Mevlüt Özgür TAŞKAPILIOĞLU, Ender KORFALI, Tolga KAPLAN, Turgut KUYTU, Hasan KOCAELİ

Pediatrik kolloid kistlere anterior transkallozal yaklaşım sonuçları

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 anterior interhemisferik transkallozal yaklaşımla tedavi edilen pediatrik olgular sunulmuş ve tedavi prensipleri üzerinde durulmuştur. Gereç ve Yöntem: Bu çalışmada 2001-2009 yılları arasında opere edilen kolloid kistli 16 yaş ve altı hastalar retrospektif olarak incelendi. Bulgular: Hastaların 3’ü erkek, 1’i kız; yaş aralığı 12-16; ortalama yaş 13,75; ortalama semptom süresi 2,5 ay; ortalama takip süresi 46,75 (15-102) ay idi. Başvuru şikayetlerine bakıldığında, 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. Kranial bilgisayarlı 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. Üç hastada total eksizyon mümkün olurken, 1 hastada talamostriat vene yapışık kapsülün çok küçük bir kısmı koagüle edilerek bırakıldı. Takiplerde rekürrens izlenmedi. Sonuç: Üçüncü ventrikül lezyonlarına ulaşmak için literatürde çok çeşitli yaklaşımlar tanımlanmış olmakla birlikte, olgularımızda kortikal harabiyete sebep olmadığından transkallozal girişim tercih edildi. Bu yolla yaklaşım pediatrik olgularda da güvenli tümör rezeksiyonuna imkan sağlamaktadır. (Güncel Pediatri 2011; 9: 23-7)

Results of anterior transcallosal approach to pediatric colloid cysts

Introduction: Colloid cysts represent 0.5-1% of all intracranial neoplasms and 55% of the third 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-up 46.75 (15-102) months. All the patients had frontal headache as a main complaint; 2 patients also 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 neurological deficit. Cyst was hyperintense and hypointense in cranial computed tomography of 2 and 1 patients, respectively. T1-, and T2-weighted cranial magnetic resonance images were iso-, and hyperintense in 2 patients while hypo-, and hyperintense in 1 patient, while hyper-, and isointense in 1 patient respectively. Interhemispheric-transcallosal- transforaminal approach was used in all patients. In 3 patients, total excision was performed while in 1 patient, a small part of capsule 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 the transcallosal approach in all of our pediatric patients since the approach does not cause any cortical breach and provides secure tumour resection. (Journal of Current Pediatrics 2011; 9: 23-7)

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