Koroid Pleksus Tümörleri Tedavisi
Ersin Haciyakupoglu1, Ali Erhan Kayalar2, Mustafa Efendioglu2, Serik Akshulakov5, Aydin Sav4, Sebahattin Haciyakupoğlu31Heinrich-Braun-Klinikum Zwickau, Nöroşirurji Departmanı2Sağlık Bilimleri Üniversitesi Tıp Fakültesi, Nöroşirurji Ana Bilim Dalı, İstanbul
3Acıbadem Üniversitesi Tıp Fakültesi Nöroşirurji Ana Bilim Dalı, Türkiye
4Acıbadem Üniversitesi Tıp Fakültesi Patoloji Ana Bilim Dalı, Türkiye
5Çocuk Hastanesi, Nöroşirurji Departmanı, Almati, Kazakistan
GİRİŞ ve AMAÇ: Koroid Pleksus tümörleri, hamileligin 6. haftasinda ependimal hücreler ile birlesen nöroepitelial tabakadan köken alir. Genis biyolojik ve histolojik spektrumlari vardir. Bu tömörlerin %70 i cocuklarda görülür. En sik ve önemli semptomu, kafa ici basinc artisi bulgularidir. Tanida BT ve MRG önemlidir. Bu çalışmanın amacı kliniğimizde opere edilmiş koroid pleksus papillomu tanılı hastaların cerrahi sonuçlarının değerlendirilmesi amaçlanmıştır.
YÖNTEM ve GEREÇLER: Bu yazida 2000-2020 arasinda tümör eksizyonu uygulanan, 11 pediatrik, 3 eriskin hastanin demografik özellikleri, uygulanan cerrahi yaklaşım ve bunların sonuclari retrospektif olarak degerlendirilmiştir.
BULGULAR: Pediatrik hastalarin 8 tanesinde koroid pleksus papillomu, 2 tansesinde atipik koroid pleksus papillomu, 1 tane supratentoriel ventrikülleri dolduran difüz villlöz hipertrofi ( lateral ve 3. ventrikülleri dolduran tümör) vardi. Eriskin hastalarimizin bir tanesinde (12. Vaka) koroid pleksus papillomu sag lateral ventrikülde idi, parankimal infiltrasyon mevcuttu. Bu hastanin patolojisinde pilositik astositom geldi. İki tümör beraber kolüzyon tümörü olarak degerlendirildi. Diger bir eriskin tümör (13. Vaka) pontoserebellar kösede idi. Bu hastaya 10 yil önce, patolojik tani olmadan meningeom düsünülerek radyocerrahi uygulanmis ve sonrasi kontrolleri aksatilmis ve tümör büyümeye devam etmisti.
TARTIŞMA ve SONUÇ: Sonuc olarak, koroid pleksus tümörleri anaplastik transformasyon gösterebilir, parankim irritasyonuna yol acarak burada sekonder tümor olusumuna neden olabilir. Gamma Knife radyocerrahinin etkisi sinirli olup, tedavide gross total cikarim hedeflenmelidir.
Treatment Of Choroid Plexus Tumours
Ersin Haciyakupoglu1, Ali Erhan Kayalar2, Mustafa Efendioglu2, Serik Akshulakov5, Aydin Sav4, Sebahattin Haciyakupoğlu31Department of Neurosurgery, Heinrich-Braun-Klinikum Zwickau2Department of Neurosurgery, University of Health SciencesTurkey, Haydarpaşa Numune Health Application and Research Center, Istanbul, Turkey
3Department of Neurosurgery, Acıbadem University, Turkey
4Department of Pathology, Acıbadem University, Turkey
5Department of Neurosurgery, Children
INTRODUCTION: Choroid plexus tumours develop from the neuroepithelial lining which is well fused with ependymal cells in the 6th week of pregnancy. There is a broad spectrum of histological and biological characteristics.These tumours 70% are seen in children. The most important symptom is findings of increased intracranial pressure. Computed tomography and Magnetic resonance imagingis essential in diagnosis.
The aim of this study was to evaluate the surgical results of patients with a diagnosis of choroid plexus papilloma who were operated in our clinic.
METHODS: In this article, demographic characteristics, surgical approach and results of 11 pediatric and 3 adult patients who underwent tumor excision between 2000 and 2020 were evaluated retrospectively.
RESULTS: We evaluated the findings, the treatment approaches and surgical outcomes of 11 pediatric and 3 adult cases who underwent grosstotal excision between 2000-2020.The pediatric cases comprised of 8 choroid plexus papilloma, 2 atypical choroid plexus papilloma, and 1 diffuse villous hyperplasia filling supratentorial ventricles (left, right lateral ventricles and third ventricle). In one of our adult cases (12th case) choroid plexus papilloma was located at the right lateral ventricle and we suspected of parenchymal infiltration but pathologic diagnosis was pilocytic astrocytoma. These two tumors together constructed collesion tumor.The other tumour located in the right pontocerebellar angle (case 13) had undergone stereotactic radiosurgery 10 years previously as it had been considered to be meningioma, and as there had been no follow up, growth had continued.
DISCUSSION AND CONCLUSION: In conclusion, choroid plexus tumours show anaplastic transformation, may have an effect of irritation on the parenchyma, and may cause secondary tumours with the effect of parenchyma infiltration. Gamma knife treatment is not highly effective and the basic treatment should be considered to be grosstotal resection.
Sorumlu Yazar: Ali Erhan Kayalar, Türkiye
Makale Dili: İngilizce