Division of Pediatric Neurosurgery, University of Montréal, Centre Hospitalier Saint-Justine, Montreal, QC, Canada.
Division of Neurosurgery, University of Montréal, Centre Hospitalier de L'Université de Montreal, Montreal, QC, Canada.
Childs Nerv Syst. 2022 Aug;38(8):1599-1603. doi: 10.1007/s00381-022-05443-5. Epub 2022 Jan 10.
There are no specific guidelines regarding best treatment for focal, distant metastasis in ependymoma in the context of a well-controlled primary site. A combination using maximal safe resection and adjuvant radiotherapy is usually advised. As wound healing might be hindered by repeated radiotherapy, and delay future radiation treatment if needed, there is a growing interest in less invasive surgeries to reduce post-operative pain and wound healing complications. Those approaches have been extensively used and studied in adult but never in the pediatric population. Here, we present a pediatric case of a 12-year-old boy known for a posterior fossa ependymoma completely resected 18 months earlier who presented with a dual lumbosacral intradural ependymoma metastasis. A single-stage complete resection was achieved using a fixed tubular retractor with no complication. Post-operative course was favorable with rapid healing and discharge, minimal post-operative pain, and a rapid return to normal activities. Re-irradiation could be performed 2 weeks later without any problem. To our knowledge, this is the first report of the use of minimally invasive techniques to achieve complete resection of dual intradural metastasis of an ependymoma in the pediatric population. We demonstrate its feasibility and safety as well as its advantages.
对于在原发性肿瘤得到良好控制的情况下，发生局灶性、远处转移的室管膜瘤，目前并无具体的最佳治疗指南。通常建议采用最大限度安全切除联合辅助放疗的方法。由于反复放疗可能会阻碍伤口愈合，并延迟将来的放疗，如果需要的话，因此人们越来越关注采用创伤更小的手术来减少术后疼痛和伤口愈合并发症。这些方法在成人中已得到广泛应用和研究，但从未在儿科人群中进行过研究。在这里，我们报告了 1 例儿科病例，该患儿 12 岁，18 个月前因后颅窝室管膜瘤完全切除，此次因腰骶部双重硬脊膜内室管膜瘤转移而就诊。采用固定管状牵开器进行了一次分期的完全切除，无任何并发症。术后恢复顺利，伤口愈合迅速，疼痛轻微，很快恢复正常活动。2 周后可进行再次放疗，无任何问题。据我们所知，这是首例在儿科人群中使用微创技术完全切除室管膜瘤的双重硬脊膜内转移的报道。我们证明了其可行性和安全性以及优势。
