Pediatrik Kolloid Kistlere Anterior Transkallozal Yaklaşım Sonuçları

Yıl 2011, Cilt: 9 Sayı: 2, 23 - 27, 01.09.2011

Turgut Kuytu Tolga Kaplan Mevlüt Özgür Taşkapılıoğlu Hasan Kocaeli Ender Korfalı

Öz

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

Anahtar Kelimeler

Üçüncü ventrikül, kolloid kist, baş ağrısı

Results of Anterior Transcallosal Approach to Pediatric Colloid Cysts

Öz

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

Anahtar Kelimeler

Third ventricle, colloid cysts, headache

Kaynakça

• 1. Antunes JL, Louis KM, Ganti SR. Colloid cysts of third ventricle. Neurosurgery 1980;7:450-5.
• 2. Desai KI, Nadkarni TD, Muzumdar DP, Goel AH. Surgical management of colloid cyst of the third ventricle-A study of 105 cases. Surg Neurol 2002;57:295-304.
• 3. De Witt Hamer PC, Verstegen MJ, De Haan RJ, Vandertop WP, Thomeer RT, Mooij JJ et al. High risk of acute deterioration in patients harbouring symptomatic colloid cysts of the third ventricle. J Neurosurg 2002;96:1041-5.
• 4. Aggleton JP, McMackin D, Carpenter K, Hornak J, Kapur N, Halpin S et al. Differential cognitive effects of colloid cysts in the third ventricle that spare or compromise the fornix. Brain 2000;123:800-15.
• 5. Buttner A, Winkler PA, Eisenmenger W, Weis S. Colloid cysts of the third ventricle with fatal outcome: a report of two cases and review of the literature. Int J Legal Med 1997;110:260-6.
• 6. Camacho A, Abernathey CD, Kelly PJ, Laws ER Jr. Colloid cysts: experience with the management of 84 cases since the introduction of computed tomography. Neurosurgery 1989;24:693-700.
• 7. Hodges JR, Carpenter K. Anterograde amnesia with fornix damage following removal of IIIrd ventricle colloid cyst. J Neurol Neurosurg Psychiatry 1991;54:633-8.
• 8. Jeffree RL, Besser M. Colloid cyst of the third ventricle: a clinical review of 39 cases. J Clin Neurosci 2001;8:328-31.
• 9. Stoodley MA, Nguyen TP, Robbins P. Familial fatal and near￾fatal third ventricle colloid cysts. Aust N Z J Surg 1999;10:733-6.
• 10. Wallman H. Colloid cyst in the third ventricle and lipoma in the plexus choroideus. Virchws Arch 1858;14:385-8.
• 11. Dandy WE. Case reports of colloid cysts in the third ventricle (group I). In: Dandy WE (ed) Benign tumors in the third ventricle of the brain: diagnosis and treatment. Williams & Wilkins, Baltimore, 1933.p.4-37.
• 12. Opeskin K, McD Anderson R, Lee KA. Colloid cyst of the 3rd ventricle as a cause of acute neurological deterioration and sudden death. J Paediatr Child Health 1993;29:476-7.
• 13. Alnaghmoosh N, Alkhani A. Colloid cysts in children, a clinical and radiological study. Childs Nerv Syst 2006;22:514-6.
• 14. Macdonald RL, Humphreys RP, Rutka JT, Kestle JR. Colloid cysts in children. Pediatr Neurosurg 1994;20:169-77.
• 15. Maqsood AAR, Devi IB, Mohanty A, Chandramouli BA, Sastry KVR. Third ventricular colloid cyst in children. Pediatr Neurosurg 2006;42:147-60.
• 16. Apuzzo MLJ, Litofsky NS. Surgery in and around the anterior third ventricle. In: Apuzzo MLJ (ed) Brain surgery: complication avoidance and management. Churchill Livingstone, New York, 1993.p.541-79.
• 17. Easwer HV, Bhattacharya RN, Nair S, Rao BR, Menon G, Abraham M et al. Pre-coronal, paramedian minicraniotomy: a minimal access approach for microsurgical, transcallosal, transforaminal removal of colloid cysts of the third ventricle. Minim Invasive Neurosurg 2008;5:253-7.
• 18. Hernesniemi J, Leivo S. Management outcome in third ventricular colloid cysts in a defined population: a series of 40 patients treated mainly by transcallosal microsurgery. Surg Neurol 1996;45:2-14.
• 19. Kumar V, Behari S, Singh RK, Jain M, Jaiswal AK, Jain VK. Pediatric colloid cysts of the third ventricle: management considerations. Acta Neurochir (Wien) 2010;152:451-61.
• 20. Hamlet A, Casallo-Quiliano C, Saikali S, Adn M, Brassier G. Huge colloid cyst: case report and review of unusual forms. Acta Neurochir (Wein) 2004;146:397-401.
• 21. Kachhara R, Das K, Nair S, Gupta AK. Changing characteristics of a colloid cyst of the third ventricle. Neuroradiology 1999;41:188-9.
• 22. Maeder PP, Holtås SL, Basibüyük LN, Salford LG, Tapper UA, Brun A. Colloid cysts of the third ventricle: correlation of MR and CT findings with histology and chemical analysis. AJNR Am J Neuroradiol 1990;11:575-81.
• 23. Scotti G, Scialfa G, Colombo N, Landoni L. MR in the diagno￾sis of colloid cyst of the third ventricle. AJNR Am J Neuroradiol 1987;8:370-2.
• 24. Türe U, Hiçdönmez T, Elmac› ‹, Peker S. Solid-calcified colloid cyst of the third ventricle. Clin Neurol Neurosurg 2001;103:51-5.
• 25. Pollock BE, Huston J 3rd. Natural history of asymptomatic, untreated colloid cysts of the third ventricle. J Neurosurg 1999;91:364-9.
• 26. Pollock BE, Schreiner SA, Huston J 3rd. A theory on the nat￾ural history of colloid cysts of the third ventricle. Neurosurgery 2000;46:1077-83.
• 27. Mathiesen T, Grane P, Lindquist C, von Holst H. High recur￾rence rate following aspiration of colloid cysts in the third ventricle. J Neurosurg 1993;78:748-52.