Katayama Y, Tsubokawa T, Maeda T, Yamamoto T
Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
J Neurosurg. 1994 Jan;80(1):64-72. doi: 10.3171/jns.1994.80.1.0064.
In order to determine adequate therapeutic approaches for cavernous malformations of the third ventricle, the authors reviewed a series of five such malformations managed at their institution and nine others reported in the literature. Four subgroups were identified in terms of the site of origin and could be characterized by different clinical manifestations: visual field defects and endocrine function deficits in patients with malformations in the suprachiasmatic region (six cases); symptoms caused by hydrocephalus in those with malformations in the foramen of Monro region (five cases); and deficits of short-term memory in those with malformations in the lateral wall (two cases) or of the floor of the third ventricle (one case). Unlike cavernous malformations at other locations, malformations of the third ventricle frequently demonstrated rapid growth (43%) and mass effects (71%). The surgical or autopsy findings suggested that the growth was attributable to repeated intralesional hemorrhages. Extralesional hemorrhage was also not uncommon, occurring in 29% of patients. Such tendencies require the adoption of a more aggressive approach to this particular group of cavernous malformations as compared to those in other locations. The risks of regrowth and extralesional hemorrhage appear to be reduced only by complete excision. The surgical approaches adopted should be aimed at providing the best access to the site where the malformation has arisen. The translamina terminalis approach for cavernous malformations in the suprachiasmatic region, the transventricular or transcallosal interfornicial approaches for those in the foramen of Monro region and the transvelum interpositum approach for those in the lateral wall or the floor of the third ventricle appear to be appropriate. In order to select the adequate surgical approach, precise diagnosis of the site of origin is crucial. In addition to neuroimaging techniques, the patient's initial symptoms provide valuable information.
为确定第三脑室海绵状畸形的适当治疗方法，作者回顾了其所在机构治疗的5例此类畸形病例以及文献报道的其他9例病例。根据起源部位确定了4个亚组，其临床表现各异：视交叉上区畸形患者出现视野缺损和内分泌功能缺陷（6例）；Monro孔区畸形患者出现脑积水相关症状（5例）；侧壁（2例）或第三脑室底部畸形患者出现短期记忆缺陷（1例）。与其他部位的海绵状畸形不同，第三脑室的畸形常表现为快速生长（43%）和占位效应（71%）。手术或尸检结果表明，生长归因于病灶内反复出血。病灶外出血也并不少见，29%的患者出现此类情况。与其他部位的海绵状畸形相比，针对这一特殊类型的海绵状畸形需要采取更积极的治疗方法。似乎只有通过完全切除才能降低复发和病灶外出血的风险。所采用的手术入路应旨在最佳地显露畸形起源部位。视交叉上区海绵状畸形采用终板入路，Monro孔区畸形采用经脑室或经胼胝体穹窿间入路，第三脑室侧壁或底部畸形采用经中间帆入路似乎是合适的。为选择合适的手术入路，精确诊断起源部位至关重要。除神经影像学技术外，患者的初始症状也提供了有价值的信息。
