Renovanz M, Hickmann A K, Gutenberg A, Bittl M, Hopf N J
Department of Neurosurgery, University Medical Center, Johannes-Gutenberg-University Mayence, Langenbeckstrasse 1, 55131, Mayence, Germany,
Childs Nerv Syst. 2015 May;31(5):665-74. doi: 10.1007/s00381-015-2620-y. Epub 2015 Feb 17.
Surgery is an integral component and typically the first line of therapy for children with central nervous system tumors. Conventional aims of neurosurgery including tumor removal, management of hydrocephalus, and diagnostic sampling have been radically modified with innovative technologies such as navigational guidance, functional mapping, endoscopic surgery, second-look surgery, and physiologic imaging. The aim of the study was to investigate our operative results using minimally invasive technique in children.
Clinical features, surgical technique and results, length of hospital stay, and complications were reviewed retrospectively. Pre- and early postoperative MRI was evaluated for degree of surgical resection. Correlation of tumor localization, lengths of hospital stay as well as surgical techniques and clinical outcome with follow-up was investigated.
One hundred ten patients underwent 125 tumor resections using minimally invasive approaches (image- and functional guided tailored keyhole approaches for supratentorial, retrosigmoidal, and suboccipital keyhole approaches for infratentorial lesions). Most tumors were located supratentorial (62.4 %). In 29.6 % of the cases, the surgery was performed endoscope-assisted or endoscope-controlled; neuronavigation was used in 45.6 % and ultrasound in 24 % of the cases. Astrocytomas were diagnosed in 26.4 % of cases, ependymomas in 9.6 %, and medulloblastomas in 14.4 %. Gross total resection was achieved in 60.8 %. The most common complication was CSF fistula (n = 9), and the occurrence was significantly higher in younger children (p = 0.0001) and infratentorial located tumors (p = 0.02). Surgery for posterior fossa lesions was associated with a longer hospital stay (p = 0.02) compared to surgery of supratentorial lesions. Mean follow-up was 29.7 months (range 0.3-79.1 months), and most of the children recovered during the further course of the follow-up (symptoms better or idem in 74.4 %).
In conclusion, our study shows that it is possible to achieve surgical results in the pediatric population applying minimal invasive techniques comparable to those described in the literature.
手术是中枢神经系统肿瘤患儿治疗的重要组成部分，通常也是一线治疗方法。随着导航引导、功能图谱、内镜手术、二次探查手术和生理成像等创新技术的出现，神经外科手术的传统目标，包括肿瘤切除、脑积水管理和诊断性采样，已发生了根本性的改变。本研究的目的是探讨我们在儿童中使用微创技术的手术效果。
回顾性分析临床特征、手术技术及结果、住院时间和并发症。评估术前及术后早期MRI的手术切除程度。研究肿瘤定位、住院时间以及手术技术与随访临床结果之间的相关性。
110例患者采用微创方法进行了125次肿瘤切除（幕上病变采用影像和功能引导下的定制锁孔入路，幕下病变采用乙状窦后和枕下锁孔入路）。大多数肿瘤位于幕上（62.4%）。29.6%的病例采用内镜辅助或内镜控制手术；45.6%的病例使用神经导航，24%的病例使用超声。26.4%的病例诊断为星形细胞瘤，9.6%为室管膜瘤，14.4%为髓母细胞瘤。全切除率为60.8%。最常见的并发症是脑脊液漏（n = 9），年幼儿童（p = 0.0001）和幕下肿瘤（p = 0.02）的发生率明显更高。与幕上病变手术相比，后颅窝病变手术的住院时间更长（p = 0.02）。平均随访时间为29.7个月（范围0.3 - 79.1个月），大多数儿童在随访过程中恢复（74.4%症状改善或相同）。
总之，我们的研究表明，应用微创技术在儿科人群中可以取得与文献报道相当的手术效果。
