Endoscopic Treatment for Deep-seated or Multiple Intraparenchymal Tumors: Technical Note

Abstract

Although endoscopic biopsy is a well-established technique in the treatment of intraventricular or cystic tumors, solid intraparenchymal tumors have not been considered candidates for this procedure. The purpose of this study is to describe strategies of neuroendoscopic treatment in patients with solid intraparenchymal tumors. Six patients with deep-seated or multiple intraparenchymal tumors underwent neuroendoscopic biopsy combined with frame-based or frameless stereotaxy during the one year period between October 2006 and September 2007. After histological diagnosis, all patients were treated with radiotherapy and chemotherapy or chemotherapy alone. Three patients were diagnosed histopathologically as having malignant glioma, and three with malignant lymphoma. A tumor was removed completely in one patient using an endoscopic procedure. Tumors disappeared in three patients with radiotherapy and chemotherapy after an endoscopic procedure. The growth of the tumor was controlled with therapy in one patient. Only in one patient was there a malignant transformation and growth of tumor was recognized in spite of therapy. Neuroendoscopic treatment may be a useful option in the management of deep-seated or multiple intraparenchymal tumors.

Navigation-Guided Endoscopic Biopsy for Intraparenchymal Brain Tumor

“…20) Recently, a few cases of intraparenchymal brain tumor biopsy or removal using neuroendoscopy with the navigation system (navigation-guided endoscopic biopsy) have been reported. 1,7,13,18) In our hospital, we have recently started using navigationguided endoscopic biopsy for intraparenchymal brain tumor diagnosis. Table 3) with navigation-guided endoscopic biopsy.…”

Fully endoscopic resection of intraaxial brain lesions using neuronavigated pediatric anoscope

“…In the endoscopic resection of deep-seated brain lesion, use of the tubular retractor combined with the neuronavigation system is essential (1,11,16,22,24,31). Using the tubular retractor along with the navigation probe enables the surgeon to effectively target smaller and deeper lesions via minimally invasive corridors (1,16,22) but this combination may be cumbersome for some of the tubular systems.…”

“…In the endoscopic resection of deep-seated brain lesion, use of the tubular retractor combined with the neuronavigation system is essential (1,11,16,22,24,31). Using the tubular retractor along with the navigation probe enables the surgeon to effectively target smaller and deeper lesions via minimally invasive corridors (1,16,22) but this combination may be cumbersome for some of the tubular systems. The combination of the tubular retractor system with the intraoperative navigation system offers several surgical benefits, which include small scalp incision, mini-craniotomy with limited dural and brain exposure, less blood loss, short surgical time, minimal postoperative analgesic requirement, and reduced hospital length of stay (1,2,7,9,10,16,22).…”

“…Endoscopic visualization and removal of intra-axial brain tumors using stereotactic guidance was first described in 1980 (32). Over the years, the technique has been improved and several groups have shown that the endoscopic resection of deep brain lesion using tubular retractor may have some advantages over traditional craniotomy (1,4,10,15,16,(20)(21)(22)(23)(24)(25)34). However, despite the success with the neuronavigationguided endoscopic approach, this technique never gained widespread acceptance.…”

Dual-port technique in navigation-guided endoscopic resection for intraparenchymal brain tumor

“…[1346–8] In tumor biopsy, the new method has some advantages over other biopsy procedures, including direct visualization of the lesion, larger sample volume without risk of bleeding, lesser invasiveness, and easy application in both shallow and deep lesions. [8] Furthermore, if the operator challenges the intensive removal of the lesion, single-port endoscopic surgery has a disadvantage of the operator's handling, due to the interference of surgical instruments, which often disturbs the easy resection and hemostasis procedures.…”