脳室内腫瘍—神経内視鏡—小児脳室内腫瘍における神経内視鏡手術

Neuroendoscopic Surgery for Pediatric Intraventricular Tumors

Point

・小児期に発生する脳腫瘍は，側脳室や第三脳室内に発生する腫瘍が多く，水頭症の合併頻度も高く，内視鏡手術のよい適応である．

・脳室内腫瘍に対する内視鏡下腫瘍生検術および腫瘍摘出術は，技術の向上や機器の開発により，正確で低侵襲に行うことが可能である．

・合併する水頭症に対しても，第三脳室底開窓術や透明中隔開窓術などの手技を同時に行い，髄液循環や頭蓋内圧を改善させることができる．

　Various tumors are found in ventricles and tissues surrounding the ventricles in children, adolescents, and young-adult patients. They cause cerebrospinal fluid pathway obstruction, resulting in hydrocephalus and isolated ventricles. In this paper we describe a neoplasm arising from the lateral and third ventricle. Intraventricular tumors are good candidates for neuroendoscopic surgery.

　Firstly, minimally invasive and established procedures, neuroendoscopic biopsy with flexible endoscopy or rigid endoscopy, are performed. These endoscopic biopsies can be performed concurrently with other procedures, such as third ventriculostomy or septostomy, to improve cerebrospinal fluid circulation. Neuroendoscopic biopsy for intraventricular tumor is associated with high diagnostic yield and relatively low incidence of morbidity and mortality, compared with open surgery. Endoscopic diagnostic procedure also can be applied in patients without ventricular dilatation, assisted by neuronavigation or echo-guided equipment.

　Secondly, neuroendoscopic cylinder surgery also makes it possible to remove intraventricular tumors with less damage. The two hands technique with rigid endoscopy helps debulking and hemostasis during tumor removal. Further developments in endoscopic equipment and training systems aimed at enhancing cooperation between the operator and assistant should be expected in the future. Neuroendoscopic resection appears to be a safe and reliable treatment option for patients with intraventricular tumors.