Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, IL, USA.
Biostatistics Core, Clinical Research Office, Loyola University Medical Center, Maywood, IL, USA.
Clin Neurol Neurosurg. 2024 Nov;246:108564. doi: 10.1016/j.clineuro.2024.108564. Epub 2024 Sep 21.
The goal of this study was to characterize the largest known cohort of patients presenting with different tumor pathologies in the third ventricle region to better understand outcomes of surgical management.
All patients undergoing surgical intervention on tumors in or encroaching upon the third ventricle at Loyola University Medical Center between the years 1986-2021 were reviewed. Information recorded included presenting symptoms, pre- and post-operative interventions, tumor pathology, operative technique, extent of resection (EOR), and approach of operation. The primary clinical outcome was Karnofsky Performance Status (KPS) score.
Ninety-seven patients underwent 123 operations. Forty-six (47.4 %) patients were female, and the median age at operation was 39 years. Eighty-seven (70.7 %) operations were open, and 36 (29.3 %) were endoscopic. Gross total resection (GTR) was achieved in 34.4 % of operations, near-total resection (NTR) in 31.5 %, subtotal resection in 25.0 %, and biopsy alone in 9.3 %. Median KPS increased pre- to postoperatively, regardless of surgical technique. Adjusting for preoperative KPS, age, and operation number, regression analysis demonstrated a trend that lesser EOR is associated with lower KPS at most recent follow-up (p=0.031 for NTR vs GTR, p=0.022 for biopsy vs GTR). There was no statistically significant association between the most recent KPS and either open or endoscopic surgical technique, with or without adjusting for the previously stated factors (p=0.26). There was no association between postoperative complication rates or age with either surgical technique.
Here, we characterize a large cohort of patients presenting for neurosurgical evaluation of tumors in the region of the third ventricle. Our results demonstrate a trend that a more aggressive resection may yield better KPS outcomes. Additionally, both open and endoscopic techniques lead to a similar improvement in clinical outcome and rates of complication. While ultimate surgical approach and technique is determined by individual tumor characteristics, patient health status, and surgeon expertise, ability to resect the tumor in its entirety should be taken into consideration.
本研究旨在对第三脑室区域不同肿瘤病理患者中最大的已知队列进行描述，以更好地了解手术治疗的结果。
回顾了 1986 年至 2021 年间在洛约拉大学医学中心接受第三脑室或侵犯第三脑室肿瘤手术的所有患者。记录的信息包括就诊症状、术前和术后干预、肿瘤病理、手术技术、切除程度（EOR）和手术入路。主要临床结局是卡氏行为状态（KPS）评分。
97 例患者共进行了 123 次手术。46 例（47.4%）为女性，手术时的中位年龄为 39 岁。87 例（70.7%）手术为开放性，36 例（29.3%）为内镜下手术。34.4%的手术达到了全切除（GTR），31.5%的手术达到了近全切除（NTR），25.0%的手术达到了次全切除，9.3%的手术仅进行了活检。无论手术技术如何，KPS 在术前到术后均有中位数增加。调整术前 KPS、年龄和手术次数后，回归分析显示，EOR 越低，最近随访时 KPS 越低（NTR 与 GTR 相比，p=0.031；活检与 GTR 相比，p=0.022）。最近的 KPS 与开颅或内镜手术技术之间没有统计学上的显著关联，无论是否调整之前提到的因素（p=0.26）。术后并发症发生率或年龄与任何手术技术之间均无关联。
在这里，我们对一组因第三脑室区域肿瘤而接受神经外科评估的患者进行了描述。我们的结果表明，更激进的切除可能会产生更好的 KPS 结果。此外，开颅和内镜技术都能使临床结局和并发症发生率得到相似的改善。虽然最终的手术方法和技术取决于肿瘤的个体特征、患者的健康状况和外科医生的专业知识，但应考虑能否完全切除肿瘤。
