Comparison of surgical approaches and outcome for symptomatic pineal cysts: microscopic/endoscopic fenestration vs. stereotactic catheter implantation

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica Pub Date : 2025-01-31 DOI:10.1007/s00701-025-06445-3

Michael Schmutzer-Sondergeld, Aylin Gencer, Tristan Schmidlechner, Hanna Zimmermann, Sebastian Niedermeyer, Sophie Katzendobler, Veit M. Stoecklein, Thomas Liebig, Christian Schichor, Niklas Thon

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引用次数: 0

Abstract

Purpose

Treatment strategies for space-occupying/symptomatic pineal cysts (PC) are still up for debate. In this study we present PC management, outcome data and risk factors for recurrence after surgery, focusing on microscopic/endoscopic procedures vs. stereotactic catheter implantation as alternative treatment concept to permanently drain PC into ventricles/cisterns.

Methods

This monocentric retrospective analysis included clinical data from all consecutive PC patients treated surgically between 2000 and 2022. Postoperative neurological and functional outcomes, along with perioperative complications, as well as time to PC recurrence and MR-morphological data were evaluated.

Results

39 patients (median age 32.6 years, range: 5.1–71.6 years) were analyzed. Main presenting symptoms were headaches, visual impairment, and epileptic seizures. In 18 patients (46.2%) an enlarged ventricular system was preoperatively found with 7 patients (18.0%) suffering from occlusive hydrocephalus. 14 patients underwent microscopic/endosocopic surgery, in 25 cases stereotaxy was preferred. No complication was seen in the microsurgery/endoscopy group compared to one intracystic postoperative bleeding (2.6%) and two CSF leaks (5.1%) after stereotaxy (p = 0.5). Overall, clinical improvement and significant cyst volume reduction (p < 0.0001) was seen in all patients. Recurrent PC were seen in 23.1%, independent of surgical procedure (p = 0.2). In cases of recurrence, TTR was 25.2 ± 31.2 months. Male gender (p = 0.01), longer surgery time (p = 0.03) and preoperatively increased Evans index (EI) (p = 0.007) were significant risk factors for PC recurrence in multivariate analysis.

Conclusion

In patients suffering from PC, microsurgical and stereotactic approaches can improve clinical symptoms at low procedural risk, with equal extent of volume reduction. However, preoperative ventricular enlargement and EI values should be considered for optimal treatment planning to reduce recurrence.

查看原文本刊更多论文

有症状的松果体囊肿的手术方法和结果的比较：显微镜/内镜下开窗与立体定向导管植入术。

目的：占位性/症状性松果体囊肿（PC）的治疗策略仍有争议。在这项研究中，我们介绍了PC的管理、结果数据和手术后复发的危险因素，重点是显微镜/内窥镜手术与立体定向导管植入作为永久将PC引流到脑室/池的替代治疗概念。方法：这项单中心回顾性分析包括2000年至2022年间所有连续接受手术治疗的PC患者的临床数据。评估术后神经和功能结果，以及围手术期并发症，以及PC复发时间和mr形态学数据。结果：39例患者（中位年龄32.6岁，范围5.1-71.6岁）。主要表现为头痛、视力障碍和癫痫发作。18例（46.2%）患者术前发现脑室系统增大，7例（18.0%）患者患有闭塞性脑积水。14例患者接受镜下/内镜下手术，25例首选立体定向。与立体定位术后1例囊内出血（2.6%）和2例脑脊液泄漏（5.1%）相比，显微手术/内窥镜组无并发症（p = 0.5）。结论：在PC患者中，显微外科和立体定向入路可在手术风险低的情况下改善临床症状，并可实现同等程度的体积缩小。然而，术前心室扩大和EI值应考虑最佳治疗方案，以减少复发。

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

Acta Neurochirurgica 医学-临床神经学

CiteScore

4.40

自引率

4.20%

发文量

342

审稿时长

1 months

期刊介绍： The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.