Cipri S, Gangemi A, Cafarelli F, Messina G, Iacopino P, Al Sayyad S, Capua A, Comi M, Musitano A
Operative Unit of Neurosurgery, Bianchi-Melacrino-Morelli Hospitals, Reggio Calabria, Italy.
J Neurosurg Sci. 2005 Sep;49(3):97-106.
In patients with space-occupying lesions of the pineal region, increased intracranial pressure is due to direct compression of the sylvian aqueduct. Based on results of the recent literature, neuroendoscopic management of obstructive hydrocephalus, secondary to tumors of the pineal gland, has gained a preeminent role respect to shunting procedures.
In 14 select cases, hydrocephalus was secondary to midline and pineal lesions. The patient's age ranged from 1 to 56 years (mean 47.3+/-12.5), with a follow-up ranged from 3 months to 5 years after discharge. In 9 cases the endoscopic procedure represented the only surgical treatment. In 5 cases, microsurgical removal of the lesions and/or ventriculo-peritoneal shunts placement were performed, as additional treatment, while adjuvant radiotherapy was utilized in 4 cases; high dose chemotherapy followed by bone marrow transplantation was performed in 3 cases.
In our series, obstructive hydrocephalus secondary to midline and pineal lesions, was successful treated by neuroendoscopic approach alone in 9 cases, with an unremarkable course and good outcome, except in 1 case.
Neuroendoscopic approach affords a minimally invasive way to obtain 4 objectives by one-step surgical approach, such as resolution of obstructive hydrocephalus by endoscopic third ventriculostomy (ETV), cerebrospinal fluid sample to detect tumor markers and to perform cytological analysis, biopsy specimens and tissue diagnosis, associated to absence of shunt-related complications. Therefore, in experienced hands, ETV should be the treatment of first choice, in cases of hydrocephalus secondary to lesions of the pineal gland.
在松果体区占位性病变患者中，颅内压升高是由于大脑中脑导水管直接受压所致。根据近期文献结果，对于松果体肿瘤继发的梗阻性脑积水，神经内镜治疗相对于分流手术已占据显著地位。
选取14例病例，脑积水继发于中线和松果体病变。患者年龄从1岁至56岁（平均47.3±12.5岁），出院后随访时间为3个月至5年。9例患者中，内镜手术是唯一的手术治疗方式。5例患者进行了病变的显微手术切除和/或脑室-腹腔分流术作为辅助治疗，4例患者接受了辅助放疗；3例患者进行了高剂量化疗并随后进行了骨髓移植。
在我们的系列病例中，9例中线和松果体病变继发的梗阻性脑积水通过单纯神经内镜方法成功治疗，除1例患者外，病程顺利且预后良好。
神经内镜方法提供了一种微创的一步手术方法来实现4个目标，例如通过内镜下第三脑室造瘘术（ETV）解决梗阻性脑积水、采集脑脊液样本以检测肿瘤标志物并进行细胞学分析、获取活检标本和组织诊断，同时避免分流相关并发症。因此，在经验丰富的医生手中，对于松果体病变继发的脑积水，ETV应作为首选治疗方法。
