Gaab M R, Schroeder H W
Department of Neurosurgery, Ernst Moritz Arndt University, Greifswald, Germany.
J Neurosurg. 1998 Mar;88(3):496-505. doi: 10.3171/jns.1998.88.3.0496.
The purpose of this study was to determine the efficacy of endoscopic treatment in patients with intraventricular tumors.
A series of 30 patients with endoscopically treated intraventricular lesions is reported. The lesions included seven colloid cysts, six astrocytomas, three subependymomas, two ependymomas, and one each of the following: pineoblastoma, pineocytoma/pineoblastoma (intermediate type), epidermoid cyst, pineal cyst, medulloblastoma, arteriovenous hemangioma, cavernoma, choroid plexus papilloma, pituitary adenoma, craniopharyngioma, melanoma, and germinoma. Total tumor resections, partial resections, biopsies, stent implantations, septostomies, and third ventriculostomies were performed. In two cases (two subependymomas > 2 cm in diameter), piecemeal endoscopic resection was ineffective because of the very firm consistency of the tumors. Therefore the endoscopic procedure was discontinued and the tumors were removed microsurgically. In the remaining cases the procedures were completed as planned. Even in the presence of difficulties such as poor orientation or significant bleeding, there was no need to abandon the endoscopic procedure. A total of 28 strictly endoscopic interventions were performed, in which the average duration was 85 minutes (range 35-170 minutes). All colloid cysts and the epidermoid lesion were completely evacuated and the capsules were widely resected. Total extirpation of solid tumors was achieved in five cases, whereas most astrocytomas were partially resected. The hydrocephalus-related symptoms resolved in all of the 22 patients with cerebrospinal fluid pathway obstruction. There were no endoscopy-related deaths. In two cases, major bleeding occurred and was controlled endoscopically. The authors observed one case of meningitis, one of mutism, two of memory loss attributed to forniceal injury, one of transient trochlear palsy after a biopsy specimen of an aqueductal tumor was obtained, and one of transient confusion after a biopsy specimen of a germinoma was obtained.
In the authors' preliminary experience, the endoscopic approach was found to be safe and effective. In this series, it was possible to achieve relief of noncommunicating hydrocephalus, tumor resections, and even complete tumor removals by using endoscopic techniques. Based on the results, the authors believe that endoscopic techniques should be considered in the treatment of selected intraventricular lesions.
本研究旨在确定内镜治疗脑室内肿瘤患者的疗效。
报告了一组30例接受内镜治疗的脑室内病变患者。病变包括7例胶样囊肿、6例星形细胞瘤、3例室管膜下瘤、2例室管膜瘤，以及以下各1例：松果体母细胞瘤、松果体细胞瘤/松果体母细胞瘤（中间型）、表皮样囊肿、松果体囊肿、髓母细胞瘤、动静脉血管瘤、海绵状血管瘤、脉络丛乳头状瘤、垂体腺瘤、颅咽管瘤、黑色素瘤和生殖细胞瘤。进行了肿瘤全切、部分切除、活检、支架置入、造瘘和第三脑室造瘘术。在2例（2例直径>2 cm的室管膜下瘤）中，由于肿瘤质地非常坚硬，内镜碎块切除无效。因此，停止了内镜手术，改为显微手术切除肿瘤。其余病例均按计划完成手术。即使存在定位困难或大量出血等情况，也无需放弃内镜手术。共进行了28例严格的内镜干预，平均持续时间为85分钟（范围35 - 170分钟）。所有胶样囊肿和表皮样病变均完全清除，并广泛切除包膜。5例实体瘤实现了全切，而大多数星形细胞瘤进行了部分切除。22例脑脊液通路梗阻患者的脑积水相关症状均得到缓解。无内镜相关死亡病例。2例发生大出血，经内镜控制。作者观察到1例脑膜炎、1例缄默症、2例因穹窿损伤导致的记忆丧失、1例在获取导水管肿瘤活检标本后出现短暂滑车神经麻痹，以及1例在获取生殖细胞瘤活检标本后出现短暂意识模糊。
根据作者的初步经验，内镜治疗方法安全有效。在本系列研究中，通过内镜技术可以缓解梗阻性脑积水、切除肿瘤，甚至实现肿瘤全切。基于这些结果，作者认为在治疗某些脑室内病变时应考虑采用内镜技术。
