Pituitary Research Center, Neurosurgery Department, Kocaeli University, Kocaeli, Kocaeli, Turkey.
Neurosurgery Department, Kocaeli State Hospital, Kocaeli, Kocaeli, Turkey.
Childs Nerv Syst. 2022 Nov;38(11):2071-2082. doi: 10.1007/s00381-022-05665-7. Epub 2022 Sep 10.
Optic pathway gliomas (OPGs) constitute approximately 3-5% of childhood intracranial tumors. In this study, the authors presented their experience of using the endoscopic endonasal approach to treat patients with OPG located in the chiasma-hypothalamic region and aimed to use the infrachiasmatic corridor in the endoscopic endonasal approach as an alternative to the transcranial approach in the surgical necessity of OPGs.
We retrospectively analyzed the data of ten patients diagnosed with OPG histopathologically among 3757 cases who underwent endoscopic endonasal surgery between August 1997 and March 2021 at Kocaeli University Faculty of Medicine Pituitary Research Center and Department of Neurosurgery. Mean follow-up period 48.5 months. During the postoperative follow-up period, 3 of these 10 patients underwent reoperation due to tumor recurrence. Combined (endoscopic endonasal approach + transcranial approach) approach was applied to 2 patients in the same session. Surgical and clinical outcomes were evaluated in detail.
Ten patients with a mean patient age of 20.6 ± 11.4 were included in this study. The most common complaint was visual impairment. After surgery, improvement in visual impairment was observed in five patients. No increase in postoperative visual impairment was observed in any of the patients. Postoperative panhypopituitarism was not observed in any of the patients. STR resection was performed in 5 patients and NTR resection in 5 patients. No additional treatment was required during follow-up in 4 of 5 patients who underwent NTR. A total of 6 patients received postoperative radiotherapy treatment.
In gliomas located in the chiasma-hypothalamic region, appropriate patient selection and endoscopic endonasal surgical treatment may contribute to the elimination of symptoms due to the mass effect of the tumor. It may also contribute to keeping the disease under control with targeted adjuvant therapies by clarifying the pathological diagnosis of the lesion.
视路胶质瘤（OPG）约占儿童颅内肿瘤的 3-5%。在本研究中，作者介绍了使用内镜经鼻入路治疗位于视交叉-下丘脑区域的 OPG 患者的经验，并旨在将内镜经鼻入路中的视交叉下腔作为替代颅外入路的方法，用于 OPG 手术的需要。
我们回顾性分析了 1997 年 8 月至 2021 年 3 月在科贾埃利大学医学院垂体研究中心和神经外科期间，3757 例接受内镜经鼻手术患者中 10 例经组织病理学诊断为 OPG 的患者的数据。平均随访时间为 48.5 个月。在术后随访期间，由于肿瘤复发，其中 3 例患者再次手术。2 例患者在同一手术中采用了联合（内镜经鼻入路+颅外入路）的方法。详细评估了手术和临床结果。
本研究纳入了 10 例平均年龄为 20.6±11.4 岁的患者。最常见的主诉是视力障碍。手术后，5 例患者的视力障碍得到改善。任何患者均未观察到术后视力障碍加重。术后无患者发生全垂体功能减退症。5 例患者行 STR 切除术，5 例患者行 NTR 切除术。在接受 NTR 的 4 例患者中，有 4 例在随访期间无需额外治疗。共有 6 例患者接受了术后放疗。
对于位于视交叉-下丘脑区域的胶质瘤，适当的患者选择和内镜经鼻手术治疗可能有助于消除肿瘤占位效应引起的症状。通过明确病变的病理诊断，还可能有助于通过靶向辅助治疗来控制疾病。
