Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia.
Neurosurgery. 2010 Sep;67(3 Suppl Operative):ons159-65. doi: 10.1227/01.NEU.0000383136.40033.2D.
Pineocytomas are rare pineal region tumors. The mainstay of treatment for pineocytomas is total surgical resection.
To address the worthiness of endoscopy to achieve total macroscopic resection and whether or not this portends better progression-free and overall survival.
A series of 15 patients (11 females, 4 males; mean age, 48 years) with histological diagnosis of pineocytoma were retrospectively reviewed. All patients underwent an attempt at total resection via an interhemispheric/transtentorial/retrosplenial approach. The endoscope was used at various times throughout the case and consistently at the end to evaluate any possible residual tumor. No patient in this series was given radiotherapy after surgery.
There was no surgical mortality and all patients are currently alive without recurrence (mean follow-up, 4.28 years). A macroscopic and radiological complete removal was achieved in all cases. There was only one patient with permanent neurological deficit (disconjugate eye movements). Two patients (13%) had transient poor sleep pattern, 5 patients (33%) had transient disconjugate eye movements, and 2 patients (13%) had transient short-term memory disturbance. In 6 cases (40%), the endoscope was able to detect residual tumor located either behind the Vein of Galen or attached to the undersurface of the corpus callosum. Residual tumor was then resected using a 30 degrees endoscope and dedicated angled endoscopic instruments.
This series demonstrates the advantage of endoscopic-assisted surgery in the total removal of pineocytomas. With total removal of these histologically benign tumors patients may enjoy extended progression-free survival without adjuvant radiotherapy.
松果体细胞瘤是一种罕见的松果体区域肿瘤。松果体细胞瘤的主要治疗方法是完全手术切除。
探讨内镜在实现全切除方面的价值，以及是否预示着更好的无进展生存和总体生存。
回顾性分析了 15 例（女性 11 例，男性 4 例；平均年龄 48 岁）经组织学诊断为松果体细胞瘤的患者。所有患者均采用大脑半球间/经天幕/经胼胝体后入路行全切除手术。在手术过程中，内镜被用于多个部位，并在手术结束时用于评估任何可能残留的肿瘤。本系列患者术后均未接受放疗。
无手术死亡，所有患者均存活且无复发（平均随访时间 4.28 年）。所有病例均达到了宏观和影像学上的完全切除。仅有 1 例患者出现永久性神经功能缺损（共轭眼运动障碍）。2 例（13%）患者出现短暂性睡眠模式不佳，5 例（33%）患者出现短暂性共轭眼运动障碍，2 例（13%）患者出现短暂性短期记忆障碍。在 6 例（40%）患者中，内镜能够发现位于 Galen 静脉后方或附着于胼胝体下表面的残留肿瘤。然后使用 30°内镜和专用角度内镜器械切除残留肿瘤。
本系列研究表明，内镜辅助手术在松果体细胞瘤的全切除中具有优势。通过对这些组织学良性肿瘤的完全切除，患者可能在不接受辅助放疗的情况下获得更长的无进展生存。
