INC德国Henry W.S.Schroeder教授：内镜下胶质囊肿切除术后远期疗效观察

　　Abstract

　　Background:

　　Endoscopic resection of colloid cysts is a widely accepted treatment option instead of microsurgery.However,there is still a debate about a potentially higher rate of incomplete resections and recurrence.

　　Objective:

　　The aim of this retrospective study was to evaluate long-term results after endoscopic removal of colloid cysts.

　　INTRODUCTION：

　　There has been a debate over decades as to which surgical technique is the best and most effective for colloid cysts of the third ventricle.Microsurgery and endoscopy are mostly proposed as a safe and effective treatment option.Although endoscopy offers a minimally invasive approach via a simple burr hole,the total resection rate in most studies is less than in the microsurgical series,resulting in an increased risk for recurrence.1-15 The long-term recurrence rate has only rarely been investigated.16 Therefore,we reviewed our early 20 patients who underwent endoscopic colloid cysts resection.The aim of this study is to evaluate long-term results after endoscopic colloid cyst resection regarding the rate of total resection,cyst recurrence,and patient outcome.Furthermore,we intend to show that endoscopy achieves favorable results compared with microsurgical procedures.The initial results for the first 12 patients were reported previously.

　　Methods:

　　Twenty patients underwent endoscopic treatment in our department.Eighteen patients agreed to follow-up examinations.In 17 patients,magnetic resonance images were obtained.

　　Results:

　　Total cyst resection was achieved in 16 procedures.In 3 patients,small remnants of the cyst membrane were left behind.Conversion to microsurgery became necessary in 1 patient.Mild temporary complications occurred in 6 patients.Preoperative symptoms were completely relieved in 16 patients and improved in 2 patients.The average follow-up period was 188 months.In the patient with plexus coagulation,the cyst did not change.Recurrence occurred in 2 of 3 patients with cyst remnants.To date,no cyst remnant or recurrence has caused any symptoms or required surgical treatment.

　　Conclusions:

　　Our results indicate that endoscopic treatment of colloid cysts is a safe and effective treatment option that provides excellent long-term results.However,we determined that a significant risk for recurrence exists when even small parts of the cyst capsule were left behind.Therefore,we advocate an attempt at total endoscopic cyst resection.

　　背景：

　　内镜下胶质囊肿切除术是一种除了显微外科手术被广泛接受的治疗方法。然而，关于不完全切除和复发率可能更高的问题仍存在争议。

　　目的：

　　本回顾性研究的目的是评价内镜下切除胶质囊肿后的远期疗效。

　　简介：

　　对于三脑室胶质囊肿，哪种手术方法是较好和较合适的治疗方法一直存在争议。显微外科手术和内窥镜是一种顺利合适的治疗方法。虽然内窥镜通过一个简单的毛刺孔提供了一种微创方法，但大多数研究中的总切除率低于显微外科系列，从而增加了复发的风险。1-15长期复发率的研究很少。16因此，我们回顾了我们早期的20位接受内镜下胶质囊肿切除术的病人。本研究的目的是评估内镜下胶质囊肿切除术后的远期疗效，包括全切率、囊肿复发率和患者预后。此外，我们打算证明内窥镜与显微外科手术相比取得了良好的效果。前12名患者的初步结果是先前报告的。

　　方法：

　　对20例患者行内镜治疗。18名患者同意随访检查。17例患者获得了磁共振图像。

　　结果：

　　16例均行囊肿全切除术。3例囊膜残留。1例患者需转为显微手术。6例出现轻度暂时性并发症。术前症状完全缓解16例，好转2例。平均随访期188个月。神经丛凝固患者的囊肿没有改变。3例囊肿残留患者中2例复发。迄今为止，没有囊肿残留或复发引起任何症状或需要手术治疗。

　　结论：

　　我们的研究结果表明，内镜下治疗胶质囊肿是一种顺利合适的治疗方法，具有良好的长期疗效。然而，我们确定即使囊肿囊膜的一小部分被留下，复发的风险也很大。因此，我们主张尝试全内镜囊肿切除术。

　　关于德国Henry W.S.Schroeder教授

　　作为国际神经内镜联合会主席以及的神经内镜专家，INC国际神经外科医生集团旗下国际神经外科顾问团成员、国际神经外科联合会（WFNS）神经内镜主席、德国格莱夫斯瓦尔德大学神经外科主任Henry Schroeder教授较为擅长各种形式下的神经内镜技术。Schroeder教授曾于2019年11月来华参加INC国际神经外科顾问团二届年会，期间，还受邀在“2019姑苏神外沙龙”上交流其关于内镜辅助显微镜技术的独到治疗技术，他超群的内镜技术手法获得国内众多神经外科同仁“点赞”。

　　原文链接：

　　https://www.sci-hub.pl/10.1016/j.wneu.2018.09.190