Purely neuroendoscopic resection of intraventricular tumors with an endoscopic ultrasonic aspirator

Abstract

Surgery for intraventricular tumors remains a controversial and evolving field, with endoscopic resection becoming more popular. We present a series of nine consecutive cases of purely endoscopic resection of intraventricular tumors with the aid of an ultrasonic aspirator specific for neuroendoscopy. Nine patients (five men, four women) aged 18-74 years (mean 43.7) underwent surgery. The most common symptom was headache. In all cases, magnetic resonance imaging showed single supratentorial intraventricular lesions (five lateral ventricle, four third ventricle). The average maximum diameter was 20.5 mm (range 11-42). Associated hydrocephalus was found in eight cases at diagnosis. Five patients underwent complete macroscopic resection. Three underwent subtotal resection and one underwent partial resection (two thirds of the tumor). The mean endoscopic procedure time was 70 min (37-209). The eight patients with associated hydrocephalus also underwent endoscopic septostomy to improve cerebral spinal fluid circulation, with one patient additionally requiring endoscopic third ventriculostomy and another requiring Monro foraminoplasty. One patient required ventriculoperitoneal shunting. The mean post-operative follow-up was 15.1 months (range 2-33). At the time of analysis, no patient showed recurrence or regrowth of the operated lesion. The histological diagnoses and degree of resection were three subependymomas with complete resection, three colloid cysts with two complete and one subtotal resection, one pilocytic astrocytoma with partial resection (approximately two thirds of the lesion), one epidermoid tumor with subtotal resection, and one central neurocytoma with subtotal resection. The endoscopic ultrasonic surgical aspirator can be a safe and effective tool for the removal of intraventricular tumors, even in firmer solid lesions.

Endoscopic and Endoscopically-Assisted Resection of Intraventricular Lesions Using a Neuroendoscopic Ultrasonic Aspirator

“…The average size of lesions operated with the use of NUA reported in the literature is 20.6 ± 9.7 mm (range 11-42 mm) [4]. In our series, the average size was higher with a mean of 24.1 ± 12.9 mm (range 9-45 mm).…”

“…Intra-and postoperative complication rates of the PE NUA approach are reported between 0% and 66.7% [2][3][4]. In the series from Cinalli et al, a complication rate of 8.3% is reported [3].…”

“…Selvanathan et al first described the use of NUA for neuroendoscopic resection of a solid low-grade glioneuronal tumor, located within the aqueduct. Subsequently, in the two largest case series, a total of 21 lesions were removed with a PE approach by utilizing the NUA [3,4]. The most frequent lesions were colloid cysts (n = 3, 14.3%), pilocytic astrocytoma (n = 3, 14.3%), subependymoma (n = 3, 14.3%), followed by SEGA (n = 2, 9.5%), low-grade glioneuronal tumor (n = 2, 9.5%), craniopharyngioma (n = 2, 9.5%), medulloblastoma (n = 1, 4.8%), epidermoid tumor (n = 1, 4.8%), central neurocytoma (n = 1, 4.8%), pineal anlage tumor (n = 1, 4.8%), atypical teratoid rhabdoid tumor (n = 1, 4.8%), and immature teratoma (n = 1, 4.8%) [3,4].…”

“…Subsequently, in the two largest case series, a total of 21 lesions were removed with a PE approach by utilizing the NUA [3,4]. The most frequent lesions were colloid cysts (n = 3, 14.3%), pilocytic astrocytoma (n = 3, 14.3%), subependymoma (n = 3, 14.3%), followed by SEGA (n = 2, 9.5%), low-grade glioneuronal tumor (n = 2, 9.5%), craniopharyngioma (n = 2, 9.5%), medulloblastoma (n = 1, 4.8%), epidermoid tumor (n = 1, 4.8%), central neurocytoma (n = 1, 4.8%), pineal anlage tumor (n = 1, 4.8%), atypical teratoid rhabdoid tumor (n = 1, 4.8%), and immature teratoma (n = 1, 4.8%) [3,4]. In general, based on the current literature, the NUA is recommended for the removal of soft lesions with poor vascularization and a size of less than 2-3 cm [3,4,16,17].…”

“…In 2008, the use of an NUA was described for the first time [2]. Since then, only few studies describing the use of the NUA have been published, pointing at the limited experience available and reported in this field [2][3][4][5][6][7]. This study aims to describe our experience of the purely endoscopic and endoscopically assisted resection of lesions using NUA.…”