Interest and limits of endoscopic approaches for pineal region tumours

Chaussemy, Dominique; Cebulla, H.; Coca, Andrés; Chibarro, Salvatore; Proust, F.; Kehrli, P.

doi:10.1016/j.neuchi.2015.03.001

Cited by 10 publications

(6 citation statements)

References 13 publications

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“…Their surgical treatment can be realized with a microsurgical technic or with an endoscopic approach and the presence of hydrocephaly, in adults as in children can justify the use of endoscopic removal [42,43].…”

Section: Discussionmentioning

confidence: 99%

Results of the treatment of pineal tumors in children: the Lyon experience

Szathmari

Beuriat²,

Vasiljevic³

et al. 2022

Childs Nerv Syst

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Pineal tumors are rare and their incidence is of 1% among all pediatric tumors of the central nervous system. The survival depends on the histology, the extension of the surgical removal, the e cacy of the complementary treatment (chemotherapy and cranio-spinal irradiation) in relation with the age of the children.We report our experience in Lyon concerning 151 patients treated from 1997 to 2021. All patients were recorded in the French Register of Pineal tumors which is centralized in Lyon since 2010.The analysis shows that benign tumors have a good survival rate and a total surgical removal is manadatory. Concerning true pineal tumors, pinealoblastomas have a bad prognostic especially in children aged inferior to three years old. The new pathological classi cation allows a better strati cation with different groups identi ed and also the identi cation of a DICER 1 syndrome in family of patients with a pinealoblastoma that need medical investigations. Results of Germ Cell Tumors are more favorable with a global survival rate of 87 % and a rate of survival for pure germinomas of almost 97%.Results for gliomas of the pineal gland, that are tectal plate gliomas, are good for pilocytic astrocytomas while for other gliomas the prognosis is related to the grade of malignancy and the e cacy of complementary treatment. Papillary tumors need a complete removal for the best chance of survival.Finally, AT/TR still have a bad prognosis.Our results show that many progresses have to be accomplished for pineal region tumors and that these pathologies need a multidisciplinary approach to choose the best treatment to improve the survival rate and the patients' quality of life.Out 891 tumors 316 patients (33%) are children: 165 of the 316 patients (54%) have been treated in different French centers and 151(46%) have been treated in Lyon and are considered for this report.Results of the French register were already published in a previous paper. [6] Materials And Methods All pediatric patients that have been treated from January 1997 to December 2020 in Lyon in the Department of Pediatric Neurosurgery have been considered. All these patients are recorded in the French Register of Pineal Tumors. 151 patients were eligible for the study with an age between one years to eighteen years old. The sex ratio was of 1.2 males /Girl.The symptomatology was characterized in 54% by signs of intracranial hypertension with headaches and vomiting. Ophthalmological troubles were present in 21% of patients, endocrinological problems were associated in 5% of cases, while in others 18% of patients the clinical manifestations were characterized by more insidious manifestations as asthenia, tiredness and gradual lowering of scholar performances.All patients were studied with a cerebro-spinal MRI with and without Gadolinium with angio-MRI sequences to study arterial feeders and the venous structures. The CT-scan was realized in some patients performed in peripheral hospitals. We never realized angiography by the Seldinger technique for the surgical p...

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Section: Discussionmentioning

confidence: 99%

Results of the treatment of pineal tumors in children: the Lyon experience

Szathmari

Beuriat²,

Vasiljevic³

et al. 2022

Childs Nerv Syst

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“…EAM is used for procedures in which endoscopy is performed in addition to microsurgical manipulations under the operating microscope during the same operation (13,(30)(31)(32). The advantage of EAM is that it combines the strength of microsurgery via microscope and endoscope.…”

Section: Discussionmentioning

confidence: 99%

Endoscope-Assisted Microsurgery in Pediatric Cases With Pineal Region Tumors: A Study of 18 Cases Series

et al. 2021

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Background: An endoscope-assisted technique was recently introduced to microsurgery (MS) and may compensate for the disadvantages of MS for deep-seated lesions. This study was performed to identify the effectiveness and safety of endoscopic-assisted microsurgery (EAM) and share our experience of EAM for pediatric cases with pineal region tumors.Method: We retrospectively analyzed the clinical data of consecutive pediatric cases with pineal region tumors treated by EAM or MS from January 2016 to June 2020. These data included the patient population, clinical manifestations, preoperative examination findings, surgical approach, pathological results, and clinical outcomes. The clinical outcomes were analyzed in the EAM group and MS group with a focus on the gross total resection (GTR) rate, postoperative hydrocephalus remission rate, and Karnofsky performance score (KPS). Studies on the surgical management of children with pineal region tumors in the last decade were reviewed.Result: Eighteen children successfully underwent tumor resection via MS (n = 8) or EAM (n = 10). The children's mean age was 11.4 ± 4.7 years, and the male to female ratio was 7:2. Seventeen patients (94.4%) complicated preoperative hydrocephalus, and 16 (88.9%) presented headache with nausea and/or vomiting. The pathological examination revealed germ cell tumors in 11 (61.1%) patients, neuroepithelial tumors in 4 (22.2%) patients, and a pineoblastoma, arachnoid cyst, and atypical teratoid rhabdoid tumor in 1 (5.6%) patient each. GTR was more commonly achieved in the EAM than MS group (80.0 vs. 50.0%, respectively), and the postoperative hydrocephalus remission rate was higher in the EAM than MS group (87.5 vs. 50.0%, respectively). At a mean follow-up time of 23.6 ± 11.5 weeks, the mean improvement of the KPS 6 months postoperatively was greater in the EAM than MS group (24.0 ± 9.7 vs. 17.5 ± 7.1 points, respectively).Conclusion: EAM combines endoscopic and microsurgical techniques and can be safely and effectively performed to achieve GTR of pineal region tumors in pediatric patients. In children with pineal region tumors who have obstructive hydrocephalus, EAM could improves hydrocephalus remission rates by checking and clearing the midbrain aqueduct under visualization.

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“…Chaussemy et al [1] , engloba a los procedimientos endoscópicos de abordaje a la región pineal en transventriculares/transforaminales Figura 1: Resonancias preoperatorias. A) Axial con secuencia DWI que evidencia el patrón restrictivo de la lesión en el tercer ventrículo.…”

Section: Discussionunclassified

“…Dentro de la valoración preoperatoria se sugiere realizar ecocardiografía para descartar la presencia de foramen ovale permeable y a su vez realizar RMN de encéfalo con contraste para determinar característica del tumor y presencia de venas puentes entre el tentorio y el cerebelo [9] . Chaussemy et al [1] , determina que los tumores que podrán tener mejores posibilidades de resección significativa son aquellos menores a 2,5 cm de diámetro en caso de tumores duros y vascularizados y en el caso de tumores blandos, aspirables y poco vascularizados el tamaño tumoral no sería de gran importancia. Uschold et al [12] concluye que lesiones como el tumor epidermoide, teratomas, tumores germinales, gliomas de bajo grado y pineocitomas son las lesiones más pasibles de resección total endoscópica.…”

Section: Discussionunclassified

“…Se carece al momento de la revisión bibliográfica de este trabajo estudios descriptivos in vivo de estos corredores endoscópicos. Una de las probables limitaciones del estudio cadavérico de Zaidi es la falta de volemia dentro de la fosa posterior que en cierta forma podría limitar más dichas áreas de libertad quirúrgica Al momento de la exeresis de la lesión con esta novedosa técnica, la mayoría de los autores consideran que lo fundamental consiste en controlar la hemostasia paso por paso y realizar disección generosa mediante tracción constante con técnica bimanual [1,12] .…”

Section: Discussionunclassified

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Abordaje Puramente Endoscópico Supracerebeloso Infratentorial para Quiste Epidermoide en Tercer Ventrículo

Rubino

Aguilera

Campbell

et al. 2019

Surgical Neurology International

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Introducción: El Quiste Epidermoide como tumor de la región pineal es una patología infrecuente y poco descripta. Su prevalencia en el 3er ventrículo es de 0,0042% de los tumores primarios intracraneales. Para lograr la exeresis macroscópica total se utilizó el abordaje Supracerebeloso Infratentorial con Endoscopio rígido de Base de Cráneo, técnica descripta para abordaje de lesiones de la región pineal. El Objetivo del Trabajo es la presentación de la técnica quirúrgica del abordaje, con la resolución de la patología infrecuente que se presenta. Materiales y métodos: Paciente de 16 años de edad con antecedentes de DBT insípida y cefaleas crónicas intermitentes (m-RS 1). RMN de encéfalo evidencia lesión ocupante de espacio hiperintensa T2 e hipointensa en T1 con realce periférico y restricción en la difusión. Presenta refuerzo a nivel del tallo hipofisario. Se plantea diagnóstico de tumor germinal. Marcadores en LCR negativos. Se decide realizar abordaje puramente endoscópico de la región para toma de muestra. Congelación determina quiste epidermoide y se procede a realizar exeresis macroscópica total. Resultados: Se realizó exeresis macroscópica total de quiste de epidermoide en tercer ventrículo con abordaje supracerebeloso infratentorial a través de endoscópico rígido de base de cráneo, en paciente de 16 años, cursando postoperatorio tardío sin secuelas y mejoría sintomática con persistencia de DBT insípida (m-RS 1). Conclusión: El abordaje puramente endoscópico supracerebeloso infratentorial es una opción segura para el tratamiento quirúrgico de lesiones en el tercer ventrículo, en este caso, un quiste epidermoide.

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Interest and limits of endoscopic approaches for pineal region tumours

Cited by 10 publications

References 13 publications

Results of the treatment of pineal tumors in children: the Lyon experience

Results of the treatment of pineal tumors in children: the Lyon experience

Endoscope-Assisted Microsurgery in Pediatric Cases With Pineal Region Tumors: A Study of 18 Cases Series

Abordaje Puramente Endoscópico Supracerebeloso Infratentorial para Quiste Epidermoide en Tercer Ventrículo

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