The surgical management of third ventricle region tumors

IF 1.8 4区 医学 Q3 CLINICAL NEUROLOGY
Chloe Verducci , Dayna C. Sloane , Rob Hand , Shawn Choe , Ignacio Jusue-Torres , Rachyl M. Shanker , Miri Kim , Atul K. Mallik , Anand V. Germanwala , Douglas E. Anderson
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引用次数: 0

Abstract

Objectives

The goal of this study was to characterize the largest known cohort of patients presenting with different tumor pathologies in the third ventricle region to better understand outcomes of surgical management.

Methods

All patients undergoing surgical intervention on tumors in or encroaching upon the third ventricle at Loyola University Medical Center between the years 1986–2021 were reviewed. Information recorded included presenting symptoms, pre- and post-operative interventions, tumor pathology, operative technique, extent of resection (EOR), and approach of operation. The primary clinical outcome was Karnofsky Performance Status (KPS) score.

Results

Ninety-seven patients underwent 123 operations. Forty-six (47.4 %) patients were female, and the median age at operation was 39 years. Eighty-seven (70.7 %) operations were open, and 36 (29.3 %) were endoscopic. Gross total resection (GTR) was achieved in 34.4 % of operations, near-total resection (NTR) in 31.5 %, subtotal resection in 25.0 %, and biopsy alone in 9.3 %. Median KPS increased pre- to postoperatively, regardless of surgical technique. Adjusting for preoperative KPS, age, and operation number, regression analysis demonstrated a trend that lesser EOR is associated with lower KPS at most recent follow-up (p=0.031 for NTR vs GTR, p=0.022 for biopsy vs GTR). There was no statistically significant association between the most recent KPS and either open or endoscopic surgical technique, with or without adjusting for the previously stated factors (p=0.26). There was no association between postoperative complication rates or age with either surgical technique.

Conclusions

Here, we characterize a large cohort of patients presenting for neurosurgical evaluation of tumors in the region of the third ventricle. Our results demonstrate a trend that a more aggressive resection may yield better KPS outcomes. Additionally, both open and endoscopic techniques lead to a similar improvement in clinical outcome and rates of complication. While ultimate surgical approach and technique is determined by individual tumor characteristics, patient health status, and surgeon expertise, ability to resect the tumor in its entirety should be taken into consideration.
第三脑室区域肿瘤的手术治疗
方法回顾了1986-2021年间在洛约拉大学医学中心接受手术治疗的所有第三脑室肿瘤或侵犯第三脑室肿瘤的患者。记录的信息包括主要症状、术前和术后干预、肿瘤病理、手术技术、切除范围(EOR)和手术方式。主要临床结果为卡诺夫斯基表现状态(KPS)评分。46例(47.4%)患者为女性,手术时的中位年龄为39岁。87例(70.7%)为开腹手术,36例(29.3%)为内窥镜手术。34.4%的手术实现了全切除(GTR),31.5%的手术实现了近全切除(NTR),25.0%的手术实现了次全切除,9.3%的手术仅进行了活检。无论采用哪种手术方法,术前和术后的中位KPS均有所上升。对术前 KPS、年龄和手术次数进行调整后,回归分析表明了一种趋势,即较少的 EOR 与最近随访时较低的 KPS 相关(NTR 与 GTR 相比,P=0.031;活检与 GTR 相比,P=0.022)。无论是否对之前所述的因素进行调整,最近的 KPS 与开放或内窥镜手术技术之间都没有统计学意义上的关联(P=0.26)。术后并发症发生率或年龄与两种手术技术均无关联。结论在这里,我们描述了一大批因第三脑室区域肿瘤而接受神经外科评估的患者的特征。我们的研究结果表明了一种趋势,即更积极的切除术可能会获得更好的 KPS 结果。此外,开放式和内窥镜技术在临床效果和并发症发生率方面都有类似的改善。虽然最终的手术方法和技术取决于肿瘤的个体特征、患者的健康状况和外科医生的专业知识,但也应考虑到完整切除肿瘤的能力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical Neurology and Neurosurgery
Clinical Neurology and Neurosurgery 医学-临床神经学
CiteScore
3.70
自引率
5.30%
发文量
358
审稿时长
46 days
期刊介绍: Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.
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