Choque-Velasquez Joham, Resendiz-Nieves Julio C, Baluszek Szymon, Colasanti Roberto, Muhammad Sajjad, Hernesniemi Juha
Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Department of Neurosurgery, Umberto I General Hospital, Universituà Politecnica delle Marche, Via Lodovico Menicucci, Ancona, Italy.
Surg Neurol Int. 2020 Oct 29;11:359. doi: 10.25259/SNI_41_2020. eCollection 2020.
Microsurgical removal represents a well-accepted treatment option for symptomatic benign pineal cysts (PCs). However, very few studies have quantitatively evaluated the functional status of surgically treated PC patients.
A detailed analysis of preoperative, immediate postoperative, and long-term clinical and radiological characteristics was performed. The functional status of the patients was categorized using the modified Rankin scale (mRS) and the Chicago Chiari Outcome Scale (CCOS). In addition, a comparative analysis between pediatric and adult patients with PCs was carried out.
Overall, pediatric patients experienced better long-term mRS scores than adults. The differences between the pre-, the immediate post-, and the last postoperative mRS of the patients were statistically significant for the total population ( < 0.001). All patients obtained a CCOS of 11 or more, which reflects a good/optimal result after microneurosurgery. The type of the surgical approach was independently associated with the postoperative complications ( < 0.01), more frequently reported with the midline supracerebellar infratentorial (SCIT) approach than with its paramedian modification.
The functional status of properly selected symptomatic patients with PCs may improve significantly after their surgical management through a paramedian SCIT approach in sitting position.
显微手术切除是有症状的良性松果体囊肿（PCs）公认的治疗选择。然而，很少有研究对接受手术治疗的PC患者的功能状态进行定量评估。
对术前、术后即刻及长期的临床和影像学特征进行详细分析。采用改良Rankin量表（mRS）和芝加哥Chiari结局量表（CCOS）对患者的功能状态进行分类。此外，还对PC患儿和成年患者进行了对比分析。
总体而言，儿童患者的长期mRS评分优于成人。患者术前、术后即刻及末次术后mRS的差异在总人群中具有统计学意义（<0.001）。所有患者的CCOS均为11分或更高，这反映了显微神经外科手术后的良好/最佳结果。手术入路类型与术后并发症独立相关（<0.01），中线小脑上幕下（SCIT）入路比其旁正中改良入路更常报告术后并发症。
通过旁正中SCIT入路坐位手术治疗，合适选择的有症状PC患者的功能状态可能会显著改善。
