Torres-Corzo Jaime Gerardo, Sanchez-Rodriguez Jose, Castillo-Rueda Juan Lucino, Falcon-Escobedo Reynaldo, Cervantes Dominic, Rodriguez-Della Vecchia Roberto, Vinas-Rios Juan Manuel
Department of Neurosurgery, Hospital Central, "Dr. Ignacio Morones Prieto," San Luis Potosi, San Luis Potosi, Mexico.
Department of Neurosurgery, Evangelisches Krankenhaus Oldenburg, Oldenburg, Lower Saxony, Germany.
J Neurol Surg A Cent Eur Neurosurg. 2015 Jul;76(4):291-7. doi: 10.1055/s-0034-1373661. Epub 2015 Mar 23.
To describe our experience and the results obtained in performing transventricular brainstem biopsy with the use of flexible neuroendoscops.
We identified patients who underwent a neuroendoscopic procedure with brainstem lesion biopsy to obtain histopathologic diagnosis and to treat obstructive hydrocephalus. All patients had follow-up examinations at months 1, 3, 6, and 12 postsurgery and then annually.
Seven patients had a transventricular biopsy of the brainstem performed. Of those, five were pediatric patients. The median age was 10 years (range: 3-26 years). Five of them were female and two male. Four patients presented with secondary obstructive hydrocephalus. The main clinical presentations were intracranial hypertension syndrome in four patients, motor neuron disease in four patients, two with decreased state of alertness, two with gait ataxia, and one with Parinaud syndrome. The types of tumors found in the histopathology and their location were one ventral (pons) and one aqueductal anaplastic astrocytoma, two ventral, one aqueductal, and one attached to the floor of the fourth ventricle pilocytic astrocytoma and one ventral low-grade astrocytoma. The route taken to approach the ventral tumors was made through premammillary fenestration. The tumors of the aqueduct and floor of the fourth ventricle were approached transaqueductally.
The use of flexible endoscops for biopsy of ventral, dorsal (tectum lamina quadrigemina), and diffuse brainstem tumors is a useful, effective, and safe procedure that also allows to treat obstructive hydrocephalus secondary to the tumors.
描述我们使用软性神经内镜进行经脑室脑干活检的经验及取得的结果。
我们确定了接受神经内镜手术并进行脑干病变活检以获得组织病理学诊断和治疗梗阻性脑积水的患者。所有患者在术后1、3、6和12个月进行随访检查，之后每年进行一次。
7例患者接受了经脑室脑干活检。其中，5例为儿科患者。中位年龄为10岁（范围：3 - 26岁）。5例为女性，2例为男性。4例患者出现继发性梗阻性脑积水。主要临床表现为4例颅内高压综合征，4例运动神经元病，2例意识状态减退，2例步态共济失调，1例帕里诺德综合征。组织病理学中发现的肿瘤类型及其位置为1例腹侧（脑桥）和1例导水管间变性星形细胞瘤，2例腹侧、1例导水管和1例附着于第四脑室底的毛细胞型星形细胞瘤以及1例腹侧低级别星形细胞瘤。接近腹侧肿瘤所采用的途径是通过乳头前开窗。导水管和第四脑室底的肿瘤是经导水管途径接近的。
使用软性内镜对腹侧、背侧（四叠体板）和弥漫性脑干肿瘤进行活检是一种有用、有效且安全的方法，还能治疗肿瘤继发的梗阻性脑积水。
