Pediatrik Kolloid Kistlere Anterior Transkallozal Yaklaşım Sonuçları

Year 2011, Volume: 9 Issue: 2, 23 - 27, 01.09.2011

Turgut Kuytu Tolga Kaplan Mevlüt Özgür Taşkapılıoğlu Hasan Kocaeli Ender Korfalı

Abstract

Giriş: Kolloid kistler tüm intrakranial tümörlerin %0,5-1’ini, 3. ventrikül lezyonlarının ise%55’ini oluşturur. Bu çalışmada, 3. ventrikül kolloid kisti nedeniyle kliniğimizde anteriorinterhemisferik transkallozal yaklaşımla tedavi edilen pediatrik olgular sunulmuş vetedavi prensipleri üzerinde durulmuştur.Gereç ve Yöntem: Bu çalışmada 2001-2009 yılları arasında opere edilen kolloid kistli 16 yaşve altı hastalar retrospektif olarak incelendi.Bulgular: Hastaların 3’ü erkek, 1’i kız; yaş aralığı 12-16; ortalama yaş 13,75; ortalamasemptom süresi 2,5 ay; ortalama takip süresi 46,75 ay idi. Başvuru şikayetlerinebakıldığında, hastaların tümünde frontal yerleşimli baş ağrısı, 2 hastada ek olarak bulantı-kusma ve 1 hastada vücudunun sol tarafında uyuşma şikayeti mevcuttu. Nörolojik muayenede 3 hastada bilateral papil ödem izlenirken 1 hastada defisit saptanmadı. Kranialbilgisayarlı tomografide 2 olguda kist hiperdens, 1 hastada hipodens olarak izlendi. Kranial manyetik rezonans görüntülemede kist 2 olguda T1 ağırlıklı görüntülerde izo, T2 ağırlıklı imajlarda hiper; 1 olguda T1 ağırlıklı görüntülerde hipo, T2 ağırlıklı görüntülerde hiper; 1 olguda ise T1 ağırlıklı görüntülerde hiper, T2 ağırlıklı görüntülerde izointens idi.Tüm hastalar interhemisferik-transkallosal-transforaminal yaklaşımla tedavi edildi. Üçhastada total eksizyon mümkün olurken, 1 hastada talamostriat vene yapışık kapsülünçok küçük bir kısmı koagüle edilerek bırakıldı. Takiplerde rekürrens izlenmedi. Sonuç: Üçüncü ventrikül lezyonlarına ulaşmak için literatürde çok çeşitli yaklaşımlartanımlanmış olmakla birlikte, olgularımızda kortikal harabiyete sebep olmadığından transkallozal girişim tercih edildi. Bu yolla yaklaşım pediatrik olgularda da güvenli tümörrezeksiyonuna imkan sağlamaktadır

Keywords

Üçüncü ventrikül, kolloid kist, baş ağrısı

Results of Anterior Transcallosal Approach to Pediatric Colloid Cysts

Abstract

Introduction: Colloid cysts represent 0.5-1% of all intracranial neoplasms and 55% of thethird ventricular lesions. In this study, we emphasized the principles of treatment in pediatric cases with third venricular colloid cysts treated by using anterior interhemispheric transcallosal approach. Materials and Method: The patients aged 16 years and below with colloid cysts, operated between 2001-2009, were evaluated retrospectively.Results: There were 3 males and 1 female patients aged between 12-16 mean age 13.75 years. The mean duration of symptoms were 2.5 months and mean duration of follow-up46.75 months. All the patients had frontal headache as a main complaint; 2 patientsalso had nausea and vomiting; and 1 patient also had numbness on the left side of his body.Three patients had bilateral marked papil edema while 1 patient had no neurologicaldeficit. Cyst was hyperintense and hypointense in cranial computed tomography of 2 and1 patients, respectively. T1-, and T2-weighted cranial magnetic resonance images wereiso-, and hyperintense in 2 patients while hypo-, and hyperintense in 1 patient, while hyper-, and isointense in 1 patient respectively. Interhemispheric-transcallosaltransforaminal approach was used in all patients. In 3 patients, total excision was performed while in 1 patient, a small part ofcapsule attached to thalamostriate vein was left. There were no cyst recurrences at follow-up.Conclusions: Although various approaches had been described to reach the third ventricular colloid cyst; we preferred thetranscallosal approach in all of our pediatric patients since the approach does not cause any cortical breach and provides

Keywords

Third ventricle, colloid cysts, headache

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