Outcomes in patients undergoing single-trajectory endoscopic third ventriculostomy and endoscopic biopsy for midline tumors presenting with obstructive hydrocephalus

O’Brien, Donncha F.; Hayhurst, Caroline; Pizer, Barry; Mallucci, Conor

doi:10.3171/ped.2006.105.3.219

Cited by 77 publications

(82 citation statements)

References 21 publications

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“…1,7 On the other hand, others have not demonstrated any reduced rate of diagnosis using the flexible endoscopes. 2,10,18,20 safety Endoscopic biopsy poses a risk for hemorrhage. In 2 large series of 293 and 714 biopsies reporting on the hemorrhagic rate, the following results were noted.…”

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

Roth

Constantini

2015

JNS

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T umors leading to occlusion of the sylvian aqueduct include those of pineal, thalamic, and tectal origins. These tumors frequently cause obstructive hydrocephalus and thus necessitate a CSF diversion procedure, such as an endoscopic third ventriculostomy (ETV).The histopathological differential diagnosis of tumors leading to aqueductal occlusion includes germ cell tumors, ependymomas, and astrocytomas. As the treatment paradigm may change according to pathology (and grade), a tumor biopsy is often indicated. Thus, in many cases a dual procedure is recommended: an ETV combined with an endoscopic biopsy (EBX). 17The trajectory for an ETV is pointed more anteriorly than the optimal trajectory for an EBX of a posterior third ventricular tumor. 17 The foramen of Monro limits the trajectory both anteriorly (avoiding injury to the fornix) and posteriorly (avoiding injury to the venous angle and genu of the internal capsule). 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. 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. obJect Tumors leading to occlusion of the sylvian aqueduct include those of pineal, thalamic, and tectal origins. These tumors cause obstructive hydrocephalus and thus necessitate a CSF diversion procedure such as an endoscopic third ventriculostomy (ETV), often coupled with an endoscopic biopsy (EBX). Lesions located posterior to the massa intermedia pose a technical challenge, as the use of a rigid endoscope for performing both an ETV and EBX is limited. The authors describe their experience using a combined rigid and flexible endoscopic procedure through a single bur hole for both procedures in patients with posterior third ventricular tumors. methods Since January 2012, patients with posterior third ventricular tumors causing hydrocephalus underwent dual ETV and EBX procedures using the combined rigid-flexible endoscopic technique. Following institutional review board approval, data from clinical, radiological, surgical, and pathological records were retrospectively collected. results Six patients 3.5-53 years of age were included. Lesion locations included pineal (n = 3), fourth ventricle (n = 1), aqueduct (n = 1), and tectum (n = 1). The ETV and EBX were successful in all cases. Pathologies included pilocytic astrocytoma, pineoblastoma, ependymoma G...

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confidence: 99%

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

Roth

Constantini

2015

JNS

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“…25 Other smaller studies have reported conflicting information on the role of age, etiology, and other factors on the impact of success after ETV. 1,8,9,15,19 Kulkarni et al described multinational series; predictive strategies have been used to create success scores for various populations. 10,11,25 However, it remains to be seen if a national sample has similar ETV success compared with these site-specific studies.…”

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Pediatric endoscopic third ventriculostomy: a population-based study

Lam

Harris

Rocque

et al. 2014

PED

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Object Endoscopic third ventriculostomy (ETV) is an alternative to ventriculoperitoneal shunting for hydrocephalus treatment. Choice of treatment options raises questions about which patients are likely to benefit from ETV. The authors performed a population-based analysis using an administrative claims database, examining current practice and outcomes for pediatric patients in the US. Methods The authors queried the MarketScan (Truven Health Analytics) database for Current Procedural Terminology codes corresponding to ETV and ventriculoperitoneal shunting from 2003 to 2011; they included patients 19 years or younger and extracted data from initial and subsequent hospitalizations. Hydrocephalus etiology was classified with ICD-9-CM coding. ETV failure was defined as any subsequent ETV or shunt procedure. Results Five hundred one patients underwent ETV. Of these, 46% were female. The mean age was 8.7 ± 6.4 years (± SD). The mean follow-up was 1.9 ± 1.8 years. Etiology of hydrocephalus was primarily tumor (41.7%) and congenital/aqueductal stenosis (24.4%). ETV was successful in 354 patients (71%). The mean time to failure was 109.9 ± 233 days. Of the 147 patients with ETV failure, 35 (24%) underwent repeat ETV and 112 (76%) had shunt placement. Patients in age groups 0 to < 6 months and 6 months to < 1 year had a significantly higher rate of ETV failure than those 10–19 years (HR 2.9, p = 0.05; and HR 2.3, p = 0.001, respectively). History of prior shunt was associated with higher risk of failure (HR 2.5, p < 0.001). There were no significant associations between hydrocephalus etiology and risk of failure. A second wave of failures occurred at 2.5–3.5 years postoperative in tumor and congenital/aqueductal stenosis patients; this was not observed in other etiology groups. Conclusions This study represents a cross-section of nationwide ETV practice over 9 years. ETV success was more likely among children 1 year and older and those with no history of prior shunt.

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“…Así, la neuroendoscopia adquiere especial relevancia en las masas pineales, donde la heterogeneidad histológica es elevada (20-37% de tumores de células germinales, 22-27% de tumores del tejido pineal, 24-28% de gliomas y 12-32% de otras histologías) 2 ; en los niños donde la incidencia de tumores germinales es alta 21 y en las lesiones quísticas, que pueden ser aspiradas e, incluso, resecadas 1 . Adicionalmente, la endoscopia presenta la ventaja de posibilitar el tratamiento de la hidrocefalia asociada, presente en el 73.7% de nuestros casos y en aproximadamente el 90% de las lesiones intra-periventriculares referidas en la literatura 1,2,5,6,8,12,18,[21][22][23][24] , con un éxito terapéutico similar al descrito en la VPM para el tratamiento de la estenosis del acueducto de Silvio y que puede variar entre el 60-100% en función de la serie 2,14,18,23 . Además permite obtener muestras de LCR para citología y marcadores tumorales 6,12 e identificar diseminaciones radiológicamente no visibles 15 .…”

Section: Discussionunclassified

“…La publicación de la primera serie de endoscopias para biopsia de tumores intraventriculares la realiza Fukushima en 1978, con un éxito del 52 % en 21 pacientes 7 . Actualmente es una técnica efectiva en el manejo de los tumores ventriculares y de la hidrocefalia asociada, describiéndose diferentes variantes en cuanto a la localización del trépano, número de abordajes, tipo de endoscopio, indicación de septostomía y orden de la biopsia y de la ventriculostomía premamilar (VPM) 1,2,5,12,14,16,21,23,24 . Aportamos nuestra experiencia de los últimos 7 años en neuroendoscopia aplicada al manejo de lesiones expansivas intra y/o periventriculares, y comparamos los resultados con lo descrito en la literatura hasta el momento.…”

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Biopsia neuroendoscópica: Revisión de la literatura y experiencia en 31 pacientes

et al. 2011

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ResumenObjetivos. Presentar nuestra experiencia en el manejo endoscópico de tumores intraventriculares, analizando la efectividad diagnóstica de la biopsia, y comparar los resultados obtenidos con los datos publicados en la literatura.Material y métodos. Presentamos una serie de 31 pacientes con edades comprendidas entre los 7 meses y los 77 años, diagnosticados de proceso expansivo intra y/o periventricular, sólido y/o quístico, e intervenidos quirúrgicamente en nuestro servicio entre 2003 y 2010 para la realización de una biopsia neuroendoscópica. Analizamos la técnica utilizada, el resultado anatomopatológico obtenido, el manejo de la hidrocefalia asociada, la frecuencia de complicaciones del procedimiento y la actitud terapéutica posterior.Resultados. Se realizaron 32 procedimientos neuroendoscópicos, obteniéndose muestra para biopsia en 28 de ellos, con resultado positivo en 25 (78% de éxito por procedimiento y 89% de éxito por biopsia). El diagnóstico histológico más frecuente fue de astrocitoma grado II. 30 pacientes presentaban hidrocefalia asociada practicándose una ventriculostomía premamilar (VPM) en 19 casos (éxito en 14 casos, un 73.7%); además, se realizó una septostomía en 12 pacientes (en 3 casos asociada a VPM y en 9 casos seguida de derivación ventrículo-peritoneal). En 3 casos el procedimiento endoscópico fue asistido con neuronavegación. Durante la cirugía y el postoperatorio se contabilizaron las siguientes complicaciones: hemorragia intraventricular en cuatro pacientes (en dos casos se produjo éxitus), crisis comiciales en dos pacientes, focalidad neurológica en tres casos (signo de Parinaud, paresia transitoria del III par craneal y hemiparesia asociada a parálisis del III par), y fístula de líquido cefalorraquídeo con infección meníngea en un caso. 19 pacientes recibieron tratamiento posterior (quirúrgico en 1 caso, radiocirugía estereotáxica en 2 casos, radioterapia en 8 casos, quimioterapia en 5 casos y quimio-radioterapia en 3 casos).Conclusiones. El abordaje endoscópico de las lesiones intra y/o periventriculares presenta un alto rendimiento diagnóstico, permitiendo además en muchos casos tratar la hidrocefalia asociada con un único procedimiento, por lo que podría ser el tratamiento de elección en lesiones consideradas no resecables. Aunque no está exento de complicaciones graves, la morbimortalidad podría ser inferior a la de los abordajes microquirúrgicos convencionales.

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Outcomes in patients undergoing single-trajectory endoscopic third ventriculostomy and endoscopic biopsy for midline tumors presenting with obstructive hydrocephalus

Cited by 77 publications

References 21 publications

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

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

Pediatric endoscopic third ventriculostomy: a population-based study

Biopsia neuroendoscópica: Revisión de la literatura y experiencia en 31 pacientes

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