摘要：

目的: 对改良神经内镜下双骨孔序贯入路第三脑室底造瘘术联合松果体区肿瘤组织活检术治疗肿瘤标志物阴性的儿童松果体区肿瘤伴梗阻性脑积水的疗效进行初步总结。方法与结果: 回顾分析首都医科大学附属北京天坛医院2023年6月至2025年11月收治的9例儿童松果体区肿瘤伴梗阻性脑积水患者的临床资料，4例采用传统单骨孔（单骨孔组）神经内镜下第三脑室底造瘘术联合松果体区肿瘤组织活检术，5例行改良神经内镜下双骨孔（双骨孔组）序贯入路第三脑室底造瘘术联合松果体区肿瘤组织活检术。术后评价显示：单骨孔组平均手术时间2.79h，病理诊断成功率3/4，双骨孔组平均手术时间为2.37h，病理诊断成功率5/5例；两组患儿脑积水均获得有效缓解。单骨孔组术中出血量 > 100ml者1例、穹窿轻微挫伤3例、透明隔静脉损伤1例、术后短暂性记忆力减退1例；双骨孔组无一例发生安全性事件。结论: 改良神经内镜下双骨孔序贯入路通过其精准的解剖设计和高度的可视性，为治疗儿童松果体区肿瘤伴梗阻性脑积水提供了安全、高效的一体化解决方案，有望成为此类病例的标准术式之一。

关键词: 松果体瘤, 脑积水, 脑室造口术, 第三脑室, 活组织检查, 神经内窥镜检查

Abstract:

Objective: To investigate the preliminary experience of a modified neuroendoscopic dual burr-hole sequential approach for third ventriculostomy combined with pineal region tumor biopsy in the treatment of tumor marker-negative pediatric pineal region tumor with obstructive hydrocephalus. Methods and Results: The clinical data of 9 children with pineal region tumor and obstructive hydrocephalus admitted to Beijing Tiantan Hospital, Capital Medical University from June 2023 to November 2025 were analyzed. Among them, 4 cases underwent the conventional single burr-hole endoscopic third ventriculostomy (ETV) combined with pineal region tumor biopsy (single burr-hole group), and 5 cases received the modified neuroendoscopic dual burr-hole sequential approach for third ventriculostomy combined with pineal region tumor biopsy (dual burr-hole group). Postoperative evaluation showed: in the single burr-hole group, the mean operative time was 2.79h, and the pathological diagnostic success rate was 3/4. In the dual burr-hole group, the mean operative time was 2.37h, and the pathological diagnostic success rate was 5/5. Obstructive hydrocephalus was effectively relieved in all patients in both groups. In the single burr-hole group, one case had intraoperative blood loss > 100ml, 3 cases experienced mild forniceal contusion, one case had septum pellucidum vein injury, and one case developed transient postoperative memory decline. No safety events occurred in the dual burr-hole group. Conclusions: The modified neuroendoscopic dual burr-hole sequential approach, with its precise anatomical design and excellent visualization, provides a safe, efficient and integrated solution for the treatment of pediatric pineal region tumor with obstructive hydrocephalus. It holds promise as one of the standard surgical approaches for such cases.

Key words: Pinealoma, Hydrocephalus, Ventriculostomy, Third ventricle, Biopsy, Neuroendoscopy

中图分类号: 

• R741