Prat-Acín Ricardo, Evangelista Rocío, Conde Rebeca, Ayuso-Sacido Angel, Galeano Inma
Department of Neurosurgery, Hospital Universitario y Politécnico La Fe, Bulevar Sur s/n, 46026, Valencia, Spain.
Fundación de Investigación HM Hospitales, Madrid, Spain.
Childs Nerv Syst. 2017 Nov;33(11):2057-2060. doi: 10.1007/s00381-017-3543-6. Epub 2017 Jul 18.
Posterior third ventricle ependymomas with intraaqueductal extension are relatively infrequent lesions. Its surgical management represents a formidable technical challenge and includes a wide variety of approaches. Minimally invasive surgery including the endoscopic management can play a crucial role to obtain an optimal clinical outcome.
We report the clinical outcome of an 11-year-old female patient with a 6-year history of recurrent episodes of headache and vomiting. On brain MRI a posterior third ventricle lesion with extension to the aqueduct of Sylvius and fourth ventricle, and associated hydrocephalus was observed.
Our management of the lesion included a two-step endoscopic surgery: first an anterior third ventriculostomy and biopsy of the lesion that was reported to be a low-grade ependymoma, and posteriorly an endoscopic-assisted resection of the lesion. Clinical outcome was optimal without neurological sequelae. The postoperative MRI showed a thickened ependymal area on the tumor base of implantation. It was considered to be a remnant of the lesion and subsequently treated with radiotherapy.
Posterior third ventricle ependymomas with intraaqueductal extension can be endoscopically managed to obtain a successful outcome.
伴有导水管内延伸的第三脑室后部室管膜瘤是相对少见的病变。其手术治疗是一项艰巨的技术挑战，包括多种手术入路。包括内镜治疗在内的微创手术对于取得最佳临床效果可起到关键作用。
我们报告了一名11岁女性患者的临床结果，该患者有6年反复头痛和呕吐发作史。脑部磁共振成像（MRI）显示第三脑室后部有一病变，延伸至中脑导水管和第四脑室，并伴有脑积水。
我们对该病变的治疗包括两步内镜手术：首先是第三脑室前部造瘘术及病变活检，活检结果显示为低级别室管膜瘤，随后是内镜辅助下病变切除术。临床结果理想，无神经后遗症。术后MRI显示肿瘤植入部位基底的室管膜区域增厚。考虑为病变残留，随后接受了放疗。
伴有导水管内延伸的第三脑室后部室管膜瘤可通过内镜治疗取得成功结果。
