Kulkarni Akshay, Konar Subhas, Shukla Dhaval, Sadashiva Nishanth, Devi Bhagavatula Indira
Department of Neurosurgery, University of Illinois, Chicago, Illinois, United States.
Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India.
J Neurol Surg B Skull Base. 2022 Nov 1;84(6):591-597. doi: 10.1055/a-1934-9307. eCollection 2023 Dec.
The treatment of craniopharyngioma is varied. The treatment ranges from radical excision to direct radiotherapy. As the morbidity of excision is high, more conservative approaches are used. Transventricular endoscopy is a minimally invasive treatment for cystic craniopharyngiomas. The objective of this study is to describe a personal experience with this method of treatment. This is a retrospective review of a series of patients managed with endoscopic catheter and reservoir placement for cystic craniopharyngiomas. Twenty-nine patients presented with clinical features of raised intracranial features. Imaging showed a predominantly cystic craniopharyngioma extending into the third ventricle with hydrocephalus. All patients underwent transcortical transventricular endoscopic biopsy, and catheter placement connected to a reservoir. There was no morbidity ascribed to the endoscopic procedure when fenestration and aspiration or fenestration and reservoir were placed. Twelve patients underwent radiotherapy. The median duration of follow-up was 18 months (3-72 months). Eight (27.5%) cases had recurrences. Five (17.2%) could be managed with only reaspiration, two (6.8%) required craniotomy and resection, and one (3.4%) could be managed only with ventriculoperitoneal shunt. The neuroendoscopic fenestration, aspiration of cyst, and placement of catheter reservoir followed by radiation is an optional treatment for predominantly cystic craniopharyngiomas arising within or extending into the third ventricle causing hydrocephalus.
颅咽管瘤的治疗方法多种多样。治疗范围从根治性切除到直接放疗。由于切除的发病率较高，因此采用了更为保守的方法。经脑室内镜检查是治疗囊性颅咽管瘤的一种微创治疗方法。本研究的目的是描述使用这种治疗方法的个人经验。
这是一项对一系列接受内镜下导管和储液器置入治疗囊性颅咽管瘤患者的回顾性研究。
29例患者表现出颅内压升高的临床特征。影像学显示主要为囊性颅咽管瘤，延伸至第三脑室并伴有脑积水。所有患者均接受经皮质经脑室内镜活检，并置入与储液器相连的导管。当进行开窗和抽吸或开窗和置入储液器时，内镜手术未出现并发症。12例患者接受了放疗。中位随访时间为18个月（3 - 72个月）。8例（27.5%）出现复发。5例（17.2%）仅通过再次抽吸即可处理，2例（6.8%）需要开颅切除，1例（3.4%）仅通过脑室腹腔分流术即可处理。
神经内镜开窗、囊肿抽吸、导管储液器置入并结合放疗是治疗起源于或延伸至第三脑室并导致脑积水的主要囊性颅咽管瘤的一种可选治疗方法。
