Lauretti Liverana, Legninda Sop Francois Yves, Pallini Roberto, Fernandez Eduardo, D'Alessandris Quintino Giorgio
Polo Scienze dell'invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.
Polo Scienze dell'invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.
World Neurosurg. 2018 Feb;110:e367-e373. doi: 10.1016/j.wneu.2017.11.004. Epub 2017 Nov 10.
Total removal of craniopharyngiomas is burdened by high morbidity. In cases of a cystic or mixed craniopharyngioma, when the symptoms are caused by the cystic component of the tumor, a less invasive surgical approach aiming at cyst drainage may be recommended. Here, we report our experience with intraventricular neuroendoscopy, describe our clear-cut surgical technique, and analyze results in the context of literature data.
We reviewed the clinical data of 8 consecutive adult patients affected by cystic or mixed craniopharyngioma who were treated with intraventricular neuroendoscopy at our institution in the last decade. At surgery, wide opening and emptying of the cyst was performed; a ventricular catheter with adjunctive holes was then placed to maintain a continuous cerebrospinal fluid (CSF) washout. A systematic review of the pertinent literature was performed and a pooled analysis of individual data from selected studies was made.
Ten neuroendoscopic procedures were performed. The treatment determined immediate neurologic and radiologic improvement without significant complications in all patients. No chemical meningitis was observed. Recurrence rate was 20%, in line with literature data. Median progression-free survival was 57 months. The systematic review of the literature showed that neuroendoscopy carries a lower recurrence rate than stereotaxy (P = 0.0390). Moreover, the creation of a cyst-CSF communication is a protective factor against recurrences. Finally, adjuvant radiotherapy determined no significant differences in terms of cyst recurrence rate.
We describe a neuroendoscopic treatment of cystic craniopharyngiomas that, without adjuvant radiotherapy, is safe and effective and ensures long-term recurrence-free survival.
颅咽管瘤的全切除手术具有较高的致残率。对于囊性或混合性颅咽管瘤，当症状由肿瘤的囊性成分引起时，可推荐采用旨在囊肿引流的侵入性较小的手术方法。在此，我们报告我们在脑室内神经内镜方面的经验，描述我们清晰明确的手术技术，并结合文献数据分析结果。
我们回顾了过去十年在我们机构接受脑室内神经内镜治疗的8例连续成年囊性或混合性颅咽管瘤患者的临床资料。手术时，对囊肿进行广泛开放和排空；然后放置带有辅助孔的脑室导管以维持持续的脑脊液冲洗。对相关文献进行了系统回顾，并对选定研究的个体数据进行了汇总分析。
共进行了10次神经内镜手术。该治疗使所有患者的神经和影像学症状立即得到改善，且无明显并发症。未观察到化学性脑膜炎。复发率为20%，与文献数据一致。无进展生存期的中位数为57个月。文献的系统回顾表明，神经内镜的复发率低于立体定向手术（P = 0.0390）。此外，建立囊肿与脑脊液的交通是预防复发的保护因素。最后，辅助放疗在囊肿复发率方面未显示出显著差异。
我们描述了一种无需辅助放疗的囊性颅咽管瘤神经内镜治疗方法，该方法安全有效，可确保长期无复发生存。
