Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
J Neurosurg. 2010 May;112(5):1046-55. doi: 10.3171/2009.7.JNS09571.
The aim of this study was to review the outcome of patients undergoing surgery for treatment of lateral-ventricle metastases.
Imaging information and chart reviews of operative reports were used to conduct a retrospective analysis in 29 patients who underwent resection of lateral-ventricle metastases at the authors' institution between 1993 and 2007. Clinical and neurosurgical outcomes and recurrence rates were studied.
The mean patient age was 56 years (range 20-69 years); 66% of patients were male. Single intraventricular metastases occurred in 69% of patients, and 55% of them had systemic metastases. The 30-day postoperative mortality rate was 7%. There was intracerebral tumor recurrence in 41% of patients, with 1 patient undergoing a second operation for this. The median postoperative survival duration for 28 patients (excluding 1 patient with preoperative leptomeningeal disease) was 11.7 months; the 3- and 5-year survival rates were 17 and 11%, respectively. Univariate analysis identified factors significantly influencing survival, including the preoperative Karnofsky Performance Scale (KPS) score (p = 0.02), the number of cerebral metastases (p = 0.02), the presence of primary renal cell carcinoma (RCC) (p = 0.02), and the resection method (en bloc vs piecemeal; p = 0.05). The presence of extracranial metastases did not significantly influence survival. Multivariate analysis showed that the preoperative KPS score (p = 0.002), the presence of primary RCC (p = 0.039), and the resection method (en bloc vs piecemeal; p = 0.008) correlated significantly with survival time.
Surgery is an important component in the management of intraventricular metastases. To the authors' knowledge, this is the first study focusing totally on resection of lateral-ventricle metastases. The authors found that patients with primary RCC, those with a favorable preoperative KPS score, and those who underwent en bloc resection had a better outcome than others.
本研究旨在回顾接受手术治疗侧脑室转移瘤患者的治疗结果。
对 1993 年至 2007 年间在作者所在机构接受侧脑室转移瘤切除术的 29 例患者的影像学资料和手术报告进行回顾性分析。研究了临床和神经外科结果及复发率。
患者平均年龄为 56 岁（范围 20-69 岁）；66%为男性。69%的患者出现单一侧脑室转移，55%的患者有全身转移。术后 30 天死亡率为 7%。41%的患者出现颅内肿瘤复发，其中 1 例再次手术。28 例患者（不包括 1 例术前软脑膜疾病患者）的中位术后生存时间为 11.7 个月；3 年和 5 年生存率分别为 17%和 11%。单因素分析发现，影响生存的因素包括术前卡诺夫斯基表现量表（KPS）评分（p = 0.02）、脑转移数量（p = 0.02）、原发性肾细胞癌（RCC）存在（p = 0.02）和切除方法（整块切除与分片切除；p = 0.05）。颅外转移的存在并不显著影响生存。多因素分析显示，术前 KPS 评分（p = 0.002）、原发性 RCC 存在（p = 0.039）和切除方法（整块切除与分片切除；p = 0.008）与生存时间显著相关。
手术是治疗侧脑室转移瘤的重要组成部分。据作者所知，这是第一篇完全关注侧脑室转移瘤切除术的研究。作者发现，原发性 RCC 患者、术前 KPS 评分较好的患者和接受整块切除的患者的预后优于其他患者。
