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首页> 外文期刊>Neurosurgical focus >Efficacy of simultaneous single-trajectory endoscopic tumor biopsy and endoscopic cerebrospinal fluid diversion procedures in intra- and paraventricular tumors
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Efficacy of simultaneous single-trajectory endoscopic tumor biopsy and endoscopic cerebrospinal fluid diversion procedures in intra- and paraventricular tumors

机译：内镜和脑室旁肿瘤同时行单线内镜肿瘤活检和内镜脑脊液分流术的疗效

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Object: Intraventricular and paraventricular tumors resulting in hydrocephalus commonly require a CSF diversion procedure. A tumor biopsy can often be performed concurrently. Although the tissue samples obtained during endoscopic biopsy procedures are small, a diagnosis can be made in most cases. In the present study the authors analyzed the efficacy of concurrent endoscopic biopsy and CSF diversion procedures using a single bur hole and trajectory. Methods: Eighty-seven patients with intraventricular and paraventricular tumors were treated with endoscopic biopsy and CSF diversion procedures using a rigid rod-lens endoscope or a rigid fiberscope during a 10-year period. All patients underwent a tumor biopsy and an endoscopic third ventriculostomy (ETV), aqueductal stenting (AS), or ventriculoperitoneal (VP) shunting, depending on the tumor location and site of obstruction. A single bur hole for both procedures was used in all patients. Results: Among the 87 patients, the biopsy was diagnostic in 72 (83%) and merely suggestive in 7 (8%); in 8 patients (9%) the sample was nondiagnostic. Among the 22 patients who underwent an initial endoscopic biopsy and subsequent procedures, the specimen obtained at the second surgery was concordant with the initial endoscopic biopsy sample in 13 patients; it was somewhat similar in 4 patients. In the other 5 patients, either a microsurgical or stereotactic approach was used to correctly diagnose the pathology. Fifty-five patients were considered for endoscopic CSF diversion procedures; an ETV was performed in 52 patients and AS in 2. An ETV could not be performed in 3 patients for technical reasons. A VP shunt was inserted in 32 patients, with 25 undergoing shunt placement at the same time as the ETV and 7 at a later date. Significant bleeding was encountered in 3 patients during the tumor biopsy and in 1 patient during the ETV. The ETV failed in 1 patient during the follow-up, and a repeat ETV was required. Conclusions: Endoscopic biopsy sampling and a concurrent CSF diversion procedure through a single bur hole and trajectory can be considered for intraventricular tumors. The overall success rates of 83% for the biopsy procedure and 86% for the ETV indicate that the procedures are beneficial in the majority of cases. A concordance rate of 75% was found in patients who underwent an initial biopsy procedure and a subsequent microsurgical approach for tumor excision.
机译：目的：导致脑积水的脑室内和脑室旁肿瘤通常需要脑脊液转移手术。肿瘤活检通常可以同时进行。尽管在内窥镜活检过程中获得的组织样本很小，但在大多数情况下都可以做出诊断。在本研究中，作者分析了使用单个钻头孔和轨迹同时进行内窥镜活检和CSF转移手术的疗效。方法：在10年的期间内，对87例脑室内和脑室旁肿瘤患者进行了内镜活检和CSF导流术治疗，方法是使用刚性杆状透镜内窥镜或刚性纤维镜。根据肿瘤的位置和梗阻部位，对所有患者进行肿瘤活检和内镜下第三脑室造口术（ETV），导水管支架置入术（AS）或脑室腹膜腔分流术（VP）。所有患者均使用两个手术的单个钻洞。结果：在87例患者中，活检诊断为72例（83％），仅提示性活检7例（8％）。在8例患者中（9％），该样本没有诊断价值。在接受初次内窥镜活检和随后手术的22例患者中，第二次手术获得的标本与13例初次内窥镜活检样本相符。在4位患者中有些相似。在其他5名患者中，采用显微外科手术或立体定向方法来正确诊断病理。 55例患者被考虑进行内镜CSF转移手术; 52例患者进行了ETV，2例进行了AS。由于技术原因，3例患者无法进行ETV。在32例患者中插入了VP分流器，其中25例与ETV同时接受分流，7例在以后接受分流。在肿瘤活检期间有3例患者发生了大出血，在ETV期间有1例患者发生了大出血。随访期间1例患者的ETV失败，需要再次进行ETV。结论：对于脑室内肿瘤，可以考虑内窥镜活检取样以及通过单个钻头孔和轨迹同时进行的脑脊液转移手术。活检过程的总体成功率为83％，ETV的总体成功率为86％，表明该过程在大多数情况下是有益的。在进行了首次活检和随后的显微手术切除肿瘤的患者中发现一致性率为75％。

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