Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin.
Department of Neurosurgery, The First Affiliated Hospital of Guangxi Medical University, No 6 Shuang Yong Road Nanning, Guangxi, Guangxi Province, China.
J Craniofac Surg. 2024;35(1):e60-e66. doi: 10.1097/SCS.0000000000009846. Epub 2023 Nov 10.
Pineal region lesions are more common in children than adults; however, therapeutic strategies for pineal region lesions in children are controversial.
A retrospective study involving 54 pediatric with pineal region lesions was conducted. The therapeutic strategies for lesions and hydrocephalus were classified and analyzed.
Radiotherapy of pineal region lesions was shown to result in better postoperative recovery and fewer complications in the short-term compared with lesion resection. Total resection was related to smaller lesion size, endoscopic procedures, and a better prognosis. Cerebrospinal fluid (CSF) diversion before the resection reduced hydrocephalus recurrences, whereas further lesion resection had a negative short-term influence on CSF diversion. Among the 4 therapeutic strategies to manage hydrocephalus, a third ventriculostomy (ETV) was reasonable and further resection did not have a negative impact on the ETV. The relief of hydrocephalus was also related to better postoperative recovery, a higher total resection rate, fewer complications, and a better prognosis. Logistical regression analysis indicated that lesion size and intracranial complications were predictors of outcome.
For lesion treatment, total resection and radiotherapy are essential components in children. Total resection and CSF diversion before resection were beneficial, whereas further lesion resection had a negative impact on CSF diversion. For hydrocephalus treatment, ETV was shown to be the best therapeutic strategy for management of pediatric hydrocephalus. Total resection and better preoperative health status were associated with greater hydrocephalus relief. For the overall prognosis, a lack of hydrocephalus relief was associated with poor outcomes. Lesion size and intracranial complications may be the best predictors of outcome.
松果体区域病变在儿童中比在成人中更为常见；然而，儿童松果体区域病变的治疗策略仍存在争议。
回顾性分析了 54 例松果体区域病变患儿的临床资料。对病变和脑积水的治疗策略进行了分类和分析。
与病变切除术相比，松果体区域病变的放射治疗在短期内可获得更好的术后恢复和更少的并发症。全切除与病变较小、内镜手术和更好的预后相关。病变切除前行脑脊液分流术可减少脑积水复发，而进一步的病变切除对脑脊液分流有短期的负面影响。在管理脑积水的 4 种治疗策略中，第三脑室造瘘术（ETV）是合理的，进一步的病变切除对 ETV 没有负面影响。脑积水的缓解也与更好的术后恢复、更高的全切除率、更少的并发症和更好的预后有关。逻辑回归分析表明，病变大小和颅内并发症是预后的预测因素。
对于病变治疗，全切除和放疗是儿童的重要组成部分。全切除和病变切除前的脑脊液分流术有益，而进一步的病变切除对脑脊液分流术有负面影响。对于脑积水的治疗，ETV 是治疗儿童脑积水的最佳治疗策略。全切除和更好的术前健康状况与更大的脑积水缓解相关。对于整体预后，脑积水缓解不良与预后不良相关。病变大小和颅内并发症可能是预后的最佳预测因素。
