Endoscopic Third Ventriculostomy is the Treatment of Choice for Obstructive Hydrocephalus Due to Pediatric Pineal Tumors

Abstract

Pineal lesions in the pediatric patient are often complicated by the development of hydrocephalus due to obstruction of the aqueduct or the third ventricle by tumor masses. In such cases, hydrocephalus treatment has the highest priority and should be performed prior to any surgical treatment of the pineal tumor itself. The golden standard in obstructive hydrocephalus treatment remains placement of a temporary or permanent cerebrospinal fluid shunt, although there are many long-term complications associated with a shunt system. To avoid these and to render the patients independent from a failure-prone shunt system, we employed endoscopic third ventriculostomy for permanent relief of elevated intracranial pressure prior to surgical removal of the pineal lesions. The present study summarizes the results of this approach in 7 pediatric patients with obstructive hydrocephalus. No complications of the endoscopic procedure were encountered, and the ventriculostomy remained patent in all cases, as confirmed by motion sensitive MRI. The advantages of endoscopic third ventriculostomy as compared with other techniques are discussed, and its increasing role in the management of children with space occupying lesions of the pineal region is defined.

Endoscopic Third Ventriculostomy for Hydrocephalus Secondary to Central Nervous System Infection or Intraventricular Hemorrhage in Children

“…Although ETV has emerged as the preferred treatment for obstructive hydrocephalus from etiologies such as aqueductal stenosis [2, 4, 5, 7, 8, 9, 10, 11, 12], tectal plate gliomas [3, 6, 13]and fourth ventricular outflow obstruction [20], relatively few studies have addressed its utility in patients with posthemorrhagic and postinfectious hydrocephalus. This likely reflects the traditional concept that these processes cause hydrocephalus from distal obstruction of CSF reabsorption at the level of the arachnoid granulations.…”

“…The application of neuroendoscopic techniques to Dandy’s original third ventriculocisternostomy procedure [1]has led to the evolution of endoscopic third ventriculocisternostomy (ETV) as the treatment of choice for obstructive hydrocephalus from causes such as aqueductal stenosis or tectal gliomas [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13]. ETV has also begun to emerge during the past decade as an option for treating hydrocephalus from other etiologies, such as fourth ventricular outflow obstruction, intraventricular or subarachnoid hemorrhage or infections [14, 15].…”

Current state and future development of intracranial neuroendoscopic surgery

“…This is a particular case where the steerable fiberscope could be useful. Good results have been achieved to control hydrocephalus in case of pineal region tumors by several authors [45,76,77]. A concern with endoscopic biopsy is sampling error; a multicentric study to confirm the effectiveness of endoscopic biopsies of intraventricular tumors is in progress.…”

Advances and Technical Standards in Neurosurgery

“…nih.gov) either alone or in combination with other gene therapy strategies. Even though promising results regarding HSV-tk/ganciclovir therapy have been obtained in human trials using adenoviral vectors (Immonen, 2004) there have been also failures regarding therapeutic e‰cacy of HSV-tk/ ganciclovir therapy when a retroviral vector was used for gene transfer (Rainov, 2000, Shand, 1999.…”

“…In these cases, Sylvian aqueduct obstruction is generally the result of a distortion of the whole mesencephalon from outside by part of the tumor (Rieger et al 2000). Vascular malformations are a rare cause of secondary Sylvian aqueduct obstruction; abnormal draining veins of midbrain arteriovenous malformations may obstruct the CSF flow crossing the aqueduct so as large fusiform aneurysms of the basilar artery.…”