Prajsnar-Borak Anna, Bove Ilaria, Lorenzetti Marco, Berardinelli Jacopo, Somma Teresa, Vitulli Francesca
Department of Neurosurgery, Faculty of Medicine, Saarland University Medical Center and Saarland University, 66421, Homburg, Saar, Germany.
Department of Neurosurgery, Landeskrankenhaus Feldkirch, 6800, Feldkirch, Austria.
Childs Nerv Syst. 2025 May 30;41(1):193. doi: 10.1007/s00381-025-06858-6.
Colloid cysts of the third ventricle are rare intracranial lesions, particularly uncommon in pediatric populations. Precise incidence figures in children remain uncertain, with existing data primarily derived from isolated case reports and limited case series. Pediatric colloid cysts generally present with a more aggressive clinical course, including hydrocephalus, increased intracranial pressure ICP, and even sudden death. Despite the low incidence, the high risk of life-threatening complications often necessitates surgical intervention. However, there is no consensus in the literature on the optimal surgical treatment for pediatric CCs, with microsurgical resection and endoscopic removal being the most commonly utilized methods. This meta-analysis aims to compare the efficacy and safety of microsurgical and endoscopic approaches for treating pediatric colloid cysts, focusing on surgical outcomes such as gross total resection (GTR), capsule removal, postoperative complications, the need for ventriculoperitoneal (VP) shunting, and recurrence rates.
A systematic review and meta-analysis was conducted according to PRISMA guidelines. A comprehensive literature search was conducted to identify studies published between 2000 and Dicember 2024 on paediatric patients with colloid cysts. Statistical comparisons between the two surgical approaches were made based on key outcomes.
Fifteen studies, comprising 249 pediatric cases, were included. The results showed no significant difference between the microsurgical and endoscopic approaches in terms of hydrocephalus at presentation (odds ratio [OR] = 0.9, p = 0.92), achieving GTR (OR = 0.9, p = 0.61) or capsule removal (OR = 0.9, p = 0.62). However, the microsurgical approach was associated with a significantly higher rate of postoperative complications (OR = 2.44, p = 0.01) and a higher likelihood of requiring a VP shunt (OR = 3.53, p = 0.04) compared to the endoscopic approach. There was no significant difference in recurrence rates between the two approaches (OR = 2.14, p = 0.37).
Both microsurgical and endoscopic approaches achieve similar rates of GTR and capsule removal. However, the endoscopic approach is associated with fewer postoperative complications and a lower need for VP shunting. We believe that endoscopic resection of colloid cysts, when performed by an experienced neuroendoscopist, should be considered the standard approach for treating these lesions in the paediatric population. The investigation followed a prespecified protocol registered on PROSPERO (CRD420251018505).
第三脑室胶样囊肿是罕见的颅内病变，在儿童群体中尤为少见。儿童的确切发病率尚不确定，现有数据主要来自孤立的病例报告和有限的病例系列。儿童胶样囊肿通常呈现出更具侵袭性的临床病程，包括脑积水、颅内压升高，甚至猝死。尽管发病率较低，但危及生命并发症的高风险常常需要进行手术干预。然而，对于儿童胶样囊肿的最佳手术治疗方法，文献中尚无共识，显微手术切除和内镜下切除是最常用的方法。本荟萃分析旨在比较显微手术和内镜手术治疗儿童胶样囊肿的疗效和安全性，重点关注手术结果，如全切除、囊壁切除、术后并发症、脑室腹腔分流术的需求以及复发率。
根据PRISMA指南进行系统评价和荟萃分析。进行全面的文献检索，以确定2000年至2024年12月期间发表的关于儿童胶样囊肿患者的研究。基于关键结果对两种手术方法进行统计学比较。
纳入了15项研究，共249例儿童病例。结果显示，显微手术和内镜手术在就诊时的脑积水情况（优势比[OR]=0.9，p=0.92）、实现全切除（OR=0.9，p=0.61）或囊壁切除（OR=0.9，p=0.62）方面没有显著差异。然而，与内镜手术相比，显微手术术后并发症发生率显著更高（OR=2.44，p=0.01），且需要进行脑室腹腔分流术的可能性更高（OR=3.53，p=0.04）。两种手术方法的复发率没有显著差异（OR=2.14，p=0.37）。
显微手术和内镜手术在全切除和囊壁切除率方面相似。然而，内镜手术术后并发症更少，对脑室腹腔分流术的需求更低。我们认为，由经验丰富的神经内镜医生进行内镜下切除胶样囊肿，应被视为治疗儿童这些病变的标准方法。本研究遵循在PROSPERO上注册的预先指定方案（CRD420251018505）。
