第三脑室后部肿瘤行第三脑室底造瘘术及活检术疗效随访

Neuroendoscope by endoscopic third ventriculostomy （ETV） and biopsy for treatment of the tumors in the posterior part of the third ventricle combined with obstructive hydrocephalus

目的探讨第三脑室肿瘤合并脑积水使用神经内镜行第三脑室底造瘘术和活检术的手术方法和疗效。方法收集北京天坛医院神经外科内镜组2009年1月至2012年12月期间收治的22例第三脑室肿瘤合并脑积水患者的临床资料、影像学和随访信息，分析该术式的疗效。结果随访6个月-4．5年，22例患者中，术后临床症状完全消失18例；显著改善2例，其中1例仍有视物模糊，1例轻度头痛；恶化者2例，1例术后1个月发生全脑转移，1例术后1年复查头颅MRI显示肿瘤明显增大，2例患者均为星形细胞瘤Ⅲ级。随访发现17例患者肿瘤大小未见明显改变；3例明显缩小；1例患者发生全脑转移，经全脑放疗和化疗后症状改善；1例术后1年复查肿瘤明显增大，考虑接受显微外科切除术。结论第三脑室后部占位多为低级别肿瘤，生长缓慢，可使用神经内镜进行第三脑室底造瘘术和活检术：前者治疗梗阻性脑积水，后者获取病理样本以指导后续治疗。

Objective To explore the methods of treatment and curative effects of the tumors in the posterior part of the third ventricle combined with obstructive hydrocephalusunder neuroendoscopeby ETV and biopsy. Methods The clinical data and imaging findings of 22 patients with the tumors in the posterior part of the third ventricle combined with obstructive hydrocephalus by ETV and biopsy were retrospectively followed and analyzed; and related literatures were reviewed. Results All patients were performed by ETV. The clinical symptoms improved obviously after the surgery, and no significant tumor growth except two cases, and there is no dead case. Conclusion ETV and biopsy is an effective and reliable alternative treatment for the tumors in the posterior part of the third ventricle combined with obstructive hydrocephalus. Neuroendocopic procedures offer the opportunity to combine tumors biopsy and treatment of hydrocephalus.