Meißner Anna-Katharina, Dreher Lena, Jünger Stephanie Theresa, Visser-Vandewalle Veerle, Ruge Maximilian I, Rueß Daniel
1Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne.
2Department of Stereotactic and Functional Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne; and.
J Neurosurg. 2021 Nov 12;137(1):227-234. doi: 10.3171/2021.7.JNS211180. Print 2022 Jul 1.
The treatment of symptomatic, progressive or recurrent acquired intracerebral cysts is challenging, especially when they are localized in eloquent structures. In addition to resection, endoscopic fenestration, or stereotactic puncture, the implantation of a cystoventricular shunt by stereotactic guidance (SCVS) has been reported as a minimally invasive procedure; however, only scarce data are available regarding its feasibility and efficacy. Here, the authors evaluated the feasibility and efficacy of frame-based SCVS in patients with acquired intracranial cysts.
In this single-center retrospective analysis, the authors included all patients with acquired intracerebral cysts treated by SCVS following a standardized prospective protocol between 2012 and 2020. They analyzed clinical symptoms, complications, and radiological outcome with regard to cyst volume reduction by 3D volumetry.
Thirty-four patients (17 females and 17 males; median age 44 years, range 5-77 years) were identified. The median initial cyst volume was 11.5 cm3 (range 1.6-71.6 cm3), and the mean follow-up was 20 months (range 1-82 months). At the last follow-up, 27 of 34 patients (79%) showed a cyst volume reduction of more than 50%. Initial symptoms improved or resolved in 74% (n = 25) and remained stable in 24% (n = 8). No permanent clinical deterioration after treatment was observed. The total complication rate was 5.9%, comprising transient neurological deterioration (n = 1) and ventriculitis (n = 1). There were no deaths. The overall recurrence rate was 11.8%.
In this study, SCVS proved to be a safe, minimally invasive, and effective treatment with reliable long-term volume reduction, resulting in clinical improvement and a minor complication rate.
有症状的、进行性或复发性获得性脑囊肿的治疗具有挑战性，尤其是当它们位于功能区结构时。除了切除术、内镜开窗术或立体定向穿刺术外，立体定向引导下的囊肿脑室分流术（SCVS）已被报道为一种微创手术；然而，关于其可行性和疗效的可用数据很少。在此，作者评估了基于框架的SCVS在获得性颅内囊肿患者中的可行性和疗效。
在这项单中心回顾性分析中，作者纳入了2012年至2020年间按照标准化前瞻性方案接受SCVS治疗的所有获得性脑囊肿患者。他们通过三维容积测量分析了临床症状、并发症以及囊肿体积缩小方面的影像学结果。
共纳入34例患者（17例女性和17例男性；中位年龄44岁，范围5 - 77岁）。初始囊肿中位体积为11.5 cm³（范围1.6 - 71.6 cm³），平均随访时间为20个月（范围1 - 82个月）。在最后一次随访时，34例患者中有27例（79%）囊肿体积缩小超过50%。74%（n = 25）的患者初始症状改善或消失，24%（n = 8）的患者症状保持稳定。治疗后未观察到永久性临床恶化。总并发症发生率为5.9%，包括短暂性神经功能恶化（n = 1）和脑室炎（n = 1）。无死亡病例。总体复发率为11.8%。
在本研究中，SCVS被证明是一种安全、微创且有效的治疗方法，能可靠地长期缩小囊肿体积，带来临床改善且并发症发生率较低。
