Evolving instrumentation for endoscopic tumour removal of CNS tumours

Selvanathan, Senthil; Kumar, Ramesh; Goodden, John; Tyagi, Atul; Chumas, Paul

doi:10.1007/s00701-012-1561-4

Cited by 22 publications

(33 citation statements)

References 4 publications

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“…Even though objective data regarding the overall benefits of these devices are lacking, the surgeons who use the devices describe them as useful. 10,12,15 The first experience with ultrasonic aspiration in neuroendoscopy was reported by Oertel et al in 2008. 13 The accuracy and reliability of tissue aspiration, issues with visibility, and the application of suction were tested in cadaveric porcine brains.…”

Section: Discussionmentioning

confidence: 99%

“…Selvanathan et al 15 described the first case of solid tumor removed using an ultrasonic aspirator. It was a small tumor inside the aqueduct (low-grade glioneuronal tumor).…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge after a search of the literature, intraventricular tumor resection using an ultrasonic aspirator via an endoscopic channel has been reported only once, in an adult patient. 15 This tool has the potential to expand the spectrum of intracranial pathologies treatable by modern neuroendoscopic means.…”

mentioning

confidence: 99%

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Initial experience with endoscopic ultrasonic aspirator in purely neuroendoscopic removal of intraventricular tumors

Cinalli¹,

Imperato²,

Mirone³

et al. 2017

PED

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OBJECTIVE Neuroendoscopic removal of intraventricular tumors is difficult and time consuming because of the lack of an effective decompression system that can be used through the working channel of the endoscope. The authors report on the utilization of an endoscopic ultrasonic aspirator in the resection of intraventricular tumors. METHODS Twelve pediatric patients (10 male, 2 female), ages 1–15 years old, underwent surgery via a purely endoscopic approach using a Gaab rigid endoscope and endoscopic ultrasonic aspirator. Two patients presented with intraventricular metastases from high-grade tumors (medulloblastoma, atypical teratoid rhabdoid tumor), 2 with subependymal giant cell astrocytomas (associated with tuberous sclerosis), 2 with low-grade intraparaventricular tumors, 4 with suprasellar tumors (2 craniopharyngiomas and 2 optic pathway gliomas), and 2 with pineal tumors (1 immature teratoma, 1 pineal anlage tumor). Hydrocephalus was present in 5 cases. In all patients, the endoscopic trajectory and ventricular access were guided by electromagnetic neuronavigation. Nine patients underwent surgery via a precoronal bur hole while supine. In 2 cases, surgery was performed through a frontal bur hole at the level of the hairline. One patient underwent surgery via a posterior parietal approach to the trigone while in a lateral position. The endoscopic technique consisted of visualization of the tumor, ventricular washing to dilate the ventricles and to control bleeding, obtaining a tumor specimen with biopsy forceps, and ultrasonic aspiration of the tumor. Bleeding was controlled with irrigation, monopolar coagulation, and a thulium laser. RESULTS In 7 cases, the resection was total or near total (more than 90% of lesion removed). In 5 cases, the resection was partial. Histological evaluation of the collected material (withdrawn using biopsy forceps and aspirated with an ultrasonic aspirator) was diagnostic in all cases. The duration of surgery ranged from 30 to 120 minutes. One case was complicated by subdural hygroma requiring a subduro-peritoneal shunt implant. CONCLUSIONS In this preliminary series, endoscopic ultrasonic aspiration proved to be a safe and reliable method for achieving extensive decompression or complete removal in the management of intra- and/or paraventricular lesions in pediatric patients.

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Section: Discussionmentioning

confidence: 99%

“…Selvanathan et al 15 described the first case of solid tumor removed using an ultrasonic aspirator. It was a small tumor inside the aqueduct (low-grade glioneuronal tumor).…”

Section: Discussionmentioning

confidence: 99%

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Initial experience with endoscopic ultrasonic aspirator in purely neuroendoscopic removal of intraventricular tumors

Cinalli¹,

Imperato²,

Mirone³

et al. 2017

PED

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“…8,10 The risk of CSF seeding of the tumor has never been proved to be higher with endoscopic approaches than with the microsurgical ones.…”

Section: Discussionmentioning

confidence: 99%

Purely endoscopic resection of a choroid plexus papilloma of the third ventricle: case report

Santos¹,

Souweidane²

2015

PED

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The authors report an illustrative case of a purely endoscopic surgical approach to successfully remove a solid choroid plexus papilloma of the third ventricle in an infant. A 10-week-old male infant first presented with transient episodes of forced downward gaze, divergent macrocephaly, a tense anterior fontanel, diastasis of the cranial sutures, and papilledema. Brain MRI revealed a small, multilobulated contrast-enhancing mass situated within the posterior third ventricle, with resultant obstructive hydrocephalus. A purely endoscopic removal of the tumor was performed through a single right frontal bur hole. Intraoperatively, a unique vascular tributary was recognized coming from the tela choroidea and was controlled with coagulation and sharp dissection. Postoperative MRI confirmed complete tumor removal, and the tumor was classified as a choroid plexus papilloma. There has been no evidence of tumor recurrence over 42 months of follow-up. With this case report the authors intended to show that endoscopic surgery can be an additional tool to consider when planning a choroid plexus tumor approach. It seems to be of particular interest in selected cases in which there are concerns about the patient's total blood volume, as in infants with potential hemorrhagic tumors and when it is possible to preoperatively identify a single vascular pedicle that can be approached early in the surgery.

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“…Other aqueductal pathologies include heterotopias [35], pilocytic astrocytomas [12,13] [21], glioneuronal tumors (WHO I) [14,26], and medulloblastomas [21].…”

Section: Pathologymentioning

confidence: 99%

True aqueductal tumors: a unique entity

et al. 2014

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ATs are a rare entities that usually present with obstructive hydrocephalus. Treatment includes primarily cerebrospinal fluid drainage (preferably via an endoscopic third ventriculostomy). Simultaneous endoscopic biopsy may be done in selected cases. Tumor resection should be reserved for growing tumors; the trans-fourth ventricular or trans-choroidal approaches are probably safer than other approaches used to reach the tectal region.

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Evolving instrumentation for endoscopic tumour removal of CNS tumours

Cited by 22 publications

References 4 publications

Initial experience with endoscopic ultrasonic aspirator in purely neuroendoscopic removal of intraventricular tumors

Initial experience with endoscopic ultrasonic aspirator in purely neuroendoscopic removal of intraventricular tumors

Purely endoscopic resection of a choroid plexus papilloma of the third ventricle: case report

True aqueductal tumors: a unique entity

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