Cinalli Giuseppe, Imperato Alessia, Mirone Giuseppe, Di Martino Giuliana, Nicosia Giancarlo, Ruggiero Claudio, Aliberti Ferdinando, Spennato Pietro
Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy.
J Neurosurg Pediatr. 2017 Mar;19(3):325-332. doi: 10.3171/2016.10.PEDS16352. Epub 2017 Jan 13.
OBJECTIVE Neuroendoscopic removal of intraventricular tumors is difficult and time consuming because of the lack of an effective decompression system that can be used through the working channel of the endoscope. The authors report on the utilization of an endoscopic ultrasonic aspirator in the resection of intraventricular tumors. METHODS Twelve pediatric patients (10 male, 2 female), ages 1-15 years old, underwent surgery via a purely endoscopic approach using a Gaab rigid endoscope and endoscopic ultrasonic aspirator. Two patients presented with intraventricular metastases from high-grade tumors (medulloblastoma, atypical teratoid rhabdoid tumor), 2 with subependymal giant cell astrocytomas (associated with tuberous sclerosis), 2 with low-grade intraparaventricular tumors, 4 with suprasellar tumors (2 craniopharyngiomas and 2 optic pathway gliomas), and 2 with pineal tumors (1 immature teratoma, 1 pineal anlage tumor). Hydrocephalus was present in 5 cases. In all patients, the endoscopic trajectory and ventricular access were guided by electromagnetic neuronavigation. Nine patients underwent surgery via a precoronal bur hole while supine. In 2 cases, surgery was performed through a frontal bur hole at the level of the hairline. One patient underwent surgery via a posterior parietal approach to the trigone while in a lateral position. The endoscopic technique consisted of visualization of the tumor, ventricular washing to dilate the ventricles and to control bleeding, obtaining a tumor specimen with biopsy forceps, and ultrasonic aspiration of the tumor. Bleeding was controlled with irrigation, monopolar coagulation, and a thulium laser. RESULTS In 7 cases, the resection was total or near total (more than 90% of lesion removed). In 5 cases, the resection was partial. Histological evaluation of the collected material (withdrawn using biopsy forceps and aspirated with an ultrasonic aspirator) was diagnostic in all cases. The duration of surgery ranged from 30 to 120 minutes. One case was complicated by subdural hygroma requiring a subduro-peritoneal shunt implant. CONCLUSIONS In this preliminary series, endoscopic ultrasonic aspiration proved to be a safe and reliable method for achieving extensive decompression or complete removal in the management of intra- and/or paraventricular lesions in pediatric patients.
目的 由于缺乏可通过内镜工作通道使用的有效减压系统，神经内镜下切除脑室内肿瘤困难且耗时。作者报告了内镜超声吸引器在脑室内肿瘤切除术中的应用。方法 12例年龄1至15岁的儿科患者（10例男性，2例女性），通过使用加布硬式内镜和内镜超声吸引器的单纯内镜入路接受手术。2例患者为高级别肿瘤（髓母细胞瘤、非典型畸胎样横纹肌样瘤）的脑室内转移，2例为室管膜下巨细胞星形细胞瘤（与结节性硬化症相关），2例为低级别脑室内肿瘤，4例为鞍上肿瘤（2例颅咽管瘤和2例视路胶质瘤），2例为松果体区肿瘤（1例未成熟畸胎瘤，1例松果体原基肿瘤）。5例患者存在脑积水。所有患者均通过电磁神经导航引导内镜路径和脑室入路。9例患者仰卧位经冠状位钻孔进行手术。2例患者通过发际线水平的额部钻孔进行手术。1例患者侧卧位经顶后入路至三角区进行手术。内镜技术包括观察肿瘤、脑室冲洗以扩张脑室并控制出血、用活检钳获取肿瘤标本以及超声吸引肿瘤。通过冲洗、单极电凝和铥激光控制出血。结果 7例患者实现了全切或近全切（切除病变超过90%）。5例患者为部分切除。对收集的材料（用活检钳取出并用超声吸引器吸出）进行的组织学评估在所有病例中均具有诊断价值。手术时间为30至120分钟。1例患者并发硬膜下积液，需要植入硬膜下 - 腹腔分流管。结论 在这个初步系列研究中，内镜超声吸引术被证明是一种安全可靠的方法，可在儿科患者脑室内和/或脑室周围病变的管理中实现广泛减压或完全切除。
