Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, PR China.
Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing, PR China.
Br J Neurosurg. 2024 Jun;38(3):625-631. doi: 10.1080/02688697.2021.1947971. Epub 2021 Jul 9.
To explore the prognostic factors of patients with low-grade optic pathway glioma (OPG) and the optimal treatment to reduce the incidence of postoperative hydrocephalus.
This single-center study retrospectively analyzed data from 66 patients with OPGs who underwent surgery. The patients were followed, and overall survival (OS) and progression-free survival (PFS) were determined. The effects of different treatments on the hydrocephalus of patients were compared.
Postoperative hydrocephalus was identified as a factor to increase the risk of mortality by 1.99-fold ( = .028). And, 5-year survival rate was significantly lower among patients with postoperative hydrocephalus ( = .027). The main factors leading to preoperative hydrocephalus in patients are large tumor volume and invasion into the third ventricle. Gross total resections (GTR) could reduce the risk of long-term hydrocephalus ( = .046). Age younger than 4 years ( = .046) and tumor invasion range/classification ( = .029) are the main factors to reduce the five-year survival rate. Postoperative radiotherapy (RT) and chemotherapy (CT) had no significant effects on OS. Extraventricular drainage (EVD) was not associated with perioperative infection ( = .798 > .05) and bleeding ( = .09 > .05). Compared with 2 stage surgery (external ventricular drainage or ventriculoperitoneal shunt (VPS) was first placed, followed by tumor resection), 1 stage surgery (direct resection of tumor) had no complication increase.
Postoperative hydrocephalus is mostly obstructive hydrocephalus, and it is an important factor that reduces the OS of patients with low-grade OPGs. Surgery to remove the tumor to the greatest extent improves cerebrospinal fluid circulation is effective at reducing the incidence postoperative hydrocephalus. For patients whose ventricles are still dilated after surgery, in addition to considering poor ventricular compliance, they need to be aware of the persistence and progression of hydrocephalus.
探讨低级别视神经胶质瘤（OPG）患者的预后因素及降低术后脑积水发生率的最佳治疗方法。
本单中心研究回顾性分析了 66 例接受手术治疗的 OPG 患者的数据。对患者进行随访，确定总生存期（OS）和无进展生存期（PFS）。比较不同治疗方法对患者脑积水的影响。
术后脑积水被确定为增加死亡率的因素，风险增加 1.99 倍（ = .028）。并且，术后发生脑积水的患者 5 年生存率明显较低（ =.027）。导致患者术前脑积水的主要因素是肿瘤体积大且侵犯第三脑室。大体全切除（GTR）可降低长期脑积水的风险（ = .046）。年龄小于 4 岁（ = .046）和肿瘤侵袭范围/分类（ = .029）是降低 5 年生存率的主要因素。术后放疗（RT）和化疗（CT）对 OS 无显著影响。脑室外引流（EVD）与围手术期感染无关（ = .798 > .05）和出血（ = .09 > .05）。与 2 期手术（先放置外部脑室引流或脑室-腹腔分流术（VPS），再行肿瘤切除术）相比，1 期手术（直接切除肿瘤）并未增加并发症。
术后脑积水多为梗阻性脑积水，是降低低级别 OPG 患者 OS 的重要因素。最大限度切除肿瘤以改善脑脊液循环的手术可有效降低术后脑积水的发生率。对于术后脑室仍扩张的患者，除考虑脑室顺应性差外，还需要注意脑积水的持续和进展。
