治疗方法，也用于分流失败后。在本报告中，作者回顾了他们治疗顶盖胶质瘤患者脑积水的经验。
作者回顾了31例连续的顶盖胶质瘤病例，并比较了脑室分流术与内镜下第三脑室造瘘术（ETV）的成功率。分流术出现了大量故障，大多数患者需要进行分流术修正。ETV手术既作为初始治疗方法，也在分流出现故障后尝试。总体而言，18例患者尝试了ETV，所有病例均成功实施。在随访评估时，16例患者（89%）无需分流。
作者发现，ETV无论是作为初始治疗方法还是在分流失败后进行，长期效果都很好。总体而言，在治疗与顶盖胶质瘤相关的脑积水方面，ETV被发现优于脑室分流术。
