Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
Division of Pediatric Neurosurgery, Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
Childs Nerv Syst. 2024 Aug;40(8):2367-2372. doi: 10.1007/s00381-024-06475-9. Epub 2024 Jun 10.
Outcomes for pineal region and superior cerebellar tumors in young children often hinge on extent of microsurgical resection, and thus choosing an approach that provides adequate visualization of pathology is essential. The occipital interhemispheric transtentorial (OITT) approach provides excellent exposure while minimizing cerebellar retraction. However, this approach has not been widely accepted as a viable option for very young children due to concerns for potential blood loss when incising the tentorium. The aim of this paper is to characterize our recent institutional experience with the occipital interhemispheric transtentorial approach (OITT) for tumor resection in infants and toddlers.
A retrospective study was performed between 2016 and 2023 of pediatric patients less than 36 months of age who underwent OITT for tumor resection at a high-volume referral center. Patients with at least 3 months of postoperative follow-up and postoperative MRI were included. Primary outcomes included extent of resection, intraoperative and postoperative complications, and neurologic outcome. Secondary outcomes included length of stay and estimated blood loss.
Eight patients, five male, were included. The median age at the time of surgery was 10 months (range 5-36 months). Presenting symptoms included macrocephaly, nausea/vomiting, strabismus, gait instability, or milestone regression. Hydrocephalus was present preoperatively in all patients. Average tumor volume was 38.6 cm, ranging from 1.3 to 71.9 cm. All patients underwent an OITT approach for tumor resection with stereotactic guidance. No intraoperative complications occurred, and no permanent neurologic deficits developed postoperatively. Gross total resection was achieved in all cases per postoperative MRI report, and no instances of new cerebellar, brainstem, or occipital lobe ischemia were noted.
OITT approach for tumor resection in very young children (≤ 36 months) is an effective strategy with an acceptable safety profile. In our series, no significant intraoperative or postoperative complications occurred. To our knowledge, this is the first report describing this technique specifically in patients less than 36 months of age.
对于幼儿的松果体区和小脑上肿瘤，手术结果往往取决于显微镜下切除的程度，因此选择一种能充分观察病变的手术入路至关重要。枕下经天幕中脑外侧入路（OITT）提供了极好的显露效果，同时最大限度地减少小脑的牵拉。然而，由于担心切开天幕时可能会失血，该入路尚未被广泛接受为非常年幼的儿童的可行选择。本文旨在描述我们最近在一家高容量转诊中心对婴儿和幼儿进行肿瘤切除的枕下经天幕中脑外侧入路（OITT）的机构经验。
对 2016 年至 2023 年间在高容量转诊中心接受 OITT 肿瘤切除术的年龄小于 36 个月的儿科患者进行了回顾性研究。纳入术后至少 3 个月有随访和术后 MRI 的患者。主要结局包括切除程度、术中及术后并发症以及神经功能结局。次要结局包括住院时间和估计失血量。
共纳入 8 例患者，男 5 例，中位年龄为 10 个月（5-36 个月）。就诊时的症状包括大头畸形、恶心/呕吐、斜视、步态不稳或发育里程碑倒退。所有患者术前均存在脑积水。肿瘤平均体积为 38.6cm³，范围为 1.3-71.9cm³。所有患者均在立体定向引导下接受 OITT 肿瘤切除术。术中无并发症发生，术后无永久性神经功能缺损。根据术后 MRI 报告，所有患者均达到大体全切除，未见新的小脑、脑干或枕叶缺血。
对于非常年幼的儿童（≤ 36 个月），OITT 肿瘤切除术是一种有效的策略，具有可接受的安全性。在我们的系列研究中，未发生明显的术中或术后并发症。据我们所知，这是第一篇专门描述该技术在年龄小于 36 个月患者中的应用的报告。
