综合治疗婴幼儿第三脑室巨大肿瘤的疗效

Clinical observation on the efficacy of comprehensive treatment for the giant tumor involving the third ventricle in infants and young children

目的探讨综合治疗婴幼儿第三脑室巨大肿瘤的疗效.方法回顾性分析2013年1月至2019年6月清华大学玉泉医院神经外科中心采用手术治疗年龄≤3岁的第三脑室巨大肿瘤患儿的临床资料,共16例.病理学证实生殖细胞肿瘤8例,松果体母细胞瘤4例,脑胶质瘤(星形细胞瘤)2例,脉络丛乳头状瘤2例.术前8例行脑室-腹腔分流术,2例行脑室镜第三脑室底造瘘术.均采用经胼胝体-透明隔间隙-穹窿间入路切除肿瘤.3例术前行新辅助化疗,10例术后行辅助化疗.结果16例患儿肿瘤均为全切除.术后发生硬膜下积液11例,呼吸系统功能障碍3例,均经治疗后改善.术前行化疗的3例患儿,化疗后2例体积缩小,1例体积增大;3例术中均显示肿瘤血供不丰富,局部坏死样改变;术后病理可见局部肿瘤细胞和血管壁变性坏死.术后失访1例,15例随访5~72个月(中位数为18个月).3例松果体母细胞瘤患儿均于术后10个月内因蛛网膜下腔广泛肿瘤播散死亡,其余12例肿瘤均无复发.结论经胼胝体-透明隔间隙-穹窿间入路可安全地全部切除第三脑室肿瘤;部分恶性脑肿瘤患儿术前化疗有助于肿瘤切除,术后化疗可降低肿瘤的复发.

Objective To explore the therapeutic efficacy of comprehensive treatment for the giant tumor involving the third ventricle in infants and young children.Methods A retrospective analysis was conducted on 16 patients≤3 years old who underwent surgical treatment for giant tumors of the third ventricle at Department of Neurosurgery Center,Tsinghua University Yuquan Hospital from January 2013 to June 2019.Pathological examination indicated that there were 8 cases of germ cell tumor,4 cases of pineoblastoma,2 cases of astrocytoma and 2 cases of choroid plexus papilloma.Among them,8 patients underwent ventriculoperitoneal shunting and 2 underwent ventriculoscopic third ventriculostomy prior to tumor resection.All tumors were resected through transcallosal interforniceal approach.There were 3 patients undergoing neoadjuvant chemotherapy before operation and 10 undergoing adjuvant chemotherapy after operation.Results Total removal of the tumor was achieved in all 16 cases.Postoperative complications included subdural effusion in 11 cases and respiratory dysfunction in 3,all of which improved following treatment.Of the 3 children with preoperative chemotherapy,2 were reduced in tumor volume and 1 increased in tumor volume after chemotherapy,and 3 cases showed that the tumor blood supply was not abundant and local necrosis change was reported.Postoperative pathological examination revealed degeneration and necrosis of focal tumor cells and vascular wall.One case was lost to postoperative follow-up and 15 were followed up for 72 months(median:18 months).Three cases of pineoblastoma died within 10 months of surgery due to wide dissemination of tumor in the subarachnoid space,and none of the remaining 12 cases had relapsed.Conclusions Tumors involving the third ventricle can be safely and totally resected via the transcallosal interforniceal approach.Microsurgical resection can be facilitated by preoperative neoadjuvant chemotherapy for some malignant brain tumors and postoperative chemotherapy may reduce tumor recurrence.