Sabanci Pulat Akin, Aras Yavuz, Ali Achmet, Unal Tugrul Cem, Dolen Duygu, Sencer Serra, Izgi Nail, Unal Faruk, Barlas Orhan
Istanbul University, Istanbul School of Medicine, Department of Neurosurgery, Istanbul, Turkey.
Turk Neurosurg. 2017;27(4):546-557. doi: 10.5137/1019-5149.JTN.17142-16.2.
To compare the clinical results of different transcortical approaches for the removal of third ventricular colloid cysts (CC).
Records of 41 colloid cyst patients who underwent transcortical conventional microsurgical, microsurgical with the aid of stereotactically guided cylindrical retractor (minitubular), and endoscopic removal between 1999 and 2015 were retrospectively analyzed. The clinical results of these three different transcortical surgical approaches were compared and a literature review of published series was conducted.
Ages ranged between 16 and 66 years (mean: 36.8). There were 18 female and 23 male patients. Headache was the main presenting symptom. The mean CC diameter was 15.5 mm. Intraventricular hemorrhage was encountered in 2 patients. Three patients needed postoperative ventriculoperitoneal shunt surgery. Postoperative seizures were seen in 3, postoperative neurological deficit in 3 and residual tumor in 2 patients. The conventional approach resulted in significantly higher rates of postoperative seizure compared to the minitubular and endoscopic approaches (p=0.012). The rate of residual cyst was significantly higher in endoscopic approach compared to conventional and minitubular approaches (p=0.024). Conventional approach led to significantly higher rates of neurological deficit compared to the two other approaches (p < 0.05).
With respect to complication rates, the stereotactic and endoscopic approaches are both safe and reliable compared to conventional microsurgical approach that has unacceptably high rates of seizures and neurological deficit. Concerning completeness of removal, both microsurgical approaches are by far superior to neuroendoscopy. The stereotactic microsurgical approach compares favorably in both respects with endoscopic and conventional microsurgical approaches.
比较不同经皮质入路切除第三脑室胶样囊肿（CC）的临床效果。
回顾性分析1999年至2015年间41例接受经皮质传统显微手术、立体定向引导圆柱牵开器辅助显微手术（微型管状）及内镜下切除的胶样囊肿患者的记录。比较这三种不同经皮质手术入路的临床效果，并对已发表系列文献进行综述。
年龄范围为16至66岁（平均：36.8岁）。有18例女性和23例男性患者。头痛是主要的临床表现。CC的平均直径为15.5毫米。2例患者出现脑室内出血。3例患者术后需要行脑室腹腔分流术。3例患者出现术后癫痫发作，3例出现术后神经功能缺损，2例有残留肿瘤。与微型管状和内镜入路相比，传统入路术后癫痫发作率显著更高（p = 0.012）。与传统和微型管状入路相比，内镜入路的残留囊肿率显著更高（p = 0.024）。与其他两种入路相比，传统入路导致的神经功能缺损率显著更高（p < 0.05）。
就并发症发生率而言，与癫痫发作率和神经功能缺损率高得难以接受的传统显微手术入路相比，立体定向和内镜入路均安全可靠。关于切除的完整性，两种显微手术入路均远优于神经内镜。立体定向显微手术入路在这两方面均优于内镜和传统显微手术入路。
