神经内镜治疗松果体区肿瘤致梗阻性脑积水的策略

Endoscopic treatment strategy of obstructive hydrocephalus induced by pineal region tumors

目的 探讨神经内镜辅助肿瘤活体组织检查加三脑室底造瘘术在松果体区肿瘤致梗阻性脑积水的诊疗效果.方法 对2012年2月至2014年2月解放军总医院神经外科65例松果体区肿瘤致梗阻性脑积水患者,采用神经内镜辅助肿瘤活体组织检查加三脑室底造瘘术,在获取肿瘤标本进行病理组织学检查的同时一期解决脑积水,根据肿瘤病理学诊断决定下一步治疗策略.结果 65例患者在脑室镜辅助下行肿瘤活体组织检查加三脑室底造瘘术均顺利完成手术,98.5％（64/65）成功获得病理组织学诊断,对37例生殖细胞肿瘤和6例松果体母细胞瘤行PEB方案（顺铂＋依托泊苷＋博来霉素）化疗和放疗,生殖细胞肿瘤放化疗有效率为91.7％ （33/36）;6例松果体母细胞瘤患者中4例放化疗后肿瘤缩小,总共56.9％（37/65）的患者无需开颅手术而获益.结论 采用神经内镜辅助肿瘤活体组织检查加三脑室底造瘘术治疗松果体区肿瘤致梗阻性脑积水,可以以较小的代价明确肿瘤的病理性质,使大部分患者（病理为生殖细胞瘤和松果体母细胞瘤）避免开颅手术,同时一期解决梗阻性脑积水,可考虑作为松果体区肿瘤合并梗阻性脑积水的常规治疗方案.

Objective To explore the efficacies of endoscopic third ventriculostomy （ETV） and tumor biopsy in surgical treatment of obstructive hydrocephalus induced by pineal region tumors.Methods For 65 patients of obstructive hydrocephalus induced by pineal region tumors,endoscopic third ventriculostomy （ETV） and tumor biopsy were performed from 2012 to 2014.Tumor specimens were harvested and analyzed histopathologically.According to pathological diagnosis,appropriate treatment strategies were followed.Results Sixty-five patients underwent successfully ETV and pineal region tumor biopsy.And the histological diagnosis yield rate was 98.5% （64/65）.PEB chemotherapy （cisplatin ＋ etoposide ＋ bleomycin） and radiotherapy were offered for germ cell tumors （n =37） and pineal blastomas （n =6）.The therapy effective rate of germ cell tumors was 91.7% （33/36）.A total of 56.9% （37/65） patients benefited without traditional craniotomy or shunt.Conclusion For pineal region tumor induced noncommunicating hydrocephalus,ETV and endoscopic tumor biopsy can relieve hydrocephalus while obtaining pathological diagnosis at a relative low risk.Most patients of germ cell tumors and pineoblastomas may avoid craniotomy and shunt.It will become a routine treatment for pineal region tumors with non-communicating hydrocephalus.