Cicutti Santiago Ezequiel, Gonzalez Ramos Javier Danilo, Jaimovich Sebastián Gastón
Neurosurgery Department, Juan P. Garrahan Hospital, Buenos Aires, Argentina.
Childs Nerv Syst. 2025 Aug 19;41(1):263. doi: 10.1007/s00381-025-06918-x.
Epidermoid cysts of the pineal region with posterior third ventricular extension are exceptionally rare, especially in the pediatric population. Despite their benign histology, their deep location near critical neurovascular structures poses considerable surgical challenges. We present the first reported pediatric case of a pineal epidermoid cyst extending into the posterior third ventricle successfully managed through a purely endoscopic transventricular approach, and analyze the literature.
A 12-year-old boy presented with a three-week history of progressive headache, vomiting, and somnolence. Brain MRI revealed a well-defined, lobulated, non-enhancing lesion centered in the pineal region, extending into the posterior third ventricle, with marked diffusion restriction and no contrast enhancement-features consistent with an epidermoid cyst. Obstructive hydrocephalus was also noted. A pure endoscopic ventricular approach was performed, allowing complete tumor resection and simultaneous endoscopic third ventriculostomy (ETV) to treat the hydrocephalus. Histopathological analysis confirmed the diagnosis of an epidermoid cyst. Postoperatively, the patient developed a pyoventriculitis that required the placement of a ventriculoperitoneal shunt. No neurological deficits were observed. Follow-up with annual MRI over a six-year period showed no recurrence.
This case demonstrates the safety and efficacy of a purely endoscopic transventricular approach in selected pediatric patients with pineal region epidermoid cysts extending into the posterior third ventricle. This minimally invasive technique enables simultaneous management of both tumor and hydrocephalus, avoiding cortical transgression and reducing morbidity. It may represent a valuable alternative to traditional microsurgical approaches in appropriately selected cases.
松果体区表皮样囊肿并向后扩展至第三脑室后部极为罕见，尤其是在儿童群体中。尽管其组织学表现为良性，但其靠近关键神经血管结构的深部位置给手术带来了相当大的挑战。我们报告首例经单纯内镜经脑室入路成功治疗的儿童松果体表皮样囊肿扩展至第三脑室后部的病例，并对相关文献进行分析。
一名12岁男孩，有3周进行性头痛、呕吐和嗜睡病史。脑部MRI显示松果体区有一个边界清晰、分叶状、无强化的病变，延伸至第三脑室后部，具有明显的弥散受限且无强化特征，符合表皮样囊肿。同时还发现梗阻性脑积水。采用单纯内镜经脑室入路，完整切除肿瘤并同时行内镜下第三脑室造瘘术（ETV）治疗脑积水。组织病理学分析确诊为表皮样囊肿。术后，患者发生了脑室积脓，需要放置脑室腹腔分流管。未观察到神经功能缺损。在六年期间每年进行MRI随访，未见复发。
该病例证明了单纯内镜经脑室入路在选定的患有松果体区表皮样囊肿并扩展至第三脑室后部的儿童患者中的安全性和有效性。这种微创技术能够同时处理肿瘤和脑积水，避免皮质侵犯并降低发病率。在适当选择的病例中，它可能是传统显微手术方法的一种有价值的替代方案。
