Dhandapani Sivashanmugam, Verma Rajat, Mohanty Manju, Sharma Anchal, Vyas Sameer, Dhandapani Manju, Gupta Sunil K
Department of Neurosurgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
Department of Neurosurgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
Clin Neurol Neurosurg. 2021 Oct;209:106951. doi: 10.1016/j.clineuro.2021.106951. Epub 2021 Sep 16.
Endoscopy is increasingly being adopted for removing colloid cysts. However, the neuropsychological outcome and quality of life (QOL) have not been studied in detail. This study is to evaluate the efficacy of endoscopic excision on cognitive measures and QOL.
Patients with colloid cysts larger than 7 mm, undergoing endoscopy were prospectively studied concerning clinico-radiology, cognitive parameters (age and education adjusted), extent of resection and recurrence. A cross-sectional QOL assessment was additionally performed on endoscopic patients in comparison with cases who underwent microsurgery or standalone ventriculo-peritoneal (VP) shunt.
A total of 22 endoscopic patients with a mean age of 34 years and a mean cyst diameter of 19 mm were studied. Gross total resection(GTR) could be achieved in all. Over a mean follow-up of 53.4 months, none had a recurrence, ventriculomegaly, or retreatment. Among neuropsychological parameters, digit span was the most affected before surgery. There was a broad-based improvement in the mean global cognitive score from 40.63(±10.4) at baseline to 50.25(±5.8) after endoscopy with maximum improvement in 'immediate recall.' The change in scores also had a significant inverse correlation with cyst size, with cysts larger than 18 mm, resulting in lower scores following endoscopy(R=-0.9, P=0.01). QOL was significantly influenced by visual and cognitive impairments and was better among endoscopic patients than similar microsurgery or VP shunt controls, with a significant difference in social and environmental domains(P=0.02).
Endoscopy is effective in achieving GTR and long-term control, with neuropsychological improvement correlated with cyst size. This is probably the first report to show QOL is influenced by cognitive parameters and is better following endoscopy than after microsurgery or VP shunt.
内镜切除胶体囊肿的应用日益广泛。然而，神经心理学结果和生活质量（QOL）尚未得到详细研究。本研究旨在评估内镜切除对认知指标和生活质量的疗效。
对囊肿大于7毫米且接受内镜检查的患者进行前瞻性研究，内容包括临床放射学、认知参数（校正年龄和教育程度）、切除范围和复发情况。与接受显微手术或单纯脑室-腹腔（VP）分流术的患者相比，还对内镜手术患者进行了横断面生活质量评估。
共研究了22例平均年龄34岁、平均囊肿直径19毫米的内镜手术患者。所有患者均实现了全切除（GTR）。平均随访53.4个月，无一例复发、脑室扩大或再次治疗。在神经心理学参数中，手术前数字广度受影响最大。内镜检查后，平均总体认知评分从基线时的40.63（±10.4）大幅提高到50.25（±5.8），“即时回忆”改善最为明显。评分变化也与囊肿大小呈显著负相关，囊肿大于18毫米的患者内镜检查后得分较低（R=-0.9，P=0.01）。生活质量受视觉和认知障碍的显著影响，内镜手术患者的生活质量优于类似的显微手术或VP分流术对照组，在社会和环境领域有显著差异（P=0.02）。
内镜检查在实现全切除和长期控制方面有效，神经心理学改善与囊肿大小相关。这可能是首份表明生活质量受认知参数影响且内镜检查后优于显微手术或VP分流术的报告。
