Yip C-M, Hsu S-S, Liao W-C, Chen J-Y, Liu S-H, Chen C-H
Department of Neurosurgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
Minim Invasive Neurosurg. 2011 Aug;54(4):191-5. doi: 10.1055/s-0031-1285887. Epub 2011 Sep 15.
Intraventricular tumors account for approximately 3% of adult brain tumors and 16% of childhood and adolescent brain tumors. Half of the intraventricular tumors in adults and one quarter of those in children are found in the lateral ventricles. Ependymoma, astrocytoma, oligodendroglioma, choroid plexus papilloma, meningioma and subependymal giant cell astrocytoma are the common tumors encountered at this particular site. A germinoma at this site is rare. Microsurgery of intraventricular tumors can be challenging and is performed with potential functional and cognitive complications.
A 25-year-old female harboring an intraventricular tumor at the foramen of Monro with resultant obstructive hydrocephalus underwent a right intraventricular endoscopic resection of the tumor by means of frameless neuronavigation guidance and temporary external ventricular drainage. Histology showed the tumor to be a germinoma. The post-operative imaging showed that there was some residual tumor tissue in the fornix. Concerned with possibility of cerebrospinal fluid seeding, we administered postoperative adjuvant craniospinal irradiation. The patient was discharged with a Glascow outcome scale score of 5 and at last the 6-month follow-up there was no evidence of recurrence.
This report suggests that in selected cases endoscopic resection of an intraventricular tumor under frameless neuronavigation guidance is feasible and safe. The target can be precisely located and procedure-related adverse events can be minimized.
脑室内肿瘤约占成人大脑肿瘤的3%，儿童和青少年脑肿瘤的16%。成脑室内肿瘤的一半以及儿童脑室内肿瘤的四分之一位于侧脑室。室管膜瘤、星形细胞瘤、少突胶质细胞瘤、脉络丛乳头状瘤、脑膜瘤和室管膜下巨细胞星形细胞瘤是该特定部位常见的肿瘤。该部位的生殖细胞瘤罕见。脑室内肿瘤的显微手术具有挑战性，且手术可能伴有潜在的功能和认知并发症。
一名25岁女性，在Monro孔处患有脑室内肿瘤并导致梗阻性脑积水，通过无框架神经导航引导和临时脑室外引流进行了右侧脑室内肿瘤内镜切除术。组织学检查显示肿瘤为生殖细胞瘤。术后影像学检查显示穹窿部有一些残留肿瘤组织。鉴于脑脊液播散的可能性，我们给予了术后辅助全脑脊髓照射。患者出院时格拉斯哥预后评分5分，最后6个月随访未发现复发迹象。
本报告表明，在某些病例中，在无框架神经导航引导下内镜切除脑室内肿瘤是可行且安全的。靶点可精确定位，与手术相关的不良事件可降至最低。
