Hernesniemi J, Leivo S
Department of Neurosurgery, University Hospital of Kuopio, Finland.
Surg Neurol. 1996 Jan;45(1):2-14. doi: 10.1016/0090-3019(95)00379-7.
Third ventricular colloid cysts account for 0.5% - 1.5% of all intracranial tumors. A thorough search of the world literature since 1858 revealed 1167 cases, for which a more than one-third (36%) management mortality was estimated. One third of the reported cases had modern diagnostics and surgery with minimal morbidity and nearly no mortality. The primary goal of this study was to assess the incidence and present-day management outcome of these lesions in the strictly defined area of Eastern Finland.
In a series of 2000 patients with brain tumors from our catchment area (870,000 inhabitants in eastern Finland) during a 14.5-year period (years 1980-1994), 40 patients (mean age, 45 years; range, 19-75 years, with 21 females) had a third ventricular colloid cyst. Thirty-one patients had transcallosal extirpation of their cysts. One additional tumor was extirpated by the infratentorial supracerebellar route to include simultaneous biopsy of a tectal tumor (lipoma). One elderly male with severe cardiac disease received a ventriculoatrial shunt. Five patients, admitted deeply unconscious, died. In two of these five patients, desperate shunting operations were done, but, in the remaining three moribund patients, no treatment was considered to be of any benefit. Two patients with small tumors are being followed up.
The far lateral transcallosal transforaminal extirpation of the cyst has served our patients well. There was no surgical mortality. The outcome was excellent in 30 patients and good in 3 patients. Follow-up time ranged from 2 months to 14.5 years (mean, 4.3 years). There were no tumor recurrences. Despite good surgical results, management mortality was as high as 13%,
The incidence of third ventricular colloid cysts is at least 3.2/1 million/1 year. Even nowadays, up to one fifth of these completely benign and treatable tumors are detected too late, with calamitous consequences.
第三脑室胶样囊肿占所有颅内肿瘤的0.5% - 1.5%。对自1858年以来的世界文献进行全面检索发现了1167例病例，估计其治疗死亡率超过三分之一（36%）。三分之一的报告病例采用了现代诊断和手术方法，发病率极低且几乎无死亡率。本研究的主要目的是评估在芬兰东部严格界定区域内这些病变的发病率和当前的治疗结果。
在1980年至1994年的14.5年期间，我们收集了来自服务区域（芬兰东部87万居民）的2000例脑肿瘤患者，其中40例（平均年龄45岁；范围19 - 75岁，女性21例）患有第三脑室胶样囊肿。31例患者经胼胝体入路切除囊肿。另有1例肿瘤经幕下小脑上入路切除，同时对顶盖肿瘤（脂肪瘤）进行活检。1例患有严重心脏病的老年男性接受了脑室心房分流术。5例深度昏迷入院的患者死亡。在这5例患者中，2例进行了绝望的分流手术，但在其余3例濒死患者中，未考虑任何治疗会有帮助。2例小肿瘤患者正在接受随访。
经胼胝体远外侧经室间孔囊肿切除术对我们的患者效果良好。无手术死亡。30例患者预后极佳，3例良好。随访时间为2个月至14.5年（平均4.3年）。无肿瘤复发。尽管手术效果良好，但治疗死亡率高达13%。
第三脑室胶样囊肿的发病率至少为每年百万分之3.2。即使在当今，这些完全良性且可治疗的肿瘤中仍有多达五分之一被发现过晚，导致灾难性后果。
