Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA.
Neurosurg Focus. 2011 Apr;30(4):E3. doi: 10.3171/2011.2.FOCUS10301.
Simultaneous endoscopic third ventriculostomy (ETV) and tumor biopsy is a widely accepted therapeutic and diagnostic procedure for patients with noncommunicating hydrocephalus secondary to a pineal region tumor. Multiple approaches have been advocated, including the use of a steerable fiberoptic or rigid lens endoscope via 1 or 2 trajectories. However, the optimal approach has not been established based on the individual anatomical characteristics of the patient.
A retrospective review of patients undergoing simultaneous ETV and tumor biopsy was undertaken. Preoperative MR images were examined to measure the width of the anterior third ventricle and maximal diameters of the tumor, Monro foramen (right), and massa intermedia. The distances between the tumor and massa intermedia, tumor and anterior commissure, midbrain and massa intermedia, and the dorsum sella and anterior commissure were also recorded. Single and dual trajectory approaches were compared using paired t-tests for each parameter.
Over an 8-year interval, 15 patients underwent simultaneous ETV and tumor management. These patients ranged from 6 to 71 years of age (mean 36.7 years); 5 were younger than 18 years of age. Seven were treated using a dual trajectory approach, and 8 were treated using a single trajectory approach. All cases were completed without complications or the need for an additional CSF diversionary procedure within 6 months. The diagnostic yield at biopsy was 86.7%. There were no statistically significant differences between the single and dual trajectory groups for the measured parameters. However, the dual trajectory group demonstrated a larger anterior third ventricular diameter (1.43 vs 1.21 cm, p = 0.29). The single trajectory group trended toward a smaller tumor-anterior commissure interval (2.23 vs 2.51 cm, p = 0.24) and a larger dorsum sella-anterior commissure distance (1.67 vs 1.49 cm, p = 0.28).
These data confirm the safety and diagnostic efficacy of simultaneous ETV and biopsy for tumors of the pineal region. Although no statistically significant differences were seen in the authors' recorded measurements, several trends suggest a role for a tailored approach to selecting a single or dual trajectory approach when using a rigid endoscope.
内镜第三脑室造瘘术（ETV）联合肿瘤活检术已被广泛接受，可用于治疗和诊断松果体区肿瘤继发的非交通性脑积水患者。目前已有多种入路方式被报道，包括使用可弯曲纤维光学内镜或硬性内镜，通过 1 或 2 条入路。然而，目前尚无基于患者个体解剖学特征的最佳入路选择标准。
我们对行 ETV 联合肿瘤活检术的患者进行了回顾性研究。术前磁共振成像（MRI）用于测量前第三脑室的宽度和肿瘤、Monro 孔（右侧）及中脑导水管的最大直径。同时还记录肿瘤与中脑导水管间、肿瘤与前连合间、中脑与中脑导水管间、鞍背与前连合间的距离。对各项参数采用配对 t 检验比较单入路和双入路。
在 8 年的时间里，共有 15 例患者接受了 ETV 联合肿瘤治疗。患者年龄 6~71 岁（平均 36.7 岁），5 例年龄小于 18 岁。7 例患者采用双入路，8 例采用单入路。所有患者均顺利完成手术，无并发症发生，且术后 6 个月内无需行额外的脑脊液分流术。活检的诊断率为 86.7%。两组间各测量参数均无统计学差异。然而，双入路组的前第三脑室直径更大（1.43 cm 比 1.21 cm，p = 0.29）。单入路组的肿瘤-前连合间距更小（2.23 cm 比 2.51 cm，p = 0.24），而鞍背-前连合间距更大（1.67 cm 比 1.49 cm，p = 0.28）。
本研究证实了 ETV 联合活检治疗松果体区肿瘤的安全性和诊断效能。尽管在作者记录的测量指标中未发现统计学差异，但有几个趋势表明，在使用硬性内镜时，选择单入路或双入路可能需要个体化考虑。
