Neuroendoscopic biopsy of ventricular tumors: a multicentric experience

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Although neuroendoscopic biopsy is routinely performed, the safety and validity of this procedure has been studied only in small numbers of patients in single-center reports. The Section of Neuroendoscopy of the Italian Neurosurgical Society invited some of its members to review their own experience, gathering a sufficient number of cases for a wide analysis.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Retrospective data were collected by 7 centers routinely performing neuroendoscopic biopsies over a period of 10 years. Sixty patients with newly diagnosed intraventricular and paraventricular tumors were included. No patient harboring a colloid cyst was included. Data regarding clinical presentation, neuroimaging findings, operative techniques, pathological diagnosis, postoperative complications, and subsequent therapy were analyzed.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>In all patients, a neuroendoscopic tumor biopsy was performed. In 38 patients (64%), obstructive hydrocephalus was present. In addition to the tumor biopsy, 32 patients (53%) underwent endoscopic third ventriculostomy (ETV), and 7 (12%) underwent septum pellucidotomy. Only 2 patients required a ventriculoperitoneal shunt shortly after the endoscopy procedure because ETV was not feasible. The major complication due to the endoscopy procedure was ventricular hemorrhage noted on the postoperative images in 8 cases (13%). Only 2 patients were symptomatic and required medical therapy. Infection occurred in only 1 case, and the other complications were all reversible. In no case did clinically significant sequelae affect the patient's outcome. Tumor types ranged across the spectrum and included glioma (low- and high-grade [27%]), pure germinoma (15%), pineal parenchymal tumor (12%), primary neuroectodermal tumor (4%), lymphoma (9%), metastasis (4%), craniopharyngioma (6%), and other tumor types (13%). In 10% of patients, the pathological findings were inconclusive. According to diagnosis, specific therapy was performed in 35% of patients: 17% underwent microsurgical removal, and 18% underwent chemotherapy or radiotherapy.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>This is one of the largest series confirming the safety and validity of the neuroendoscopic biopsy procedure. Complications were relatively low (about 13%), and they were all reversible. Neuroendoscopic biopsy provided meaningful pathological data in 90% of patients, making subsequent tumor therapy feasible. Cerebrospinal fluid pathways can be restored by ETV or septum pellucidotomy (65%) to control intracranial hypertension. In light of the results obtained, a neuroendoscopic biopsy should be considered a possible alternative to the stereotactic biopsy in the diagnosis and treatment of ventricular or paraventricular tumors. Furthermore, it could be the only surgical procedure necessary for the treatment of selected tumors.</jats:p></jats:sec>

Combined rigid and flexible endoscopy for tumors in the posterior third ventricle

“…1C). 7,12,20,21 In the current paper, we present our experience using a combined rigid and flexible endoscopic procedure through a single bur hole for achieving a safer and ideal trajectory for an ETV, as well as an effective method for performing the EBX.…”

“…1B); 3,6,13,14,25,27 and 3) using a flexible endoscope through a single bur hole. 2,[8][9][10]20,23 The limitations of these options are a compromise for both the ETV and for the EBX when using a single bur hole and rigid endoscope, the need for 2 entry points and trajectories in the second option, and compromised visual quality and technical limitations using only a flexible endoscope. To overcome abbreviatioNs EBX = endoscopic biopsy; ETV = endoscopic third ventriculostomy; IVH = intraventricular hemorrhage.…”

“…Various techniques have been suggested to combine an ETV with an EBX, including 1) performing 1 bur hole, between both ideal entry points and using a rigid endoscope (Fig. 1A); 15,[20][21][22]26 2) performing 2 separate bur holes: one in an "ideal" location for an ETV and the second more anteriorly in an "ideal" location for a biopsy (Fig. 1B); 3,6,13,14,25,27 and 3) using a flexible endoscope through a single bur hole.…”

Comparison of Intracranial Neuroendoscopic Procedures in Children versus Adults

“…Neuroendoscopy in the field of neurooncology offers the advantages of improved visualization of intraventricular pathology, better management of tumor-related hydrocephalus, less morbid biopsies, and the allowance of minimally invasive removal of intraventricular tumors. 77,91 Certain characteristics make a tumor ideally suited for endoscopic biopsy or resection. 78 These include moderate to low vascularity, soft-consistency, tumors smaller than 2 cm in diameter, those associated with secondary hydrocephalus, those that are histologically low grade, and lesions situated in the lateral ventricle and pineal region.…”

Result of Endoscopic Third Ventriculostomy for Hydrocephalus Caused by Cerebral Aqueductal Stenosis in Infant Patients

“…[1][2][3] Endoscopic third ventriculostomy (ETV) is well accepted for obstructive hydrocephalus of various etiologies. [4][5][6][7][8][9][10] It is considered as a better alternative to shunt surgery in obstructive HCP. Though some authors advocate ETV in patients of all ages, [1][2][3]11 others showed that patients younger than 1 year have a higher failure rate for ETVs compared with older children.…”