Nigri Flávio, Telles Carlos, Acioly Marcus André
Department of Surgical Specialties, Division of Neurosurgery, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro-RJ, Brazil.
J Neurosurg Pediatr. 2010 Jun;5(6):641-4. doi: 10.3171/2010.1.PEDS09320.
Endoscopic third ventriculostomy (ETV) has been established as an effective method in the treatment of tumoral obstructive hydrocephalus. Delayed closure of the ETV stoma has been attributed to scarring involving the third ventricular floor. Secondary obstruction of the stoma due to intraventricular tumor seeding is an extremely rare condition, with only one case described to date. The authors report on a unique case of late closure of the ETV stoma caused by metastatic seeding of a recurrent medulloblastoma 9 years after the initial treatment. The patient was submitted to a second endoscopic procedure in which a reddish mass located just at the third ventricular floor was resected, leading to reopening of the previous ETV stoma. To the best of the authors' knowledge, this case is the first report of an ETV obstruction due to metastatic CSF seeding of a medulloblastoma. In such cases of late failure of the ETV stoma because of tumor obstruction, a second ETV can be safely performed and lead to adequate function of the stoma, even if limited by the aggressive nature of the disease.
内镜下第三脑室造瘘术（ETV）已被确立为治疗肿瘤性梗阻性脑积水的有效方法。ETV造瘘口延迟闭合归因于涉及第三脑室底部的瘢痕形成。由于脑室内肿瘤播散导致的造瘘口继发性梗阻是一种极其罕见的情况，迄今为止仅报道过1例。作者报告了1例独特病例，初始治疗9年后，复发性髓母细胞瘤转移播散导致ETV造瘘口延迟闭合。该患者接受了第二次内镜手术，切除了位于第三脑室底部的红色肿块，使先前的ETV造瘘口重新开放。据作者所知，该病例是第一例因髓母细胞瘤脑脊液转移播散导致ETV梗阻的报告。在因肿瘤梗阻导致ETV造瘘口晚期失效的此类病例中，即使受疾病侵袭性的限制，也可安全地进行第二次ETV手术并使造瘘口功能恢复正常。
