Mottolese C, Szathmari A, Ricci-Franchi A C, Gallo P, Beuriat P A, Capone G
Service of Pediatric Neurosurgery, Neurological and Neurosurgical Hospital "P. Wertheimer", 59, boulevard Pinel, 69677 Bron, France.
Service of Pediatric Neurosurgery, Neurological and Neurosurgical Hospital "P. Wertheimer", 59, boulevard Pinel, 69677 Bron, France.
Neurochirurgie. 2015 Apr-Jun;61(2-3):176-83. doi: 10.1016/j.neuchi.2014.02.004. Epub 2014 May 24.
The infratentorial supracerebellar approach is most widely used for pineal tumors. We report our own experience and technical considerations using this approach.
From 1982 to 2010, we operated on 232 patients with pineal region tumors. Of these, 201 patients were operated on using a suboccipital transtentorial approach while 31 patients were operated on using a supracerebellar infratentorial approach. The median age of the patients ranged between 8 months and 74 years. There were 19 children and 12 adults. All patients presented with elevated intracranial pressure. There were 6 pinealocytomas, 3 papillary tumors, 7 germinomas, 2 benign teratomas, 4 pineal cysts and 9 gliomas. Adjuvant post-surgical therapy consisted of chemo-radiotherapy in 4 patients, 2 with germinomas and 2 with a grade II/III gliomas. Radiotherapy was performed in the other twelve patients (5 germinomas and 7 gliomas).
All patients are still alive at a median follow-up of eight years. Twelve of the 19 children are attending normal school classes for their age, 5 are attending classes for special needs children and 2 are not yet of school age at the last follow-up. Seven of the 12 adults are working normally, three are working part-time at the same job and two have retired but are able to lead a normal life. Postoperative complications included symptomatic diffuse cerebellar edema (one patient) completely resolved with a mild residual cerebellar syndrome; double vision secondary to IV nerve palsy (one patient); transitory Parinaud's syndrome (2 patients) and cerebellar gait (2 patients) nearly completely recovered at respectively six and twelve months.
The supracerebellar infratentorial approach seems to be a safe and effective choice in the treatment of pineal region tumors. In our experience, it permits complete tumor resections with acceptable morbidity and all neurosurgeons should master this approach in order to adapt their surgical choice according to size, extent and the relationship of the lesion with the surrounding anatomical structures.
幕下小脑上入路是松果体区肿瘤最常用的手术入路。我们报告了使用该入路的经验和技术要点。
1982年至2010年，我们对232例松果体区肿瘤患者进行了手术。其中，201例采用枕下经小脑幕入路，31例采用小脑上幕下入路。患者年龄中位数在8个月至74岁之间。有19名儿童和12名成人。所有患者均有颅内压升高。其中有6例松果体细胞瘤、3例乳头状肿瘤、7例生殖细胞瘤、2例良性畸胎瘤、4例松果体囊肿和9例胶质瘤。术后辅助治疗包括4例患者接受放化疗，其中2例生殖细胞瘤患者和2例II/III级胶质瘤患者。另外12例患者（5例生殖细胞瘤和7例胶质瘤）接受了放疗。
所有患者在中位随访8年时均存活。19名儿童中，12名在最后一次随访时正常上学，5名在特殊需求儿童班级上课，2名尚未达到上学年龄。12名成人中，7名正常工作，3名在同一工作岗位兼职，2名已退休但能正常生活。术后并发症包括有症状的弥漫性小脑水肿（1例患者），通过轻度残留小脑综合征完全缓解；IV神经麻痹继发复视（1例患者）；短暂性帕里诺德综合征（2例患者）和小脑性步态（2例患者）分别在6个月和12个月时几乎完全恢复。
小脑上幕下入路似乎是治疗松果体区肿瘤的一种安全有效的选择。根据我们的经验，它能在可接受的发病率情况下实现肿瘤全切，所有神经外科医生都应掌握此入路，以便根据病变的大小、范围以及与周围解剖结构的关系来调整手术选择。
