OBJECT The purpose of this study was to evaluate whether endoscopic third ventriculostomy (ETV) and endoscopic cyst fenestration are effective minimally invasive alternatives to a craniotomy with cyst resection for the treatment of symptomatic pineal cyst-associated aqueductal stenosis. METHODS Sixteen patients with symptomatic pineal cysts were operatively managed endoscopically and these cases were retrospectively reviewed. There were 12 females and 4 males. The median age at the time of surgery was 31 years (range 3 to 62 years). RESULTS All patients presented with symptoms and imaging consistent with elevated intracranial pressure. The median maximum cyst diameter was 15 mm (range 10 mm to 27 mm). In all cases, there was mass effect on the tectum that resulted in effacement of the cerebral aqueduct and ventriculomegaly was present in 38% of cases. ETV was performed in 15 patients. Cyst fenestration was performed in 2 patients, one of which also had an ETV. Resolution of symptoms was achieved in 81% of patients with a median follow-up of 13 months. CONCLUSION This study showed that ETV is effective for symptomatic pineal cyst-associated aqueductal stenosis. Patients can be symptomatic without overt ventriculomegaly and normal ventricular volume does not preclude safe endoscopic management. Endoscopic cyst fenestration is recommended if a Perinaud syndrome is present or if ETV is not feasible.

中文翻译：

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松果体囊肿相关水管狭窄的内窥镜处理。

目的本研究的目的是评估内镜下第三脑室造口术（ETV）和内镜下囊肿开窗术是否有效，是开颅性囊肿切除术治疗有症状的松果体囊肿相关性导尿管狭窄的有效微创替代方案。方法对16例有症状的松果体囊肿患者进行内镜手术治疗，并对这些病例进行回顾性检查。有12位女性和4位男性。手术时的中位年龄为31岁（3至62岁）。结果所有患者均表现出与颅内压升高一致的症状和影像学。中位最大囊肿直径为15毫米（范围为10毫米至27毫米）。在所有情况下，38％的病例对顶盖产生了质量效应，导致大脑水管消失，脑室肥大。15例患者接受了ETV。囊肿开窗术2例，其中1例也有ETV。81％的患者获得了症状缓解，中位随访时间为13个月。结论本研究表明，ETV对于有症状的松果体囊肿相关性导水管狭窄有效。患者可以有症状而没有明显的心室肥大，并且正常的心室容积并不妨碍安全的内镜治疗。如果存在Perinaud综合征或ETV不可行，建议进行内镜囊肿开窗术。81％的患者获得了症状缓解，中位随访时间为13个月。结论本研究表明，ETV可有效治疗有症状的松果体囊肿相关的导水管狭窄。患者可以有症状而没有明显的心室肥大，并且正常的心室容积并不妨碍安全的内镜治疗。如果存在Perinaud综合征或ETV不可行，建议进行内镜囊肿开窗术。81％的患者获得了症状缓解，中位随访时间为13个月。结论本研究表明，ETV可有效治疗有症状的松果体囊肿相关的导水管狭窄。患者可以有症状而没有明显的心室肥大，并且正常的心室容积并不妨碍安全的内镜治疗。如果存在Perinaud综合征或ETV不可行，建议进行内镜囊肿开窗术。