Kim Kyunghwan, Yeon Je Young, Seol Ho Jun, Shin Hyung Jin
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea.
Childs Nerv Syst. 2013 Aug;29(8):1285-91. doi: 10.1007/s00381-013-2085-9. Epub 2013 Apr 2.
The purpose of this study was to investigate the efficacy and safety of transventricular neuroendoscopic biopsies in pediatric patients with suprasellar tumors.
Twenty-three pediatric patients (12 males and 11 females) with suprasellar tumors underwent transventricular neuroendoscopic biopsy at our institute by a single surgeon from 2000 to 2011. Neuronavigation has been combined with endoscopic procedures since 2008. Neuroendoscopic biopsies were performed to verify the histopathological diagnosis of neoplasms and to plan appropriate treatment strategies.
Neuroendoscopic biopsy specimens were appropriate for diagnosis in 22 of the 23 patients (95.7%) and revealed 14 germ cell tumors (12 germinomas, one choriocarcinoma, and one immature teratoma), seven astrocytomas, and one craniopharyngioma. Subsequent treatment modalities including chemotherapy, radiation therapy, or microscopic surgery were determined according to the pathological findings. Seventeen of the 23 patients (73.9%) showed ventriculomegaly. Among them, ventriculomegaly in 14 patients was resolved after an endoscopic procedure and/or adjuvant chemotherapy, but the remaining three patients (17.6%) required a ventriculoperitoneal shunt to relieve the ventriculomegaly. The pathologic diagnosis of these three patients was uniformly a large astrocytoma. Navigational tracking was helpful to enter small ventricles and the narrow foramen of Monro in patients without hydrocephalus. No mortalities were related to the procedures, but three transient diabetes insipidus (13.0%) cases occurred but fully recovered before the patients received adjuvant therapy.
Endoscopic biopsy is feasible and shows acceptable operation-related complications to obtain tissue from suprasellar tumors in pediatric patients. Navigation-assisted neuroendoscopic procedure improves the accuracy of the endoscopic approach. An associated endoscopic procedure can resolve hydrocephalus, but it has limitations with large ventricle-occupying tumors.
本研究旨在探讨经脑室神经内镜活检术在小儿鞍上肿瘤患者中的有效性和安全性。
2000年至2011年，我院一名外科医生为23例小儿鞍上肿瘤患者（12例男性，11例女性）实施了经脑室神经内镜活检术。自2008年起，神经导航技术已与内镜手术相结合。进行神经内镜活检以验证肿瘤的组织病理学诊断并制定合适的治疗策略。
23例患者中有22例（95.7%）的神经内镜活检标本适合诊断，结果显示14例生殖细胞瘤（12例生殖细胞瘤、1例绒毛膜癌和1例未成熟畸胎瘤）、7例星形细胞瘤和1例颅咽管瘤。根据病理结果确定了后续的治疗方式，包括化疗、放疗或显微手术。23例患者中有17例（73.9%）出现脑室扩大。其中，14例患者的脑室扩大在内镜手术和/或辅助化疗后得到缓解，但其余3例患者（17.6%）需要行脑室腹腔分流术以缓解脑室扩大。这3例患者的病理诊断均为大型星形细胞瘤。神经导航有助于进入无脑积水患者的小脑室和狭窄的室间孔。手术未导致死亡，但发生了3例短暂性尿崩症（13.0%），但在患者接受辅助治疗前均完全康复。
内镜活检可行，在小儿患者中从鞍上肿瘤获取组织时显示出可接受的手术相关并发症。导航辅助神经内镜手术提高了内镜手术的准确性。相关的内镜手术可缓解脑积水，但对于占据脑室的大型肿瘤存在局限性。
