儿童第三脑室胶样囊肿。
Colloid cysts of the third ventricle in children.
机构信息
1Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
2Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida.
出版信息
J Neurosurg Pediatr. 2021 Apr 23;27(6):700-706. doi: 10.3171/2020.10.PEDS18458. Print 2021 Jun 1.
OBJECTIVE
The rarity of colloid cysts in children makes it difficult to characterize this entity and offer meaningful advice on treatment. Infrequent case reports exist, but to date there has been no age-specific assessment. The purpose of this study was to define any differences between children and adults who are evaluated and treated for colloid cysts of the third ventricle.
METHODS
Patients with colloid cysts were reviewed and stratified by age. Individuals ≤ 18 years of age were defined as pediatric patients and those > 18 years of age as adults. Clinical and radiographic data, treatment, and postoperative outcomes were compared between both groups. Bivariate analysis was conducted using the Fisher exact test for categorical variables and Mann-Whitney U-test for continuous variables.
RESULTS
Of 132 endoscopic resections (121 primary, 10 secondary, and 1 tertiary) of a colloid cyst, 9 (6.8%) were performed in pediatric patients (mean age 14.1 years, range 9-18 years) and 123 (93.2%) were performed in adult patients (mean age 43.8 years, range 19-73 years). Cases were found incidentally more commonly in pediatric than adult patients (66.7% vs 37.4%, p > 0.05), and pediatric patients had lower rates of hydrocephalus than adult patients (11.1% vs 63.4%, p < 0.05). Acute decompensation at presentation was found in 8 adults (6.5%) but no children. Complete cyst removal (88.9% vs 90.2%, p > 0.05) and length of stay (1.6 days vs 2.9 days, p > 0.05) were not significantly different between the groups. Postoperative complications (6.5% in adults, 0% in children) and recurrence (2.4% in adults, 0% in children) were rare in both groups, and there were no treatment-related deaths. The mean postoperative radiological follow-up was longer in pediatric patients (45 months, range 4-89 months) than adults (44.1 months, range 1-171 months).
CONCLUSIONS
While differences exist between children and adults regarding colloid cyst presentation, these are in keeping with the predicted evolution of a slow-growing lesion. Consistent with this observation, children had lower rates of hydrocephalus and a smaller mean maximal cyst diameter. Contrary to the published literature, however, sudden deterioration was not observed in pediatric patients but occurred in adult patients. In this limited pediatric sample size, the authors have not recorded any postoperative complications or recurrences to date. These encouraging results with endoscopic removal may positively impact future decisions related to children given their protracted life expectancy and projected rates of progression.
目的
儿童脑胶样囊肿较为罕见，因此难以对其特征进行描述并提供有意义的治疗建议。虽然有少数罕见病例报告，但迄今为止尚无特定年龄组的评估。本研究旨在明确接受第三脑室胶样囊肿评估和治疗的儿童与成人之间的任何差异。
方法
回顾性分析了接受内镜切除手术的胶样囊肿患者，并按年龄进行分层。将≤ 18 岁的患者定义为儿科患者，＞ 18 岁的患者定义为成人患者。比较两组的临床和影像学数据、治疗方法和术后结果。采用 Fisher 确切概率法进行分类变量的二变量分析，采用 Mann-Whitney U 检验进行连续变量的二变量分析。
结果
在 132 例内镜切除胶样囊肿手术（121 例原发性手术，10 例继发性手术和 1 例复发性手术）中，有 9 例（6.8%）为儿科患者（平均年龄 14.1 岁，范围 9-18 岁），123 例（93.2%）为成人患者（平均年龄 43.8 岁，范围 19-73 岁）。与成人患者相比，儿科患者的囊肿更常为偶然发现（66.7%比 37.4%，p ＞ 0.05），且儿科患者的脑积水发生率低于成人患者（11.1%比 63.4%，p ＜ 0.05）。8 例成人患者（6.5%）在就诊时出现急性失代偿，而儿科患者中未出现。两组的囊肿完全切除率（88.9%比 90.2%，p ＞ 0.05）和住院时间（1.6 天比 2.9 天，p ＞ 0.05）无显著差异。两组术后并发症（成人患者为 6.5%，儿科患者为 0%）和复发率（成人患者为 2.4%，儿科患者为 0%）均较低，且均无治疗相关死亡。儿科患者的术后影像学随访时间（平均 45 个月，范围 4-89 个月）长于成人患者（平均 44.1 个月，范围 1-171 个月）。
结论
虽然儿童与成人的胶样囊肿表现存在差异，但这些差异与缓慢生长的病变的预期演变一致。与这一观察结果一致的是，儿童的脑积水发生率较低，囊肿最大直径的平均值也较小。然而，与文献报道相反，在儿科患者中并未观察到突然恶化，而是在成人患者中观察到。在本有限的儿科样本中，作者尚未记录到任何术后并发症或复发。由于儿童的预期寿命较长，预计进展速度较快，因此内镜切除手术的这些令人鼓舞的结果可能会对未来与儿童相关的决策产生积极影响。
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