Roth Jonathan, Constantini Shlomi
Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
J Neurosurg. 2015 Jun;122(6):1341-6. doi: 10.3171/2014.9.JNS141397. Epub 2015 Mar 27.
Tumors leading to occlusion of the sylvian aqueduct include those of pineal, thalamic, and tectal origins. These tumors cause obstructive hydrocephalus and thus necessitate a CSF diversion procedure such as an endoscopic third ventriculostomy (ETV), often coupled with an endoscopic biopsy (EBX). Lesions located posterior to the massa intermedia pose a technical challenge, as the use of a rigid endoscope for performing both an ETV and EBX is limited. The authors describe their experience using a combined rigid and flexible endoscopic procedure through a single bur hole for both procedures in patients with posterior third ventricular tumors.
Since January 2012, patients with posterior third ventricular tumors causing hydrocephalus underwent dual ETV and EBX procedures using the combined rigid-flexible endoscopic technique. Following institutional review board approval, data from clinical, radiological, surgical, and pathological records were retrospectively collected.
Six patients 3.5-53 years of age were included. Lesion locations included pineal (n = 3), fourth ventricle (n = 1), aqueduct (n = 1), and tectum (n = 1). The ETV and EBX were successful in all cases. Pathologies included pilocytic astrocytoma, pineoblastoma, ependymoma Grade II, germinoma, low-grade glioneural tumor, and atypical choroid plexus papilloma. One patient experienced an immediate postoperative intraventricular hemorrhage necessitating evacuation of the clots and resection of the tumor, eventually leading to the patient's death.
The authors recommend using a combined rigid-flexible endoscope for endoscopic third ventriculostomy and biopsy to approach posterior third ventricular tumors (behind the massa intermedia). This technique overcomes the limitations of using a rigid endoscope by reaching 2 distant regions.
导致中脑导水管阻塞的肿瘤包括松果体、丘脑和顶盖起源的肿瘤。这些肿瘤会引起梗阻性脑积水，因此需要进行脑脊液分流手术，如内镜下第三脑室造瘘术（ETV），通常还会联合内镜活检（EBX）。中间块后方的病变带来了技术挑战，因为使用硬质内镜进行ETV和EBX都受到限制。作者描述了他们在患有第三脑室后部肿瘤的患者中，通过单一骨孔使用硬质和柔性内镜联合手术进行这两种操作的经验。
自2012年1月起，对因第三脑室后部肿瘤导致脑积水的患者采用硬质-柔性内镜联合技术进行ETV和EBX双重手术。经机构审查委员会批准后，回顾性收集临床、放射学、手术和病理记录数据。
纳入6例年龄在3.5至53岁之间的患者。病变部位包括松果体（n = 3）、第四脑室（n = 1）、导水管（n = 1）和顶盖（n = 1）。所有病例的ETV和EBX均成功。病理类型包括毛细胞型星形细胞瘤、松果体母细胞瘤、II级室管膜瘤、生殖细胞瘤、低级别神经胶质瘤和非典型脉络丛乳头状瘤。1例患者术后立即发生脑室内出血，需要清除血凝块并切除肿瘤，最终导致患者死亡。
作者建议使用硬质-柔性内镜联合进行内镜下第三脑室造瘘术和活检，以处理第三脑室后部（中间块后方）的肿瘤。该技术通过到达两个不同区域克服了使用硬质内镜的局限性。
