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Otero-Fernández P, Abarca-Olivas J, González-López P, Martorell-Llobregat C, Flores-Justa A, Villena-Martín M, Nieto-Navarro J. Endoscopic approaches to the posterior wall of the third ventricle: An anatomical comparison. Clin Neurol Neurosurg 2024; 245:108511. [PMID: 39180812 DOI: 10.1016/j.clineuro.2024.108511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 08/27/2024]
Abstract
INTRODUCTION Surgery of lesions in the posterior wall of the third ventricle requires great expertise due to its deep location and important surrounding structures. This region has been traditionally reached through a supracerebellar infratentorial approach, but new options have emerged, especially with the development of neuroendoscopy. METHODS One formalin-fixed cadaver human head was dissected. Five different endoscopic approaches were performed: interhemispheric transcallosal transchoroidal, frontal transforaminal transchoroidal, supraorbital subfrontal translamina terminalis, expanded endonasal, and supracerebellar infratentorial. An anatomical description of the different approaches was conducted and quantitative measurements (craniocaudal and latero-lateral distances) were taken using the StealthStation ® workstation after performing a CT scan of the specimen. RESULTS The interhemispheric transcallosal transchoroidal, frontal transforaminal transchoroidal, and supraorbital subfrontal translamina terminalis approaches provided great view of all the structures of the posterior wall of the third ventricle. Maximum craniocaudal distance was obtained through the supraorbital subfrontal translamina terminalis approach (10.6 mm), with great difference from the expanded endonasal approach (5.2 mm). The widest latero-lateral distance from inside the third ventricle was achieved through the interhemispheric transcallosal transchoroidal approach (4.6 mm), similar to the expanded endonasal (4.1 mm), and differing from the supraorbital subfrontal translamina terminalis (2.4 mm). CONCLUSIONS The endoscopic approaches provided an adequate alternative to more traditional microsurgical approaches to the posterior wall of the third ventricle, with a great view of all its structures. The selection of the approach must be taken under consideration in each case.
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Affiliation(s)
- Paula Otero-Fernández
- Department of Neurosurgery, Ciudad Real General University Hospital, Ciudad Real, Spain; University of Alcalá, Alcalá de Henares, Madrid, Spain.
| | - Javier Abarca-Olivas
- Department of Neurosurgery, Alicante General University Hospital, Alicante, Spain
| | - Pablo González-López
- Department of Neurosurgery, Alicante General University Hospital, Alicante, Spain
| | | | - Ana Flores-Justa
- Department of Neurosurgery, Alicante General University Hospital, Alicante, Spain
| | - Maikal Villena-Martín
- Department of Neurosurgery, Ciudad Real General University Hospital, Ciudad Real, Spain
| | - Juan Nieto-Navarro
- Department of Neurosurgery, Alicante General University Hospital, Alicante, Spain
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Vignolles-Jeong J, Finger G, Magill ST, McGahan BG, Wu KC, Godil S, Prevedello DM. Supraorbital Eyebrow Approach for Translamina Terminalis Resection of Third Ventricle Metastasis: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 27:252-253. [PMID: 38376162 DOI: 10.1227/ons.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/08/2024] [Indexed: 02/21/2024] Open
Abstract
Tumors involving the third ventricle are rare, accounting for 0.6%–0.9% of all brain tumors. This deep-seated cavity is surrounded by critical neurovascular structures, making safe surgical resection of lesions in this region challenging. Traditionally, tumors of the third ventricle have been approached through a craniotomy and microsurgical resection.
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The supraorbital keyhole approach is a minimally invasive technique that can be used with minimal retraction of the brain and limited craniotomy while establishing a surgical field comparable with what can be achieved using traditional transcranial approaches. In this video, we describe the case of a 54-year-old man who underwent a supraorbital eyebrow approach for translamina terminalis resection of papillary thyroid carcinoma metastasis to the third ventricle. A gross total resection was achieved. The results achieved in our series are comparable with previously published reports of patients who underwent surgical resection of metastatic lesions involving the third ventricle.
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The patient consented to the procedure and to the publication of his image.
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Affiliation(s)
- Joshua Vignolles-Jeong
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus , Ohio , USA
| | - Guilherme Finger
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus , Ohio , USA
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University, Chicago , Illinois , USA
| | - Ben G McGahan
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus , Ohio , USA
| | - Kyle C Wu
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus , Ohio , USA
| | - Saniya Godil
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus , Ohio , USA
| | - Daniel M Prevedello
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus , Ohio , USA
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Serrano Sponton L, Alhoobi M, Archavlis E, Shaaban AT, Dumour E, Nimer A, Conrad J, Kantelhardt SR, Ayyad A. Endoscopic-assisted paramedian supracerebellar infratentorial approach to the posterior portion of the third ventricle: anatomical study and surgical cases. J Neurosurg Sci 2024; 68:390-402. [PMID: 35416454 DOI: 10.23736/s0390-5616.22.05622-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To date, morphometrical data providing a systematic quantification of accessibility and operability parameters to the boundaries of the posterior portion of the third ventricle (PTV) when applying an endoscopic-assisted paramedian supracerebellar infratentorial approach (EPSIA) are lacking. We performed an anatomical study and complemented our findings with surgical cases. METHODS Eight EPSIAs towards the PTV were performed in cadaveric specimens. Optimal approach angles (OA), surgical freedom (SF) and operability indexes (Oi) to the PTV boundaries were assessed. Additionally, a 54-year-old man and 33-year-old woman were operated on PTV tumors applying the EPSIA. RESULTS Sagittal OA to ventricle's roof and floor was 36±1.4° and 25.5±3.5° respectively, axial OA to the ipsilateral and contralateral ventricle's wall were 9.5±1.3° and 28.5±1.6°. SF was maximal on the contralateral wall (121.2±19.3mm2), followed by the roof (112.7±18.8mm2), floor (106.6±19.2mm2) and ipsilateral wall (94.1±15.7mm2). SF was significantly lower along the ipsilateral compared the contralateral wall (P<0.01) and roof (P<0.05). Facilitated surgical maneuvers with multiangled exposure were possible up to 8.5±1.07mm anterior to ventricle's entrance, whereas surgical maneuvers were possible but difficult up to 15.25±3.7mm. Visualization of more anterior was possible up to a distance of 27±2.9mm, but surgical maneuvers were barely feasible. EPSIA enabled successful resection of both PTV tumors and postoperative course was uneventful. CONCLUSIONS EPSIA can be effective for approaching the PTV, enabling surgery along all boundaries, but especially on its roof and contralateral wall. In the not-enlarged ventricle, surgical maneuvers are feasible up to the level of the Monro foramen, becoming more limited anteriorly.
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Affiliation(s)
- Lucas Serrano Sponton
- Department of Neurosurgery, Sana Klinikum Offenbach, Offenbach am Main, Germany -
- Department of Neurosurgery, Mainz University Medical Center, Mainz, Germany -
| | - Mohammed Alhoobi
- Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Ahmed T Shaaban
- Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar
| | - Elias Dumour
- Department of Neurosurgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Amr Nimer
- Department of Neurosurgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jens Conrad
- Department of Neurosurgery, Mainz University Medical Center, Mainz, Germany
| | - Sven R Kantelhardt
- Department of Neurosurgery, Mainz University Medical Center, Mainz, Germany
| | - Ali Ayyad
- Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar
- Department of Neurosurgery, Saarland University Medical Center, Homburg, Germany
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Mishra S, Mishra S, Regmi S, Katiyar V, Verma S, Satyarthee GD, Garg K, Mishra S, Sharma MC, Singh M, Kale SS. Comparative Analysis of Supratentorial Intraventricular Tumors in Adults and Pediatrics in a Developing Country: Clinicopathological Features, Surgical Management, and Outcomes. Neuropediatrics 2024. [PMID: 39074800 DOI: 10.1055/s-0044-1788661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
BACKGROUND Supratentorial intraventricular tumors, encompassing lateral and third ventricular tumors, are uncommon intracranial neoplasms, typically slow-growing and benign, manifesting symptoms only upon reaching a substantial size. This study aims to identify optimal surgical approaches, assess the prevalence and characteristics of these tumors, and evaluate postoperative outcomes among pediatric and adult age groups. METHODS A retrospective comparative study at a tertiary care hospital from January 2014 to June 2020 included 165 patients (68 pediatrics, 97 adults) meeting inclusion criteria for intraventricular tumor management. Data covered demographic factors, clinical history, neurological assessments, neuroimaging, surgical approaches, histopathological diagnoses, immunohistochemical features, adjuvant therapies, follow-up status, postoperative complications, and morbidity/mortality. RESULTS Ventricular tumor incidence showed male preponderance in both adults (M:F = 1.2:1) and pediatrics (M:F = 3:1). Lateral ventricles were the most common location. Pediatric cases exhibited more frequent calcifications on computed tomography scans (35.6% vs. 29.5%). Grade II and III tumors were more prevalent in adults within the lateral ventricle (27.1 and 1.9%) compared with pediatrics (6.5 and 8.4%). The third ventricle predominantly featured benign lesions, with pediatric patients experiencing significantly longer hospital stays (16.12 ± 21.94 days vs. 9.58 ± 6.21 days) (p = 0.006). Adults and pediatric patients showed a significant difference in high-grade lateral ventricle tumors (p-value = 0.002*). CONCLUSIONS Supratentorial ventricular tumors are relatively more prevalent in children than adults, presenting challenges due to size and bleeding risks. Surgical resection is the primary treatment, with a focus on the optimal approach for gross total excision to reduce recurrence risk.
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Affiliation(s)
- Sandeep Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
- Department of Neurosurgery and Neurointervention, Neo Multispeciality Hospital, Noida, Uttar Pradesh, India
| | - Saurav Mishra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sabina Regmi
- Department of Anaesthesia and Intensive Care, Neo Multispeciality Hospital, Noida, Uttar Pradesh, India
| | - Varidh Katiyar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Satish Verma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Guru Dutt Satyarthee
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - M C Sharma
- Department of Neuropathology, All India Institute of Medical Sciences, New Delhi, India
| | - ManMohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Sadeh M, Abou-Mrad T, Theiss P, Hage Z, Charbel FT. Transcallosal Retroforniceal Transchoroidal Approach: To the Posterior Third Ventricle and Beyond. World Neurosurg 2024; 190:255-259. [PMID: 39038645 DOI: 10.1016/j.wneu.2024.07.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/11/2024] [Accepted: 07/12/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND The transcallosal retroforniceal transchoroidal approach represents an advanced neurosurgical technique that allows access to lesions located within the posterior third ventricle and mesencephalon. It relies on a comprehensive understanding of microsurgical anatomy and embryology, integrating modern neurosurgical operative techniques to minimize retraction and injury to the normal neuronal structures. METHODS We report the cases of 2 patients undergoing treatment via this approach, one presenting with a thalamic cavernoma and the other with cystic low-grade glioma of the midbrain. RESULTS In these 2 cases, the decision to use the transcallosal approach was mainly due to improved trajectory, gravitational retraction of the hemisphere, and improved delivery of the lesion into the operative field by gravity alone. CONCLUSIONS Through a detailed description of the surgical approach and anatomy, we illustrate the feasibility of the transcallosal retroforniceal transchoroidal approach for accessing lesions located deeply in the brain.
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Affiliation(s)
- Morteza Sadeh
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Tatiana Abou-Mrad
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Peter Theiss
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ziad Hage
- Department of Neurosurgery, Novant Health Greater Charlotte Market, Charlotte, North Carolina, USA; Department of Surgery, Campbell University School of Osteopathic Medicine, Charlotte, North Carolina, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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Atallah O, Chaurasia B, Badary A, Maria LD, Almealawy YF, Awuah WA, Moustafa W, Ergen A, Fontanella MM. Pineal Apoplexy: Highlighting the Causes, Treatment, and Outcome. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 38788759 DOI: 10.1055/s-0044-1786538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
BACKGROUND Pineal apoplexy, alternatively referred to as pineal hemorrhage or pineal gland hemorrhagic stroke, is an infrequent pathologic condition characterized by bleeding within the pineal gland. In this review, we encompass the primary factors contributing to this uncommon ailment. METHODS The retrieval of pertinent research, including patients with pineal apoplexy, was conducted through PubMed, Google Scholar, and Scopus databases. This study exclusively incorporated comprehensive articles written in the English language. The search encompassed the MeSH terms "pineal apoplexy" and "pineal hemorrhage." RESULTS A total of 41 articles were identified, encompassing a collective sample size of 57 patients. The median age of the patients in the study was 30 years, with a range spanning from 1 to 73 years. There were 27 males, representing 47.4% of the participants. The study identified the most often reported symptoms as headache (49; 86%), nausea/vomiting (19; 33.3%), and Parinaud's syndrome (16; 28.1%). The treatment options encompass several approaches, including open resection, shunting, ventriculostomy, endoscopic aspiration, and conservative care. In the conducted study, a notable number of patients, amounting to 45 cases (78.9%), indicated an amelioration of their symptoms upon their discharge. CONCLUSION Data from a cohort of 57 cases provide insights into symptoms, lesions, treatments, and outcomes. Management approaches range from conservative measures to surgical interventions, with prognosis hinged on timely intervention. This investigation serves as a valuable resource for clinicians and researchers, underscoring the need for early diagnosis before permanent neurologic dysfunction happens and tailored treatments for optimal outcomes in pineal apoplexy cases.
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Affiliation(s)
- Oday Atallah
- Departemnt of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| | - Amr Badary
- Departemnt of Neurosurgery, Klinikum Dessau, Dessau-Roßlau, Germany
| | - Lucio De Maria
- Unit of Neurosurgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
- Department of Neurosurgery, University of Brescia, Brescia, Italy
| | | | | | - Wahab Moustafa
- Departemnt of Neurosurgery, Klinikum Dessau, Dessau-Roßlau, Germany
| | - Anil Ergen
- Department of Neurosurgery, Derince Research Hospital, Kocaeli, Turkey
| | - Marco Maria Fontanella
- Unit of Neurosurgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
- Department of Neurosurgery, University of Brescia, Brescia, Italy
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Deopujari C, Shroff K, Malineni S, Shaikh S, Mohanty C, Karmarkar V, Mittal A. Intraventricular Tumors: Surgical Considerations in Lateral and Third Ventricular Tumors. Adv Tech Stand Neurosurg 2024; 50:63-118. [PMID: 38592528 DOI: 10.1007/978-3-031-53578-9_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Management of lateral and third ventricular tumors has been a challenge for neurosurgeons. Advances in imaging and pathology have helped in a better understanding of the treatment options. Technical refinement of microsurgical technique and addition of endoscopy has enabled more radical excision of tumors, when indicated, and added more safety.A proper understanding of the pathology at various ages and treatment options is continuously evolving. Many pediatric tumors are amenable to conservative surgical methods with effective complementary treatments. However, radical surgery is required in many adults as the main treatment and for many benign tumors. Various intraventricular lesions encountered and their surgical management is reviewed here for their efficacy, safety, and outcome, encompassing changes in our practice over the last 20 years.
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Affiliation(s)
- Chandrashekhar Deopujari
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - Krishna Shroff
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - Suhas Malineni
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
| | | | - Chandan Mohanty
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - Vikram Karmarkar
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - Amol Mittal
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
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Pitskhelauri DI, Grachev NS, Kudieva ES, Sanikidze AZ. [Microsurgical ventriculostomy of the third ventricle with access through a burrhole in the treatment of midly located deep-seated brain tumors]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2024; 88:5-13. [PMID: 38549405 DOI: 10.17116/neiro2024880215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Currently, endoscopic third ventriculostomy and simultaneous biopsy of deep midline brain tumors are a generally accepted option in neurooncology. Nevertheless, effectiveness of this surgery and diagnostic accuracy of biopsy are not without drawbacks. An alternative to endoscopic surgery may be simultaneous microsurgical third ventriculostomy and biopsy of deep midline tumors. OBJECTIVE To evaluate effectiveness and safety of burr hole microsurgical third ventriculostomy in the treatment of deep midline brain tumors. MATERIAL AND METHODS We used transcortical (25 cases) and transcallosal (8 cases) approaches for microsurgical third ventriculostomy. RESULTS Initially scheduled biopsy was performed in 19 cases, partial resection in 6 cases, subtotal resection in 4 cases and total resection in 4 cases. All patients underwent microsurgical third ventriculostomy. In 12 cases, stenting of stoma was performed in addition to ventriculostomy. Biopsy was informative in all cases. Postoperative follow-up period ranged from 3 to 44 months (mean 29 months). There was no postoperative hydrocephalus and need for shunting procedure. CONCLUSION Burr hole microsurgery may be an alternative to endoscopic surgery for the treatment of pineal, periaqueductal and third ventricular tumors.
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Affiliation(s)
| | - N S Grachev
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - E S Kudieva
- Burdenko Neurosurgical Institute, Moscow, Russia
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Szathmari A, Vasiljevic A, Di Rocco F, Beuriat PA, Mottolese C. Pineal cysts in children: a paediatric series treated over the last twenty years in Lyon. Childs Nerv Syst 2023; 39:3467-3474. [PMID: 37898987 DOI: 10.1007/s00381-023-06181-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/10/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Pineal cysts are a rare lesion of the pineal gland. Pineal cysts are benign lesions, generally asymptomatic, and are usually an incidental discovery on MRI performed for other problems. The management of pineal cysts in children remains a matter for debate. Here, we report our own retrospective paediatric cases that have been surgically treated and review the paediatric literature on this topic. METHODS This is a retrospective monocentric study. All patients operated by the senior author (CM) for a benign pineal cyst from 2000 to 2021 were included. All other pineal region cystic lesions were excluded. Medical and surgical data were extracted from the hospital medical database. RESULTS Twelve patients were included. The clinical symptomatology was characterized by headaches in seven patients, visual troubles in two patients, precocious puberty in one patient, signs of intracranial hypertension in two patients, seizures associated with headache in one patient, and headaches associated with behavioural troubles in another patient. No major post-operative complications were observed in this series. It is to noted that surgery was performed because a suspicion of a true pineal parenchymal tumour has been made. Histopathological study came back with the diagnosis of pineal cyst. CONCLUSIONS Pineal cyst is rare. If the radiological diagnosis is clear, no surgery is advocated except in cases associated with hydrocephalus and rapid growth. In case of a suspicion of a true pineal parenchymal tumour, a surgery may be needed to confirm the diagnosis. Lastly, we stress that only cystic lesions of the pineal gland itself should be considered as pineal cyst.
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Affiliation(s)
- Alexandru Szathmari
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 32 Avenue du Doyen Jean Lépine, 69500, Bron, France
| | - Alexandre Vasiljevic
- Department of Pathology and Neuropathology, GHE, Hospices Civils de Lyon, 69500, Bron, France
| | - Federico Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 32 Avenue du Doyen Jean Lépine, 69500, Bron, France
- Université Claude Bernard, Lyon 1, 69100, Villeurbanne, France
| | - Pierre-Aurélien Beuriat
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 32 Avenue du Doyen Jean Lépine, 69500, Bron, France
- Université Claude Bernard, Lyon 1, 69100, Villeurbanne, France
| | - Carmine Mottolese
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 32 Avenue du Doyen Jean Lépine, 69500, Bron, France.
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Deopujari C, Shroff K, Karmarkar V, Mohanty C. Neuroendoscopy in the management of pineal region tumours in children. Childs Nerv Syst 2023; 39:2353-2365. [PMID: 35665837 DOI: 10.1007/s00381-022-05561-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/24/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Pineal region tumours (PRTs) are more common in children and represent a wide variety of lesions. The practise of a radiation test dose is obsolete and a biochemical/histological diagnosis is recommended before further therapy. Many patients present with hydrocephalus. Advances in neuroendoscopic techniques have allowed safe and effective management of this obstructive hydrocephalus with an opportunity to sample cerebrospinal fluid (CSF) and obtain tissue for histopathology. Definitive surgery is required in less than a third. Endoscopic visualisation and assistance is increasingly used for radical resection, where indicated. METHODOLOGY Our experience of endoscopic surgery for paediatric PRTs from 2002 to 2021 is presented. All patients underwent MRI with contrast. Serum tumour markers were checked. If negative, endoscopic biopsy and endoscopic third ventriculostomy (ETV) were performed; and CSF collected for tumour markers and abnormal cells. For radical surgery, endoscope-assisted microsurgery procedures were performed to minimise retraction, visualise the extent of resection and confirm haemostasis. RESULTS M:F ratio was 2:1. The median age of presentation was 11 years. Raised ICP (88.88%) was the commonest mode of presentation. Nineteen patients had pineal tumours, one had a suprasellar and pineal tumour, one had disseminated disease, while six had tectal tumours. The ETB diagnosis rate was 95.45%, accuracy rate was 83.3% and ETV success rate was 86.96%. CONCLUSION Neuroendoscopy has revolutionised the management of paediatric PRTs. It is a safe and effective procedure with good diagnostic yield and allows successful concurrent CSF diversion, thereby avoiding major surgeries and shunt implantation. It is also helpful in radical resection of lesions, where indicated.
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Affiliation(s)
- Chandrashekhar Deopujari
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India, 400020.
| | - Krishna Shroff
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India, 400020
| | - Vikram Karmarkar
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India, 400020
| | - Chandan Mohanty
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India, 400020
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Sakata K, Hashimoto A, Kotaki Y, Yoshitake H, Shimokawa S, Komaki S, Nakamura H, Furuta T, Morioka M. Successful Treatment of Pure Aqueductal Pilomyxoid Astrocytoma and Arrested Hydrocephalus With Endoscopic Tumor Resection Followed by Chemotherapy: A Case Report and Technical Considerations. NEUROSURGERY OPEN 2023. [DOI: 10.1227/neuprac.0000000000000030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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12
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Al-Saiari S, Al Orabi K, Abdoh MG, Basurrah AA, Albalawi SF, Farag AA. Simultaneous biportal endoscopic management of pineal region tumors in patients with obstructive hydrocephalus: technical notes. Chin Neurosurg J 2023; 9:1. [PMID: 36624512 PMCID: PMC9830701 DOI: 10.1186/s41016-022-00313-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 12/25/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The goal of this study is to show the feasibility and benefits of using the simultaneous biportal endoscopic procedure to treat pineal tumors in patients with obstructive hydrocephalus. METHODS We retrospectively reviewed three patients with pineal tumors and acute obstructive hydrocephalus who were treated in one session with a frameless stereotactic guided simultaneous biportal endoscopic third ventriculostomy and endoscopic tumor biopsy performed through two separate ports using one rigid ventriculoscope. RESULTS In the three patients, ventriculostomy and endoscopic biopsies were conducted. There was no death or morbidity throughout the 45-min procedure. All of the patients' histological findings were confirmed. Germinoma was diagnosed in two patients who recieved postoperative radiotherapy, and the third patient diagnosed with a pineocytoma. Magnetic resonance imaging with flow-sensitive sequences was used to confirm ventriculostomy patency in all patients 6 months after the surgery. CONCLUSION Biportal endoscopic approach enables better visual control of both procedures. Furthermore, it allows the surgeon to safely pass the ventriculoscope via the foramen of monro, even if it is narrow. Moreover, during endoscopic tumor biopsy and third ventriculostomy, the intracranial pressure can be smoothly managed using the outlet tubes accessible. This treatment may be an alternative to traditional uniportal endoscopic operations in certain patients.
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Affiliation(s)
- Sultan Al-Saiari
- grid.498593.a0000 0004 0427 1086Neurosurgery Department, King Abdullah Medical City, P.O 24246, Makkah, Saudi Arabia
| | - Khalid Al Orabi
- grid.498593.a0000 0004 0427 1086Neurosurgery Department, King Abdullah Medical City, P.O 24246, Makkah, Saudi Arabia
| | - Mohammad Ghazi Abdoh
- grid.498593.a0000 0004 0427 1086Neurosurgery Department, King Abdullah Medical City, P.O 24246, Makkah, Saudi Arabia
| | - Abdulaziz A. Basurrah
- grid.498593.a0000 0004 0427 1086Neurosurgery Department, King Abdullah Medical City, P.O 24246, Makkah, Saudi Arabia
| | - Sultan Faez Albalawi
- grid.498593.a0000 0004 0427 1086Neurosurgery Department, King Abdullah Medical City, P.O 24246, Makkah, Saudi Arabia
| | - Ahmed A. Farag
- grid.498593.a0000 0004 0427 1086Neurosurgery Department, King Abdullah Medical City, P.O 24246, Makkah, Saudi Arabia
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Muroya Y, Suzuki K, Nagasaka S, Nakano Y, Yamamoto J. Primary central nervous system lymphoma of the third ventricle with intra-tumoral hemorrhage: A case report and literature review. Oncol Lett 2022; 25:47. [PMID: 36644156 PMCID: PMC9811644 DOI: 10.3892/ol.2022.13633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/02/2022] [Indexed: 12/16/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare brain tumor that most commonly arises in the cerebral white matter, basal ganglia, peri-ventricle or corpus callosum. Confinement of PCNSL to the third ventricle is extremely rare, and seldom presents with intratumoral hemorrhage (ITH). The present study described the case of a 75-year-old woman who presented with obstructive hydrocephalus due to third-ventricle PCNSL. On magnetic resonance imaging (MRI), the tumor presented ITH on T2*-weighted images and a highly elevated regional cerebral blood volume on dynamic susceptibility contrast-enhanced MRI (DSC-MRI). Due to the high elevation of the regional cerebral blood volume, high-grade glioma was suspected as a preoperative diagnosis. The patient underwent endoscopic tumor biopsy and third ventricle PCNSL was successfully diagnosed. The patient achieved good prognosis at an early stage after the start of treatment initiation. There are many differential considerations for a third-ventricle tumor, and DSC-MRI can help the differential diagnosis of these tumors. Furthermore, the presence of ITH can lead to the inaccurate estimation of regional cerebral blood volume values. Overall, silent or microhemorrhage in PCNSL may be underestimated, and clinicians should therefore carefully evaluate tumor vascularity by MRI.
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Affiliation(s)
- Yu Muroya
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
| | - Kohei Suzuki
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan,Correspondence to: Dr Kohei Suzuki, Department of Neurosurgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan, E-mail:
| | - Shohei Nagasaka
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
| | - Yoshiteru Nakano
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
| | - Junkoh Yamamoto
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
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Efficacy of endoscopic management of primary central nervous system lymphoma: a multicentric study and literature review. J Neurooncol 2022; 159:457-468. [PMID: 35829848 DOI: 10.1007/s11060-022-04081-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION To date, confined intra-ventricular localization of primary central nervous system lymphoma (PCNSL) has been usually managed with open surgical resection and/or stereotactic biopsy; nonetheless, the endoscopic approach to such localization can provide many advantages over standard microsurgery and/or stereotactic biopsy. Here we present our experience in managing such a rare pathology through the endoscopic approach. METHOD In order to gather more information about such a rare pathology, a retrospective multicentric study on a prospectively built database has been performed during a 5 year period. Ten different European centers have been involved. RESULTS A total of 60 patients, 25 women and 35 men, have been enrolled in the study. The mean age was 65.3 years. The mean lesion size was 40.3 mm. Among all selected patients, 40 (66.6%) had superficial lesions within the ventricle, whereas the remaining 20 (33.4%) had lesions involving/extending to deeper structures. All surgical procedures were uneventful and ETV was deemed necessary only in 20/60 cases. CONCLUSION In our experience, endoscopic management of intraventricular PCNSL is an effective option. It should be considered after a careful examination of neurological and immunological status, alternative options for diagnostic sampling, location of the lesion, and presence or absence of hydrocephalus. Endoscopic management could be considered as a safe and minimally invasive option to obtain: (a) a biopsy sample of the lesion for further diagnostic workup, (b) CSF diversion through third ventriculostomy or VP shunt for the management of hydrocephalus, and (c) insertion of ventricular access devices for long term medical management and whenever necessary as a rescue option for ventricular tap.
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15
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Karadag A, Camlar M, Turkis OF, Bayramli N, Middlebrooks EH, Tanriover N. Endoscopic Endonasal Approach to the Third Ventricle Using the Surgical Corridor of the Reverse Third Ventriculostomy: Anatomo-Surgical Nuances. J Neurol Surg B Skull Base 2022. [DOI: 10.1055/s-0042-1748630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Objective Surgical access to the third ventricle can be achieved through various corridors depending on the location and extent of the lesion; however, traditional transcranial approaches risk damage to multiple critical neural structures.
Methods Endonasal approach similar to corridor of the reverse third ventriculostomy (ERTV) was surgically simulated in eight cadaveric heads. Fiber dissections were additionally performed within the third ventricle along the endoscopic route. Additionally, we present a case of ERTV in a patient with craniopharyngioma extending into the third ventricle.
Results The ERTV allowed adequate intraventricular visualization along the third ventricle. The extracranial step of the surgical corridor included a bony window in the sellar floor, tuberculum sella, and the lower part of the planum sphenoidale. ERTV provided an intraventricular surgical field along the foramen of Monro to expose an area bordered by the fornix anteriorly, thalamus laterally, anterior commissure anterior superiorly, posterior commissure, habenula and pineal gland posteriorly, and aqueduct of Sylvius centered posterior inferiorly.
Conclusion The third ventricle can safely be accessed through ERTV either above or below the pituitary gland. ERTV provides a wide exposure of the third ventricle through the tuber cinereum and offers access to the anterior part as far as the anterior commissure and precommissural part of fornix and the whole length of the posterior part. Endoscopic ERTV may be a suitable alternative to transcranial approaches to access the third ventricle in selected patients.
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Affiliation(s)
- Ali Karadag
- Department of Neurosurgery, Health Science University, Tepecik Research and Training Hospital, Izmir, Turkey
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University–Cerrahpasa, Istanbul, Turkey
| | - Mahmut Camlar
- Department of Neurosurgery, Health Science University, Tepecik Research and Training Hospital, Izmir, Turkey
| | - Omer Furkan Turkis
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University–Cerrahpasa, Istanbul, Turkey
- Department of Neurosurgery, Health Science University, Van Research and Training Hospital, Van, Turkey
| | - Nijat Bayramli
- Department of Neurosurgery, Health Science University, Tepecik Research and Training Hospital, Izmir, Turkey
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University–Cerrahpasa, Istanbul, Turkey
| | - Erik H. Middlebrooks
- Departments of Neurosurgery and Radiology, Mayo Clinic, Jacksonville, Florida, United States
| | - Necmettin Tanriover
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University–Cerrahpasa, Istanbul, Turkey
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University–Cerrahpasa, Istanbul, Turkey
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16
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Karadag A, Camlar M, Turkis OF, Bayramli N, Middlebrooks EH, Tanriover N. Endoscopic Endonasal Approach to the Third Ventricle using the Corridor of the Reverse Third Ventriculostomy: anatomo-surgical nuances. J Neurol Surg B Skull Base 2022; 84:296-306. [PMID: 37187474 PMCID: PMC10171930 DOI: 10.1055/a-1808-1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 03/18/2022] [Indexed: 10/18/2022] Open
Abstract
Objective: Surgical access to the third ventricle can be achieved through various corridors depending on the location and extent of the lesion; however, traditional transcranial approaches risk damage to multiple critical neural structures.
Methods: Endonasal approach similar to corridor of the reverse third ventriculostomy (ERTV) was surgically simulated in eight cadaveric heads. Fiber dissections were additionally performed within the third ventricle along the endoscopic route. Additionally, we present a case of ERTV in a patient with craniopharyngioma extending into the third ventricle.
Results: The ERTV allowed adequate intraventricular visualization along the third ventricle. The extracranial step of the surgical corridor included a bony window in the sellar floor, tuberculum sella and the lower part of the planum sphenoidale. ERTV provided an intraventricular surgical field along the foramen of Monro to expose an area bordered by the fornix anteriorly, thalamus laterally, anterior commissure anterior superiorly, posterior commissure, habenula and pineal gland posteriorly, and aqueduct of Sylvius centered posterior inferiorly.
Conclusion: The third ventricle can safely be accessed through ERTV either above or below the pituitary gland. ERTV provides a wide exposure of the third ventricle through the tuber cinereum and offers access to the anterior part as far as the anterior commissure and pre-commissural part of fornix and the whole length of the posterior part. Endoscopic ERTV may be a suitable alternative to transcranial approaches to access the third ventricle in selected patients.
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Affiliation(s)
- Ali Karadag
- Neurosurgery, Tepecik Egitim ve Arastirma Hastanesi Kliniklerimiz, Izmir, Turkey
| | - Mahmut Camlar
- Neurosurgery, Tepecik Egitim ve Arastirma Hastanesi Kliniklerimiz, Izmir, Turkey
| | | | - Nijat Bayramli
- Neurosurgery, Tepecik Egitim ve Arastirma Hastanesi Kliniklerimiz, Izmir, Turkey
| | - Erik H Middlebrooks
- Neurological Surgery and Radiology, Mayo Clinic Hospital Jacksonville, Jacksonville, United States
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Cai Y, Xiong Z, Xin C, Chen J, Liu K. Endoscope-Assisted Microsurgery in Pediatric Cases With Pineal Region Tumors: A Study of 18 Cases Series. Front Surg 2021; 8:641196. [PMID: 34414209 PMCID: PMC8368719 DOI: 10.3389/fsurg.2021.641196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 07/08/2021] [Indexed: 11/29/2022] Open
Abstract
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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Affiliation(s)
- Yuankun Cai
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Zhongwei Xiong
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Can Xin
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Kui Liu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
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18
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Feletti A, Fiorindi A, Lavecchia V, Boscolo-Berto R, Marton E, Macchi V, De Caro R, Longatti P, Porzionato A, Pavesi G. A light on the dark side: in vivo endoscopic anatomy of the posterior third ventricle and its variations in hydrocephalus. J Neurosurg 2021; 135:309-317. [PMID: 32619975 DOI: 10.3171/2020.4.jns20493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/15/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Despite the technological advancements of neurosurgery, the posterior part of the third ventricle has always been the "dark side" of the ventricle. However, flexible endoscopy offers the opportunity for a direct, in vivo inspection and detailed description of the posterior third ventricle in physiological and pathological conditions. The purposes of this study were to describe the posterior wall of the third ventricle, detailing its normal anatomy and surgical landmarks, and to assess the effect of chronic hydrocephalus on the anatomy of this hidden region. METHODS The authors reviewed the video recordings of 59 in vivo endoscopic explorations of the posterior third ventricle to describe every identifiable anatomical landmark. Patients were divided into 2 groups based on the absence or presence of a chronic dilation of the third ventricle. The first group provided the basis for the description of normal anatomy. RESULTS The following anatomical structures were identified in all cases: adytum of the cerebral aqueduct, posterior commissure, pineal recess, habenular commissure, and suprapineal recess. Comparing the 2 groups of patients, the authors were able to detect significant variations in the shape of the adytum of the cerebral aqueduct and in the thickness of the habenular and posterior commissures. Exploration with sodium fluorescein excluded the presence of any fluorescent area in the posterior third ventricle, other than the subependymal vascular network. CONCLUSIONS The use of a flexible scope allows the complete inspection of the posterior third ventricle. The anatomical variations caused by chronic hydrocephalus might be clinically relevant, in light of the commissure functions.
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Affiliation(s)
- Alberto Feletti
- 1Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona
- 2Department of Neurosciences, Neurosurgical Unit, University of Modena
| | - Alessandro Fiorindi
- 3Neurosurgical Department, Spedali Civili, University of Brescia
- 4Neurosurgical Department, Treviso Regional Hospital, University of Padova, Treviso; and
| | | | - Rafael Boscolo-Berto
- 5Department of Neuroscience, Institute of Human Anatomy, University of Padova, Italy
| | - Elisabetta Marton
- 4Neurosurgical Department, Treviso Regional Hospital, University of Padova, Treviso; and
| | - Veronica Macchi
- 5Department of Neuroscience, Institute of Human Anatomy, University of Padova, Italy
| | - Raffaele De Caro
- 5Department of Neuroscience, Institute of Human Anatomy, University of Padova, Italy
| | - Pierluigi Longatti
- 4Neurosurgical Department, Treviso Regional Hospital, University of Padova, Treviso; and
| | - Andrea Porzionato
- 5Department of Neuroscience, Institute of Human Anatomy, University of Padova, Italy
| | - Giacomo Pavesi
- 2Department of Neurosciences, Neurosurgical Unit, University of Modena
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Schonauer C, Jannelli G, Tessitore E, May AT, Guatta R, Bartoli A. Endoscopic resection of a low-grade ependymoma of the pineal region. Surg Neurol Int 2021; 12:279. [PMID: 34221610 PMCID: PMC8248020 DOI: 10.25259/sni_250_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/08/2021] [Indexed: 11/04/2022] Open
Abstract
Background Full endoscopic resection of solid brain tumors represents a challenge for neurosurgeons. This can be achieved with modern technology and advanced surgical tools. Case Description A 23-years-old male was referred to our unit with raised intracranial pressure. Head computed tomography and magnetic resonance imaging (MRI) revealed obstructive hydrocephalus and a third ventricle lesion. Endoscopic third ventriculostomy and biopsy were performed, a left frontal external ventricular drain was left in place. A second-look surgery for endoscopic removal was planned. Decision to proceed with an endoscopic removal was supported by the following characteristics found during the first surgery: tumor exophytic, soft texture, scarce vascularity, and low-grade appearance. A rescue strategy for microscopic resection via transcallosal approach was decided. A straight trajectory to the tumor was planned with navigation. A further anterior left frontal burr-hole was performed, and the ventricular system was entered via the left frontal horn. Resection was carried out alternating laser for hemostasis and cutting, endoscopic ultrasonic aspirator, and endoscopic forceps for piecemeal resection. Laser hemostasis and cutting (1 Watt power at tip, continuous wave mode) were useful at the ventricular wall-tumor interface. Relevant landmarks guided the approach and the resection (foramen of Monro, mammillary bodies, aqueduct, pineal and suprapineal recess, and posterior commissure). The surgery was carried uneventfully. Histopathology confirmed a lowgrade ependymoma. Post-operative MRI showed residual tumor within the lower aqueduct. At 3 years follow-up, residual tumor is stable. Conclusion In selected cases, endoscopic resection for third ventricular tumors is feasible and safe, and represents a valid alternative to microsurgical approaches.
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Affiliation(s)
| | - Gianpaolo Jannelli
- Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - Enrico Tessitore
- Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - Adrien Thomas May
- Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - Ramona Guatta
- Neurosurgical Unit, Lugano Regional Hospital Civico and Italian Sites, Lugano, Switzerland
| | - Andrea Bartoli
- Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
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20
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Pineal region tumors: an entity with crucial anatomical nuances. Childs Nerv Syst 2021; 37:383-390. [PMID: 32725465 DOI: 10.1007/s00381-020-04826-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/21/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Intra-axial "pineal region" tumors include pineal, tectal, and aqueductal tumors. All three tumor subgroups cause obstruction of the aqueduct; however, they differ in radiological nuances, pathology, differential diagnosis, and treatment. The goal of this manuscript is to describe the radiological, clinical, and pathological nuances that differentiate between these subgroups. METHODS All patients with intra-axial pineal region tumors were analyzed retrospectively, including demographics, radiological characteristics, pathology, treatment, and outcome. RESULTS Forty-nine patients (1-69 years of age) were included: 19 pineal, 10 tectal, 10 aqueductal, 4 periaqueductal, and 6 complex. The 3 main subgroups differed in various radiological and anatomical nuances. Age and gender did not differ between groups. Other factors that did not differ between groups included T1 and T2 signals, presence of blood products, a normally located (non-displaced) tectum, anterior tectal displacement, thalamic involvement, and presence of hydrocephalus. The pathological spectrum differed between the 3 main subgroups, as well as the surgical treatment, and outcome. CONCLUSIONS Despite sharing a close anatomical location, as well as all causing obstruction of the aqueduct with secondary hydrocephalus, the differential diagnosis, diagnostic methods, and possible treatment and surgical options differ between the various subgroups. Anatomical nuances are described to better delineate the various tumor subgroups and recommend specific treatment approaches.
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21
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Attri G, Gosal JS, Khatri D, Das KK, Bhaisora KS, Mehrotra A, Sardhara J, Srivastava AK, Behari S, Jaiswal S, Jaiswal AK. Endoscopic Third Ventriculostomy and Simultaneous Tumor Biopsy in Pineal Region Tumors using the "Single Burr Hole" Technique: An Analysis of 34 Cases. Asian J Neurosurg 2020; 15:976-982. [PMID: 33708673 PMCID: PMC7869259 DOI: 10.4103/ajns.ajns_194_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/07/2020] [Accepted: 05/15/2020] [Indexed: 11/04/2022] Open
Abstract
Background Pineal region tumors often present with hydrocephalus. Endoscopic third ventriculostomy (ETV) and simultaneous tumor biopsy remain a minimally invasive procedure offering both diagnostic and therapeutic advantages in the management of these tumors. However, different operative techniques have been described in the literature. Aim The aim is to study the ETV success rate, diagnostic rate of simultaneous tumor biopsy, complications, and follow-up of patients of pineal region tumors managed with ETV and simultaneous tumor biopsy using the single burr hole technique. Methods The study was performed by retrospectively reviewing the records of patients of pineal region tumors managed by simultaneous ETV and tumor biopsy using a "single burr hole" technique from January 2012 to December 2019. Results Thirty-four patients (22 males and 12 females) with a mean age of 28.7 years were analyzed. ETV was successful in relieving hydrocephalus in 29 (87.8%) patients. Three patients needed a ventriculoperitoneal shunt, and one required Ommaya reservoir placement for persistent hydrocephalus. Histological diagnosis was successfully established in 26 (78.8%) patients. There were two procedure-related mortalities. Two patients underwent craniotomy and tumor excision subsequently. Radiotherapy was given to 11 patients, and 9 patients were managed by observation alone. The mean follow-up of our study was 15.8 months. Conclusions Simultaneous ETV and tumor biopsy using a single burr hole technique is a safe, minimally invasive procedure for the management of pineal region tumors.
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Affiliation(s)
- Gagandeep Attri
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | - Deepak Khatri
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | - Anant Mehrotra
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Jayesh Sardhara
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | - Sanjay Behari
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Sushila Jaiswal
- Department of Pathology, SGPGIMS, Lucknow, Uttar Pradesh, India
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22
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Spazzapan P, Velnar T, Bosnjak R. Endoscopic supracerebellar infratentorial approach to pineal and posterior third ventricle lesions in prone position with head extension: a technical note. Neurol Res 2020; 42:1070-1073. [PMID: 32892737 DOI: 10.1080/01616412.2020.1805926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The supracerebellar infratentorial (SCIT) approach is frequently used for the treatment of lesions in the pineal and posterior third ventricle region and can be performed in a sitting or prone position. We describe our experience with the purely endoscopic SCIT approach, using a prone position, with neck extension and head rotation. METHODS We analysed all paediatric and adult patients operated on between July 2013 and January 2018 using the purely endoscopic SCIT approach. The surgical procedure was conducted through a paramedian subtorcular key-hole suboccipital craniotomy. The assistant held the endoscope and the surgeon used fine, long shaft instruments for bimanual tumour dissection. The prone position with head retroflexion allowed a gravity-aided enlargement of the anatomical surgical corridor between tentorium and cerebellum and enhanced venous blood drainage, similarly to the sitting or semi-sitting position, but with a decreased risk of air embolism. RESULTS The approach allowed a complete removal of lesions located in the pineal region and in the posterior part of the third ventricle. Seven patients have been operated with this approach. All of them had the tumour completely removed. No permanent neurological deficits have been observed. CONCLUSIONS The endoscopic SCIT approach enables effective and safe removal of pineal and posterior third ventricle lesions, even of moderate dimensions (up to 3 cm). The endoscope guarantees a detailed view and illumination of the deep-seated structures. The tumour resection can be performed with bimanual use of microsurgical instruments.
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Affiliation(s)
- Peter Spazzapan
- Department of Neurosurgery, University Medical Centre Ljubljana , Ljubljana, Slovenia
| | - Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana , Ljubljana, Slovenia
| | - Roman Bosnjak
- Department of Neurosurgery, University Medical Centre Ljubljana , Ljubljana, Slovenia
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Shah MH, Abdelhady M, Own A, Elsotouhy A. A Rare Case of Choroid Plexus Papilloma of the Third Ventricle in an Adult. Cureus 2020; 12:e9582. [PMID: 32923188 PMCID: PMC7478700 DOI: 10.7759/cureus.9582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Colloid cysts are the commonest masses of the third ventricle. Third ventricle neoplasms are uncommon. They include tumors arising from the choroid plexus (papillomas, carcinomas), tumors arising from other than the choroid plexus (ependymomas, meningiomas), metastases, and lymphoma. Choroid plexus tumors usually occur in the lateral ventricle in children and fourth ventricle in adults, and often present with hydrocephalus. We herein describe the extremely rare occurrence of third ventricle choroid plexus papilloma in a 35-year-old man who presented to the emergency department with a long history of intermittent headaches, occasionally associated with photophobia. CT and MR imaging revealed a lobulated ovoid lesion in the third ventricle with minimal extension into the right lateral ventricle through the foramen of Monro, causing mild ventricular dilatation. Surgical resection was performed and histopathology revealed choroid plexus papilloma.
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Role of endoscopic surgical biopsy in diagnoses of intraventricular/periventricular tumors: review of literature including a monocentric case series. Acta Neurol Belg 2020; 120:517-530. [PMID: 32107717 DOI: 10.1007/s13760-020-01299-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/09/2020] [Indexed: 12/28/2022]
Abstract
The intra- and periventricular location tumor (IPVT) of a brain remains a hard challenge for the neurosurgeon because of the deep location and eloquent anatomic associations. Due to this high risk of iatrogenic injury, many surgeons elect to perform biopsies of such lesions to establish a diagnosis. On the one hand, stereotaxic needle biopsy (SNB) is a minimally invasive procedure but with a significant risk of complications and a high risk of lack of tissue for molecular analyses for this region [Fukushima in Neurosurgery 2:110-113 (1978)]; on the other hand, the use of endoscopic intraventricular biopsy (EIB) allows for diagnosis with minimal surgical intervention [Iwamoto et al. in Ann Neurol 64(suppl. 6):628-634 (2008)]. IPVTs and related CSF pathway obstructions can be safely and effectively treated with endoscopic techniques. It is not possible to compare EIB with diagnoses made by any other method or with the established treatment. We aim to analyze the accuracy of EIB results by comparing them with results of biopsies performed later, in other methods and thereby evaluating the treatment evolution considering our personal experience. The difficulties and complications encountered are presented and compared with those reported in the literature to obtain the best review possible for this topic. A systematic review of literature was done using MEDLINE, the NIH Library, PubMed, and Google Scholar yielded 1.951 cases for EIB and 1912 for SNB, according to standard systemic review techniques. Review was conducted on 50 studies describing surgical procedures for lesions intra- and para-ventricular. The primary outcome measure was a diagnostic success. We also consider 20 patients with IPVT treated in our department. Clinical characteristics and surgical outcome were evaluated and a systematic review of the literature was performed. Overall, all our biopsies were diagnostic, with a positive histologic sample in 100% of our patients. 8 patients underwent a concurrent endoscopic third ventriculostomy. 4 patients underwent a concurrent ventriculostomy combined with septostomy. For 1 patient was necessary the only septostomy combined with biopsy. Every case has obtained a histological diagnosis. The percentage of complications was very low with only 1 case of post-operative infection and 1 case of hemorrhage. It was impossible to create a specific comparison from literature data of IPVTs between a stereotactic and endoscopic procedure, it presents only the collection of pineal gland tumor [Kelly in Neurosurgery 25(02):185-194 (1989); Quick-Weller in World Neurosurgery 96:124-128 (2016)] or unknown location of the lesion in major review [Marenco-Hillembrand et al. in Front Oncol 8:558 (2018)]. The present study aims to report our experience with the surgical management of IPVTs. The EIB sample yields an accurate histologic diagnosis tumor, with a positive histologic sample in 87, 95% of patients. The choice of the appropriate procedure should consider not only the preference and the experience of the neurosurgeon but also the several other variables as the location. While some periventricular lesions are better approached by endoscopic techniques, others are more suited for stereotactic-guided approaches. The ability to perform an EIB and relieve tumor-associated hydrocephalus by neuroendoscopy is considered to be a benefit of this procedure since this is less invasive than other treatments.
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Suresh MP, Munoz-Bendix C, Felsberg J, Steiger HJ, Hänggi D, Beseoglu K, Beez T. Calcifying Pseudoneoplasm of Neuraxis (CAPNON) in the Posterior Third Ventricle-Challenge for Neuroendoscopy. World Neurosurg 2020; 138:481-484. [PMID: 32135316 DOI: 10.1016/j.wneu.2020.02.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND We report the first case of a purely intraventricular calcifying pseudoneoplasm of neuraxis (CAPNON) in the posterior third ventricle. CASE DESCRIPTION A 63-year-old male without any previous medical history presented with Hakim triad. Imaging showed a calcified lesion of the posterior third ventricle with hydrocephalus. An endoscopic third ventriculostomy was performed. Endoscopic removal or debulking of the lesion was impossible due to its rock-hard consistency, and thus the procedure was aborted after biopsy. CONCLUSIONS When encountering such calcified lesions within the ventricular system, especially in proximity to eloquent regions, the decision making process should include the hard consistency and parenchymal adhesions as obstacles to neuroendoscopic removal. Even for biopsy, a higher morbidity rate compared with typical soft tumors should be assumed. Although data on intraventricular CAPNON is limited, biopsy of the lesion and treatment of associated hydrocephalus appear to be the primary neurosurgical goals, followed by imaging surveillance.
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Affiliation(s)
- Marian Preetham Suresh
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
| | | | - Jörg Felsberg
- Department of Neuropathology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Hans-Jakob Steiger
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Kerim Beseoglu
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Thomas Beez
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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Gao Y, Takagi K, Kato T, Shono N, Hata N. Continuum Robot With Follow-the-Leader Motion for Endoscopic Third Ventriculostomy and Tumor Biopsy. IEEE Trans Biomed Eng 2020; 67:379-390. [PMID: 31034405 PMCID: PMC7098325 DOI: 10.1109/tbme.2019.2913752] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In a combined endoscopic third ventriculostomy (ETV) and endoscopic tumor biopsy (ETB) procedure, an optimal tool trajectory is mandatory to minimize trauma to surrounding cerebral tissue. OBJECTIVE This paper presents wire-driven multi-section robot with push-pull wire. The robot is tested to attain follow-the-leader (FTL) motion to place surgical instruments through narrow passages while minimizing the trauma to tissues. METHODS A wire-driven continuum robot with six sub-sections was developed and its kinematic model was proposed to achieve FTL motion. An accuracy test to assess the robot's ability to attain FTL motion along a set of elementary curved trajectory was performed. We also used hydrocephalus ventricular model created from human subject data to generate five ETV/ETB trajectories and conducted a study assessing the accuracy of the FTL motion along these clinically desirable trajectories. RESULTS In the test with elementary curved paths, the maximal deviation of the robot was increased from 0.47 mm at 30 ° turn to 1.78 mm at 180 ° in a simple C-shaped curve. S-shaped FTL motion had lesser deviation ranging from 0.16 to 0.18 mm. In the phantom study, the greatest tip deviation was 1.45 mm, and the greatest path deviation was 1.23 mm. CONCLUSION We present the application of a continuum robot with FTL motion to perform a combined ETV/ETB procedure. The validation study using human subject data indicated that the accuracy of FTL motion is relatively high. The study indicated that FTL motion may be useful tool for combined ETV and ETB.
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Samadian M, Maloumeh EN, Shiravand S, Ebrahimzadeh K, Sharifi G, Mousavinejad A, Rezaei O. Pineal region tumors: Long-term results of endoscopic third ventriculostomy and concurrent tumor biopsy with a single entry approach in a series of 64 cases. Clin Neurol Neurosurg 2019; 184:105418. [PMID: 31319237 DOI: 10.1016/j.clineuro.2019.105418] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/04/2019] [Accepted: 07/06/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Endoscopic third ventriculostomy and concurrent biopsy is increasingly used in management of the pineal region tumors. Our objective was to assess the results of single entry approach to surgically manage the tumors of the pineal region. PATIENTS AND METHODS A retrospective study was designed, and a series of 64 consecutive patients (31 male, 33 female) with pineal region tumor undergoing endoscopic third ventriculostomy and concurrent biopsy of the tumor was undertaken. RESULTS A total of 64 patients underwent simultaneous endoscopic third ventriculostomy and biopsy of the pineal tumors with a single entry approach. A positive initial diagnosis was established in 97% of patients. 5 patients (7%) required the insertion of an external ventricular drain which was removed in all patients after 72 h but in one case (1%) undergoing permanent VP shunt insertion. The postoperative complications were divided into two transient and permanent complications. The transient complications included intraventricular hemorrhage (18%), seizure (1 to two episodes of seizure) (5%), diabetes insipidus (3%) and meningitis (3%) all were successfully managed. The only permanent complication was memory deficits occurred in one patient (1%). There was no mortality rate in current study. CONCLUSION The results of this study support the safety and efficacy of endoscopic third ventriculostomy and concurrent biopsy of the pineal region tumors as a less invasive surgical method associated with low morbidity and mortality rate. Our data demonstrated how simultaneous endoscopic third ventriculostomy and biopsy of the pineal region tumors with a single entry approach can produce favorable results.
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Affiliation(s)
- Mohammad Samadian
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ehsan Nazari Maloumeh
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Sepideh Shiravand
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Kaveh Ebrahimzadeh
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Guive Sharifi
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ali Mousavinejad
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Omidvar Rezaei
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Perin A, Galbiati TF, Casali C, Legnani FG, Mattei L, Prada FU, Saini M, Saladino A, Riker N, DiMeco F. Brain Tectal Tumors: A Flexible Approach. Oper Neurosurg (Hagerstown) 2019; 16:E95-E100. [PMID: 29873789 DOI: 10.1093/ons/opy114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/17/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Mesencephalic tectal gliomas represent a subset of midbrain tumors, which are more frequent in children than in adults. They usually become symptomatic when causing hydrocephalus by occluding the aqueduct. Because of their slow progression, due to their benign histology, they are characterized by a relatively good prognosis, although hydrocephalus might jeopardize patients' prognosis. Treatment is usually represented by cerebrospinal fluid diversion associated or not with biopsy. CLINICAL PRESENTATION We report 2 illustrative cases of tectal gliomas in adults where endoscopic third ventriculostomy (ETV) and simultaneous endoscopic biopsy were obtained during the same operation by means of a single burr hole with a flexible endoscope. CONCLUSION We recommend using this overlooked neurosurgical tool for such cases, since it allows the surgeon to safely perform an ETV, then judge whether biopsy can be done or not, without harming the patient, and possibly achieving an important piece of information (histopathological diagnosis) to manage this subset of oncological patients.
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Affiliation(s)
- Alessandro Perin
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Nazionale "C. Besta," Milan, Italy.,Department of Life Sciences, University of Trieste, Trieste, Italy.,Besta NeuroSim Center, Fondazione IRCCS Istituto Neurologico Nazionale "C. Besta", Milan, Italy
| | - Tommaso Francesco Galbiati
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Nazionale "C. Besta," Milan, Italy.,Besta NeuroSim Center, Fondazione IRCCS Istituto Neurologico Nazionale "C. Besta", Milan, Italy
| | - Cecilia Casali
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Nazionale "C. Besta," Milan, Italy
| | | | - Luca Mattei
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Nazionale "C. Besta," Milan, Italy
| | - Francesco Ugo Prada
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Nazionale "C. Besta," Milan, Italy.,Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, Virginia
| | - Marco Saini
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Nazionale "C. Besta," Milan, Italy
| | - Andrea Saladino
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Nazionale "C. Besta," Milan, Italy
| | - Nicole Riker
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Nazionale "C. Besta," Milan, Italy.,Besta NeuroSim Center, Fondazione IRCCS Istituto Neurologico Nazionale "C. Besta", Milan, Italy
| | - Francesco DiMeco
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Nazionale "C. Besta," Milan, Italy.,Besta NeuroSim Center, Fondazione IRCCS Istituto Neurologico Nazionale "C. Besta", Milan, Italy.,Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, Maryland
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Ahmed SI, Javed G, Laghari AA, Bareeqa SB, Aziz K, Khan M, Samar SS, Humera RA, Khan AR, Farooqui MO, Shahbaz A. Third Ventricular Tumors: A Comprehensive Literature Review. Cureus 2018; 10:e3417. [PMID: 30542631 PMCID: PMC6284874 DOI: 10.7759/cureus.3417] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Third ventricle tumors are uncommon and account for 0.6 - 0.9% of all the brain tumors. Tumors of the third ventricle are classified into primary tumors, such as colloid cysts, choroid plexus papillomas, and ependymomas, or secondary tumors, such as craniopharyngiomas, optic nerve gliomas, pineal tumors, and meningiomas. Third ventricular tumors are uncommon, and their treatment involves significant morbidity and mortality. The colloid cyst has a better surgical outcome and many approaches are available to achieve a complete cure. Choroid plexus papilloma is also a common tumor documented with its treatment majorly based on surgical resection. In addition to multiple treatment options for craniopharyngiomas, surgery is the most preferred treatment option. Ependymomas also have few treatment options, with surgical resection adopted as the first line of treatment.
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Affiliation(s)
- Syed Ijlal Ahmed
- Neurosurgery, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Gohar Javed
- Neurosurgery, The Aga Khan University, Karachi, PAK
| | | | | | - Kashif Aziz
- Internal Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, New York, USA
| | - Mehreen Khan
- Internal Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Syeda Sana Samar
- Internal Medicine, Jinnah Sindh Medical University, Karachi , PAK
| | | | - Alizay Rashid Khan
- Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, PAK
| | | | - Amir Shahbaz
- Internal Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, New York, USA
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Abbassy M, Aref K, Farhoud A, Hekal A. Outcome of single-trajectory rigid endoscopic third ventriculostomy and biopsy in the management algorithm of pineal region tumors: a case series and review of the literature. Childs Nerv Syst 2018; 34:1335-1344. [PMID: 29808320 DOI: 10.1007/s00381-018-3840-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/14/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Tumors within the pineal region represent 1.5 to 8.5% of the pediatric brain tumors and 1.2% of all brain tumors. A management algorithm has been proposed in several publications. The algorithm includes endoscopic third ventriculostomy (ETV) and biopsy in cases presenting with hydrocephalus. In this series, we are presenting the efficacy of a single-trajectory approach for both ETV and biopsy. METHODS Eleven cases were admitted to Alexandria main university hospital from 2013 to 2016 presenting with pineal region tumors and hydrocephalus. Mean age at diagnosis was 11 years (1-27 years). All cases had ETV and biopsy using rigid ventriculoscope through a single trajectory from a burr hole planned on preoperative imaging. Follow-up period was 7-48 months. RESULTS All 11 cases presented with hydrocephalus and increased intracranial pressure manifestations. Histopathological diagnosis was successful in 9 out of 11 cases (81.8%). Three cases were germ-cell tumors, two cases were pineoblastomas, two cases were pilocytic astrocytomas, and two cases were grade 2 tectal gliomas. Five of the ETV cases (45.5%) failed and required VPS later on. Other complications of ETV included one case of intraventricular hemorrhage and a case with tumor disseminated to the basal cisterns. CONCLUSION In our series, we were able to achieve ETV and biopsy through a single trajectory and a rigid endoscope with results comparable to other studies in the literature.
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Affiliation(s)
- Mahmoud Abbassy
- Neurosurgery Department, Alexandria University, Khartoum sq. Al-Azareeta, Faculty of Medicine, Surgery Building 6th Floor Neurosurgery Department, Alexandria, Egypt.
| | - Khaled Aref
- Neurosurgery Department, Alexandria University, Khartoum sq. Al-Azareeta, Faculty of Medicine, Surgery Building 6th Floor Neurosurgery Department, Alexandria, Egypt
| | - Ahmed Farhoud
- Neurosurgery Department, Alexandria University, Khartoum sq. Al-Azareeta, Faculty of Medicine, Surgery Building 6th Floor Neurosurgery Department, Alexandria, Egypt
| | - Anwar Hekal
- Neurosurgery Department, Alexandria University, Khartoum sq. Al-Azareeta, Faculty of Medicine, Surgery Building 6th Floor Neurosurgery Department, Alexandria, Egypt
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Aljohani H, Romano A, Iaccarino C, Ganau M, Diemidio P, Chibbaro S. Pure Endoscopic Management of Fourth Ventricle Arachnoid Cyst: Case Report and Literature Review. Asian J Neurosurg 2018; 13:184-187. [PMID: 29492157 PMCID: PMC5820883 DOI: 10.4103/1793-5482.180956] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Arachnoid cysts (ACs) within the fourth ventricle are rare, and only a few cases have been reported in the literature. These are benign lesions within the arachnoid membrane, and they have been reported to occur in almost all locations where arachnoid is present. Different procedures have been performed to restore a normal cerebrospinal fluid dynamic and/or pressure, including shunting and partial or complete excision of the cyst by open microsurgery or endoscopic fenestration. We report the case of a fourth ventricle AC successfully treated using only endoscopic anterior trans-frontal cyst fenestration/marsupialization and standard third ventriculostomy. Clinical and technical features are discussed, along with the pertinent literature.
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Affiliation(s)
- Hani Aljohani
- Department of Neurosurgery, Pasteur Hospital of Colmar, Colmar, France
| | - A Romano
- Department of Neurosurgery, Parma University Hospital, Parma, Italy
| | - C Iaccarino
- Department of Neurosurgery, Parma University Hospital, Parma, Italy
| | - M Ganau
- Department of Neurosurgery, Parma University Hospital, Parma, Italy
| | - P Diemidio
- Department of Neurosurgery, Parma University Hospital, Parma, Italy
| | - S Chibbaro
- Department of Neurosurgery, Parma University Hospital, Parma, Italy
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Ishikawa T, Takeuchi K, Tsukamoto N, Kawabata T, Wakabayashi T. A Novel Dissection Method Using a Flexible Neuroendoscope for Resection of Tumors Around the Aqueduct of Sylvius. World Neurosurg 2017; 110:391-396. [PMID: 29158099 DOI: 10.1016/j.wneu.2017.11.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/04/2017] [Accepted: 11/07/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Flexible endoscopes have both a wide range of movement and a wide field of view and are therefore widely used for endoscopic third ventriculostomy and biopsy. However, tumor resection around the aqueduct of Sylvius using flexible endoscopes has scarcely been reported. CASE DESCRIPTION We report 2 cases of tumor resection around the aqueduct of Sylvius. The first case is a 38-year-old man presenting with progressive headache, nausea, and diplopia. Magnetic resonance imaging (MRI) revealed a 1.4 cm nonenhancing mass at the entry of the aqueduct of Sylvius and occlusive hydrocephalus. We performed tumor resection and endoscopic third ventriculostomy (ETV) simultaneously. His symptoms disappeared after the operation. Final pathologic diagnosis was ancient schwannoma. The second case is a 78-year-old woman presenting with progressive disturbance of consciousness (coma). MRI showed 0.7 cm nonenhancing mass at the entry of the aqueduct of Sylvius and occlusive hydrocephalus. We performed tumor resection and ETV similarly. Her consciousness improved after the operation. Final tumor diagnosis was cavernous malformation. In both cases there was no additional neurologic deficit after the surgery. CONCLUSIONS By using a flexible endoscope for tumor dissection, resection of a tumor without a neck, which cannot be removed through aspiration alone, becomes possible. To our knowledge, the presented cases are the first to describe the effectiveness of complete resection of a tumor in the third ventricle using flexible endoscopy.
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Affiliation(s)
| | | | - Nobuhiro Tsukamoto
- Department of Neurosurgery, Hekinan Municipal Hospital, Hekinan City, Japan
| | - Teppei Kawabata
- Department of Neurosurgery, Nagoya University, Nagoya City, Japan
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Neuroendoscopic management of posterior third ventricle ependymoma with intraaqueductal and fourth ventricle extension: a case report and review of the literature. Childs Nerv Syst 2017; 33:2057-2060. [PMID: 28721597 DOI: 10.1007/s00381-017-3543-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Posterior third ventricle ependymomas with intraaqueductal extension are relatively infrequent lesions. Its surgical management represents a formidable technical challenge and includes a wide variety of approaches. Minimally invasive surgery including the endoscopic management can play a crucial role to obtain an optimal clinical outcome. PATIENTS AND METHODS We report the clinical outcome of an 11-year-old female patient with a 6-year history of recurrent episodes of headache and vomiting. On brain MRI a posterior third ventricle lesion with extension to the aqueduct of Sylvius and fourth ventricle, and associated hydrocephalus was observed. RESULTS Our management of the lesion included a two-step endoscopic surgery: first an anterior third ventriculostomy and biopsy of the lesion that was reported to be a low-grade ependymoma, and posteriorly an endoscopic-assisted resection of the lesion. Clinical outcome was optimal without neurological sequelae. The postoperative MRI showed a thickened ependymal area on the tumor base of implantation. It was considered to be a remnant of the lesion and subsequently treated with radiotherapy. CONCLUSION Posterior third ventricle ependymomas with intraaqueductal extension can be endoscopically managed to obtain a successful outcome.
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Iacoangeli M, Colasanti R, Esposito D, Di Rienzo A, di Somma L, Dobran M, Gladi M, Scerrati M. Supraorbital subfrontal trans-laminar endoscope-assisted approach for tumors of the posterior third ventricle. Acta Neurochir (Wien) 2017; 159:645-654. [PMID: 28236180 DOI: 10.1007/s00701-017-3117-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Different surgical approaches have been developed for dealing with third ventricle lesions, all aimed at obtaining a safe removal minimizing brain manipulation. The supraorbital subfrontal trans-lamina terminalis route, commonly employed only for the anterior third ventricle, could represent, in selected cases with endoscopic assistance, an alternative approach to posterior third ventricular lesions. METHODS Seven patients underwent a supraorbital subfrontal trans-laminar endoscope-assisted approach to posterior third ventricle tumors (two craniopharyngiomas, one papillary tumor of the pineal region, one pineocytoma, two neurocytomas, one glioblastoma). Moreover, a conventional third ventriculostomy was performed via the same trans-laminar approach in four cases. RESULTS Complete tumor removal was accomplished in four cases, subtotal removal in two cases, and a simple biopsy in one case. Adjuvant radiotherapy and/or chemotherapy was administered, if required, on the basis of the histologic diagnosis. No major complications occurred after surgery except for an intratumoral hemorrhage in a patient undergoing a biopsy for a glioblastoma, which simply delayed the beginning of adjuvant radiochemotherapy. No ventriculoperitoneal shunt placement was needed in these patients at the most recent clinical and radiologic session (average 39.57 months, range 13-85 months). Two illustrative cases are presented. CONCLUSIONS The supraorbital subfrontal trans-laminar endoscope-assisted approach may provide, in selected cases, an efficient and safe route for dealing with posterior third ventricular tumors.
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Manjila S, Mencattelli M, Rosa B, Price K, Fagogenis G, Dupont PE. A multiport MR-compatible neuroendoscope: spanning the gap between rigid and flexible scopes. Neurosurg Focus 2017; 41:E13. [PMID: 27581309 DOI: 10.3171/2016.7.focus16181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Rigid endoscopes enable minimally invasive access to the ventricular system; however, the operative field is limited to the instrument tip, necessitating rotation of the entire instrument and causing consequent tissue compression while reaching around corners. Although flexible endoscopes offer tip steerability to address this limitation, they are more difficult to control and provide fewer and smaller working channels. A middle ground between these instruments-a rigid endoscope that possesses multiple instrument ports (for example, one at the tip and one on the side)-is proposed in this article, and a prototype device is evaluated in the context of a third ventricular colloid cyst resection combined with septostomy. METHODS A prototype neuroendoscope was designed and fabricated to include 2 optical ports, one located at the instrument tip and one located laterally. Each optical port includes its own complementary metal-oxide semiconductor (CMOS) chip camera, light-emitting diode (LED) illumination, and working channels. The tip port incorporates a clear silicone optical window that provides 2 additional features. First, for enhanced safety during tool insertion, instruments can be initially seen inside the window before they extend from the scope tip. Second, the compliant tip can be pressed against tissue to enable visualization even in a blood-filled field. These capabilities were tested in fresh porcine brains. The image quality of the multiport endoscope was evaluated using test targets positioned at clinically relevant distances from each imaging port, comparing it with those of clinical rigid and flexible neuroendoscopes. Human cadaver testing was used to demonstrate third ventricular colloid cyst phantom resection through the tip port and a septostomy performed through the lateral port. To extend its utility in the treatment of periventricular tumors using MR-guided laser therapy, the device was designed to be MR compatible. Its functionality and compatibility inside a 3-T clinical scanner were also tested in a brain from a freshly euthanized female pig. RESULTS Testing in porcine brains confirmed the multiport endoscope's ability to visualize tissue in a blood-filled field and to operate inside a 3-T MRI scanner. Cadaver testing confirmed the device's utility in operating through both of its ports and performing combined third ventricular colloid cyst resection and septostomy with an endoscope rotation of less than 5°. CONCLUSIONS The proposed design provides freedom in selecting both the number and orientation of imaging and instrument ports, which can be customized for each ventricular pathological entity. The lightweight, easily manipulated device can provide added steerability while reducing the potential for the serious brain distortion that happens with rigid endoscope navigation. This capability would be particularly valuable in treating hydrocephalus, both primary and secondary (due to tumors, cysts, and so forth). Magnetic resonance compatibility can aid in endoscope-assisted ventricular aqueductal plasty and stenting, the management of multiloculated complex hydrocephalus, and postinflammatory hydrocephalus in which scarring obscures the ventricular anatomy.
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Affiliation(s)
- Sunil Manjila
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Margherita Mencattelli
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benoit Rosa
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karl Price
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Georgios Fagogenis
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pierre E Dupont
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Inoue A, Ohnishi T, Kohno S, Ohue S, Iwata S, Matsumoto S, Nishikawa M, Ozaki S, Mizuno Y, Kitazawa R, Kunieda T. Identification of characteristic features of pineal germinoma that enhance accuracy of preoperative differentiation in pineal region tumors: its significance on optimum surgical treatment. Neurosurg Rev 2017; 41:197-206. [PMID: 28247123 DOI: 10.1007/s10143-017-0835-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/06/2016] [Accepted: 02/20/2017] [Indexed: 11/24/2022]
Abstract
The aim of the study is to identify characteristic features of pineal germinoma that enhance preoperative accuracy in differentiating germinoma from other pineal region tumors. Twenty-one consecutive patients with pineal region tumors were enrolled. In all patients, tumor resection was performed to verify the histology. Clinical records including upward gaze palsy of Parinaud's syndrome and neuroimaging were analyzed. In addition, we evaluated the relationship between magnetic resonance imaging (MRI) findings and tumor progression patterns in pineal germinoma. Among 21 patients, 15 patients were diagnosed with germ cell tumor, 4 with pineal parenchymal cell tumor, and 2 with meningioma. Upward gaze palsy was seen in 11 patients; nine had pure germinomas and two had mixed germ cell tumors. These tumors occupied the pineal region with extension to the area of the mesodiencephalic junction (MDJ) and the bi-epithalamic area between the bilateral pulvinar and the third ventricle. Tumor involvement of the former area could cause upward gaze palsy by insulting the rostral interstitial nucleus of the medial longitudinal fasciculus located in the MDJ area. Tumor invasion into the latter area is commonly seen as a cardioid-shaped tumor as the tumor image on the axial MRI view. Upward gaze palsy and a cardioid-shaped tumor image on the axial MRI views were demonstrated to be specific features of pineal pure germinoma. It is suggested that combination of both features may become useful tools to preoperatively differentiate germinoma from other pineal tumors, resulting in achievement of the optimum treatment of pineal region tumors.
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Affiliation(s)
- Akihiro Inoue
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Takanori Ohnishi
- Department of Neurosurgery, Washoukai Sadamoto Hospital, 1-6-1 Takehara, Matsuyama, Ehime, 790-0052, Japan
| | - Shohei Kohno
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Shiro Ohue
- Department of Neurosurgery, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan
| | - Shinji Iwata
- Department of Neurosurgery, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan
| | - Shirabe Matsumoto
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Masahiro Nishikawa
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Saya Ozaki
- Department of Neurosurgery, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan
| | - Yosuke Mizuno
- Division of Diagnostic Pathology, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Riko Kitazawa
- Division of Diagnostic Pathology, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Takeharu Kunieda
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
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Nagm A, Ogiwara T, Goto T, Chiba A, Hongo K. Neuroendoscopy via an Extremely Narrow Foramen of Monro: A Case Report. NMC Case Rep J 2016; 4:37-42. [PMID: 28664024 PMCID: PMC5364906 DOI: 10.2176/nmccrj.cr.2016-0157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/18/2016] [Indexed: 11/25/2022] Open
Abstract
Herein, safe and reliable neuroendoscopic biopsy via an extremely narrow foramen of Monro (ENFM) for a non-hydrocephalic patient with hypothalamic and pineal region tumors was successfully applied. A 17-year-old boy presented with hypothalamic manifestations attributed to hypothalamic and pineal region tumors. Small ventricles were seen. Intraoperatively, to advance different diameter steerable fiberscopes via ENFM, the third ventricle was flushed to induce a moment increase in the intraventricular pressure with subsequent dilatation of FM. Postoperative course was uneventful. Histopathological studies revealed a yolk sac tumor. Adjuvant therapy was applied. Follow-up neuroimaging disclosed marvellous improvement of the condition. His symptoms gradually improved.
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Affiliation(s)
- Alhusain Nagm
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan and.,Department of Neurosurgery, Al-Azhar University Faculty of Medicine-Nasr city, Cairo, Egypt
| | - Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan and
| | - Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan and
| | - Akihiro Chiba
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan and
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan and
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Waqar M, Ellenbogen JR, Stovell MG, Al-Mahfoudh R, Mallucci C, Jenkinson MD. Long-Term Outcomes of Endoscopic Third Ventriculostomy in Adults. World Neurosurg 2016; 94:386-393. [DOI: 10.1016/j.wneu.2016.07.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 11/30/2022]
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Eastwood KW, Bodani VP, Drake JM. Three-Dimensional Simulation of Collision-Free Paths for Combined Endoscopic Third Ventriculostomy and Pineal Region Tumor Biopsy: Implications for the Design Specifications of Future Flexible Endoscopic Instruments. Oper Neurosurg (Hagerstown) 2016; 12:231-238. [PMID: 29506110 DOI: 10.1227/neu.0000000000001177] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/18/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recent innovations to expand the scope of intraventricular neuroendoscopy have focused on transitioning multiple-incision procedures into single-corridor approaches. However, the successful adoption of these combined procedures requires minimizing the unwanted torques applied to surrounding healthy structures. OBJECTIVE To define the geometry of relevant anatomical structures in endoscopic third ventriculostomy (ETV) and pineal region tumor biopsy (ETB). Second, to determine the optimal instrument shaft path required for collision-free single burr hole combined ETV/ETB. METHODS Magnetic resonance and computed tomography data from 15 pediatric patients who underwent both ETV and ETB procedures between 2006 and 2014 was segmented by using the 3DSlicer software package to create virtual 3-D patient models. Anatomical regions of interest were measured including the foramen of Monro, the massa intermedia, the floor of the third ventricle, and the tumor margin. Utilizing the MATLAB software package, virtual dexterous instruments were inserted into the models and optimal dimensions were calculated. RESULTS The diameters of the foramen of Monro, massa intermedia (anterior-posterior, superior-inferior), anterior third ventricle, and tumor margin are 6.85, 4.01, 5.05, 14.2, and 28.5 mm, respectively. The average optimal burr placement was determined to be 22.5 mm anterior to the coronal and 30 mm lateral to the sagittal sutures. Optimal flexible instrument geometries for novel instruments were calculated. CONCLUSION We have established a platform for estimating the shape of novel curved dexterous instruments for collision-free targeting of multiple intraventricular points, which is both patient and tool specific and can be integrated with image guidance. These data will aid in developing novel dexterous instruments.
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Affiliation(s)
- Kyle W Eastwood
- Institute of Biomaterials and Biomedical Engineering, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Center for Image Guided Innovation and Therapeutic Intervention (CIGITI), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vivek P Bodani
- Institute of Biomaterials and Biomedical Engineering, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Center for Image Guided Innovation and Therapeutic Intervention (CIGITI), Hospital for Sick Children, Toronto, Ontario, Canada
| | - James M Drake
- Institute of Biomaterials and Biomedical Engineering, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Center for Image Guided Innovation and Therapeutic Intervention (CIGITI), Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
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Endoscopic Histologic Mapping of a Mixed Germ Pineal Tumor. World Neurosurg 2016; 95:625.e1-625.e5. [PMID: 27554308 DOI: 10.1016/j.wneu.2016.08.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND The accurate histologic diagnosis of germ cell tumors in the pineal region is a keystone for determining the best treatment strategy and prognosis. This situation poses a challenge for the neuropathologist, considering the lack of a standarized procedure to obtain biopsy samples, which results in few and small specimens, which are not suitable for diagnosis. CASE DESCRIPTION We report a case in which a pineal region mixed germ cell tumor was accurately diagnosed by performing histologic mapping through a dual burr-hole endoscopic approach. The technical pitfalls and other considerations necessary for obtaining an accurate diagnosis in this tumor subgroup are specified. In addition, the histologic analysis regarding the sampling technique used is described. CONCLUSIONS The supraorbital frontal endoscopic approach enables the surgeon to perform histologic mapping of pineal region tumors, allowing standarization of the procedure used to obtain the specimens. This approach could result in a more accurate diagnosis, especially in mixed germ cell neoplasms.
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Eastwood KW, Looi T, Naguib HE, Drake JM. Design optimization of neuroendoscopic continuum instruments for third ventriculostomy and tumor biopsy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:4853-6. [PMID: 26737380 DOI: 10.1109/embc.2015.7319480] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A simulation-based approach to the design of procedure-specific dexterous neuroendoscopic continuum instruments for endoscopic third ventriculostomy and tumor biopsy is proposed. Given pre-operative CT and MRI images, the algorithm returns instrument design specifications including lengths, curvatures and alternative positions for the surgical incision while respecting anatomical boundaries. This methodology proposes a novel clinically-guided geometric representation of surgical targets specific to this indication. The additional constraints imposed by the presence of surgical trocars and endoscopes are also considered. Finally, we conclude with a clinical example to demonstrate the proposed approach.
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Kato T, Okumura I, Kose H, Takagi K, Hata N. Tendon-driven continuum robot for neuroendoscopy: validation of extended kinematic mapping for hysteresis operation. Int J Comput Assist Radiol Surg 2015; 11:589-602. [PMID: 26476639 DOI: 10.1007/s11548-015-1310-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/28/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE The hysteresis operation is an outstanding issue in tendon-driven actuation--which is used in robot-assisted surgery--as it is incompatible with kinematic mapping for control and trajectory planning. Here, a new tendon-driven continuum robot, designed to fit existing neuroendoscopes, is presented with kinematic mapping for hysteresis operation. METHODS With attention to tension in tendons as a salient factor of the hysteresis operation, extended forward kinematic mapping (FKM) has been developed. In the experiment, the significance of every component in the robot for the hysteresis operation has been investigated. Moreover, the prediction accuracy of postures by the extended FKM has been determined experimentally and compared with piecewise constant curvature assumption. RESULTS The tendons were the most predominant factor affecting the hysteresis operation of the robot. The extended FKM including friction in tendons predicted the postures in the hysteresis operation with improved accuracy (2.89 and 3.87 mm for the single and the antagonistic-tendons layouts, respectively). The measured accuracy was within the target value of 5 mm for planning of neuroendoscopic resection of intraventricle tumors. CONCLUSION The friction in tendons was the most predominant factor for the hysteresis operation in the robot. The extended FKM including this factor can improve prediction accuracy of the postures in the hysteresis operation. The trajectory of the new robot can be planned within target value for the neuroendoscopic procedure by using the extended FKM.
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Affiliation(s)
- Takahisa Kato
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Healthcare Optics Research Laboratory, Canon U.S.A., Inc., Cambridge, MA, USA
| | | | | | | | - Nobuhiko Hata
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. .,Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
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Chaussemy D, Cebulla H, Coca A, Chibarro S, Proust F, Kehrli P. Interest and limits of endoscopic approaches for pineal region tumours. Neurochirurgie 2015; 61:160-3. [PMID: 25911532 DOI: 10.1016/j.neuchi.2015.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 03/07/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
Abstract
Endoscopy of pineal region tumours has been developed since the year 2000 either via a transventricular or extracerebral approach. The initial purpose of applying neuroendoscopy in the management of pineal region tumours was to resolve the obstructive hydrocephalus, and identify the pathological characteristics of the tumour. Based on this approach, a piecemeal resection of the tumour can be performed. The approaches, derived from the microsurgical pathway using an endoscope to expose the operative field, have been proposed either via an infratentorial supracerebellar approach or posterior transtentorial interhemispheric approach. Neuroendoscopic procedures can be considered as a therapeutic alternative to the microsurgical approach when CSF markers are negative. This procedure is considered mini-invasive for the approach along the surgical corridor access but extensive and in depth at the interface between the tumour and the surrounding neurological parenchyma. The limitations and complications are related to the type of procedure (mono- or bimanual) as well as the tumoral characteristics. Different approaches are presented in detail in order to avoid the occurrence of any surgical complications.
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Affiliation(s)
- D Chaussemy
- Department of neurosurgery, Strasbourg university hospital, hôpital Hautepierre, avenue Molière, 67000 Strasbourg cedex, France
| | - H Cebulla
- Department of neurosurgery, Strasbourg university hospital, hôpital Hautepierre, avenue Molière, 67000 Strasbourg cedex, France
| | - A Coca
- Department of neurosurgery, Strasbourg university hospital, hôpital Hautepierre, avenue Molière, 67000 Strasbourg cedex, France
| | - S Chibarro
- Department of neurosurgery, Strasbourg university hospital, hôpital Hautepierre, avenue Molière, 67000 Strasbourg cedex, France
| | - F Proust
- Department of neurosurgery, Strasbourg university hospital, hôpital Hautepierre, avenue Molière, 67000 Strasbourg cedex, France.
| | - P Kehrli
- Department of neurosurgery, Strasbourg university hospital, hôpital Hautepierre, avenue Molière, 67000 Strasbourg cedex, France
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Neuroendoscopy and pineal tumors: A review of the literature and our considerations regarding its utility. Neurochirurgie 2015; 61:155-9. [DOI: 10.1016/j.neuchi.2013.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 11/28/2013] [Accepted: 12/08/2013] [Indexed: 11/20/2022]
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Ahmed AI, Zaben MJ, Mathad NV, Sparrow OC. Endoscopic Biopsy and Third Ventriculostomy for the Management of Pineal Region Tumors. World Neurosurg 2015; 83:543-7. [DOI: 10.1016/j.wneu.2014.11.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 07/12/2014] [Accepted: 11/20/2014] [Indexed: 10/24/2022]
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Cavallo LM, Di Somma A, de Notaris M, Prats-Galino A, Aydin S, Catapano G, Solari D, de Divitiis O, Somma T, Cappabianca P. Extended Endoscopic Endonasal Approach to the Third Ventricle: Multimodal Anatomical Study with Surgical Implications. World Neurosurg 2015; 84:267-78. [PMID: 25827043 DOI: 10.1016/j.wneu.2015.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 03/04/2015] [Accepted: 03/05/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A certain interest for the extended endoscopic endonasal approach for the management of sellar-suprasellar lesions extending inside the third ventricle has been growing in recent years. The aim of this anatomical study was to evaluate the possibilities in terms of exposure and access to the different areas of the third ventricle, with the endoscopic endonasal technique, as compared with the microscopic or endoscopic view provided via different transcranial approaches. The advantages and limitations of both surgical pathways were analyzed. MATERIALS AND METHODS Ten human cadaver heads were dissected. In order to standardize the comparison between the endonasal and the transcranial routes, the third ventricle cavity has been divided into four areas by means of two ideal planes, one passing through the optic chiasm and the interthalamic commissure and one passing through the posterior edge of the foramen of Monro and the interthalamic commissure. Accordingly, two anterior (infundibular and foraminal) and two posterior (mesencephalic and tectal) areas have been defined. RESULTS The endoscopic endonasal approach allows for exploration and surgical maneuverability, especially in the anterior areas of the third ventricle. In the infundibular and foraminal areas the surgical maneuverability seems to be better as compared with that obtained inside the mesencephalic region, while via the endonasal route the tectal area could not be reached. In particular, the infundibular area can be explored either passing through the lamina terminalis or via the tuber cinereum; this latter trajectory enables visualization of the foramina of Monro and the floor of the third ventricle up to the pineal recess. CONCLUSION This anatomical study shows that the lamina terminalis and, above all, the tuber cinereum represent two safe entry points defining possible surgical corridors to be considered for the extended endoscopic endonasal approach to the third ventricle.
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Affiliation(s)
- Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy.
| | - Alberto Di Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Matteo de Notaris
- Department of Neuroscience, G. Rummo Hospital, Neurosurgery Operative Unit, Benevento, Italy
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Salih Aydin
- Department of Neurosurgery, Emsey Hospital, Pendik, Istanbul, Turkey
| | - Giuseppe Catapano
- Department of Neuroscience, G. Rummo Hospital, Neurosurgery Operative Unit, Benevento, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Oreste de Divitiis
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Paolo Cappabianca
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
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Giannetti AV, Alvarenga AYH, de Lima TOL, Pedrosa HASR, Souweidane MM. Neuroendoscopic biopsy of brain lesions: accuracy and complications. J Neurosurg 2015; 122:34-9. [PMID: 25361487 DOI: 10.3171/2014.9.jns132648] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors conducted a study to analyze the accuracy of neuroendoscopic biopsies of ventricular and periventricular lesions and record any difficulties or complications of the neuroendoscopic biopsy procedure. METHODS A total of 50 patients with different diseases consecutively underwent endoscopic biopsy procedures. The biopsy result was considered diagnostic if the pathologist reported any specific finding on which clinicians could base decisions about treatment or observation. The biopsy result was referred to as accurate if the results matched results of a sample obtained later or if the treatment response and disease evolution were compatible with the diagnosis. The biopsy result was considered inaccurate if results showed any relevant differences from those of the later sample or if the patient's disease did not evolve as expected. Complications were recorded and compared with those found in a literature review. RESULTS For 2 patients, the procedure had to be terminated. The biopsy diagnostic rate was 89.6%, and the accuracy rate was 86%. Complications associated with the procedure were 3 hemorrhages (6%), 2 infections (4%), and 1 death (2%); no reoperations were needed. CONCLUSIONS Endoscopic biopsy seems to be an accurate procedure with acceptable morbidity and mortality rates.
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True aqueductal tumors: a unique entity. Acta Neurochir (Wien) 2015; 157:169-77. [PMID: 25377385 DOI: 10.1007/s00701-014-2264-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pure aqueductal tumors (ATs) differ from pineal region and tectal/tegmental tumors in that they are epicentered within the aqueduct. Nevertheless, these tumors are rarely described as a separate type of tumor, and are often grouped with other lesions located in the same vicinity. The present multicenter study focuses on our experience treating patients with pure ATs. METHODS Data from three large tertiary centers was collected retrospectively, including presenting symptoms, treatment paradigm, surgical approaches, pathology, and outcome. RESULTS Between 1999 and 2013, 16 patients with AT were diagnosed and treated at the three tertiary centers. Ages at presentation ranged from 5.5 to 57 years. Thirteen patients presented with hydrocephalus-related symptoms, and two were identified incidentally. Thirteen patients underwent an endoscopic third ventriculostomy, and two of these underwent a simultaneous endoscopic biopsy (one grade II ependymoma, one non-specified low-grade glioma). Two others underwent shunt placement. Three patients underwent resection due to tumor progression. Pathologies included glioblastoma multiforme, glioneural tumor, and ependymoma grade II. All non-resected tumors remained stable or grew only minimally. CONCLUSIONS 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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Azab WA, Nasim K, Chelghoum A, Parwez A, Salaheddin W. Endoscopic biopsy of brain tumors: Does the technique matter? Surg Neurol Int 2014; 5:159. [PMID: 25506504 PMCID: PMC4253053 DOI: 10.4103/2152-7806.144597] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/20/2014] [Indexed: 12/13/2022] Open
Abstract
Background: Endoscopic biopsy of brain tumors is an important part of the armamentarium of management of intra- and periventricular tumors that is generally considered an acceptable and, in some situations, a preferred method for tissue sampling. The diagnostic yield of the procedure has been variably reported. Technical aspects of the procedure should undoubtedly reflect on its success rate and accuracy. Such impact on diagnostic yield of endoscopic brain biopsy is infrequently discussed in the literature. Methods: A search of the medical literature was conducted for publications on endoscopic brain biopsy. These reports were analyzed regarding the various technical aspects. Results: In the 43 publications analyzed, lenscopes were exclusively used in 22 reports and a tissue diagnosis was possible in 362 out of 387 endoscopic biopsies with a diagnostic yield of 93.54%. Only fiberscopes were used in 8 reports and a tissue diagnosis was possible in 100 out of 132 endoscopic biopsies with a diagnostic yield of 75.76%. The diagnostic yield in the mixed and unspecified groups was 88.95 and 88.04%, respectively. Very few details on the histopathological methods and tumor molecular genetics could be found. Conclusion: Endoscopic biopsy of brain tumors has a higher diagnostic yield when lenscopes are used. Neuronavigation seems to add to the diagnostic accuracy of the procedure. Studies detailing molecular genetic features of biopsied tumors are necessary in the future.
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Affiliation(s)
- Waleed A Azab
- Neurosurgery Department, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Khurram Nasim
- Neurosurgery Department, Ibn Sina Hospital, Kuwait City, Kuwait
| | | | - Aslam Parwez
- Neurosurgery Department, Ibn Sina Hospital, Kuwait City, Kuwait
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Balossier A, Blond S, Touzet G, Lefranc M, de Saint-Denis T, Maurage CA, Reyns N. Endoscopic versus stereotactic procedure for pineal tumour biopsies: Comparative review of the literature and learning from a 25-year experience. Neurochirurgie 2014; 61:146-54. [PMID: 25312672 DOI: 10.1016/j.neuchi.2014.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 04/17/2014] [Accepted: 06/06/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE Pineal tumours account for 1% to 4% of brain tumours in adults and for around 10% in children. Except in a few cases where germ cell markers are elevated, accurate histological samples are mandatory to initiate the treatment. Open surgery still has a high morbidity and is often needless. Biopsies can either be obtained by endoscopic or stereotactic procedures. METHODS Following an extensive review of the literature (PubMed 1970-2013; keywords pineal tumour, biopsy; English and French), 33 studies were analysed and relevant data compared regarding the type of procedure, diagnosis rate, cerebrospinal fluid diversion type and rate, perioperative mortality, morbidity. RESULTS Endoscopic and stereotactic biopsies showed a diagnosis rate of 81.1% (20%-100%) and 93.7% (82%-100%), respectively. Endoscopic biopsies involved 21.0% of minor and 2.0% of major complications whereas stereotactic biopsies involved 6.4% of minor and 1.6% of major complications. The most frequently reported complication was haemorrhage for both endoscopic and stereotactic procedures, accounting for 4.8% and 4.3%, respectively. Mortality rate was low for both endoscopic and stereotactic procedures, equal to 0.4% and 1.3%, respectively. Local experience of stereotactic biopsies was also reported and corroborated the previous data. CONCLUSIONS The difference between both procedures is not statistically significant (p>0.05) across large series (≥20patients). Nevertheless, tissue diagnosis appears less accurate with endoscopic procedures than with stereotactic procedures (81.1% versus 93.7%, weighted mean across all series). In our opinion, the neuroendoscopic approach is the best tool for managing hydrocephalus, whereas stereotactic biopsies remain the best way to obtain a tissue diagnosis with accuracy and low morbidity.
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Affiliation(s)
- A Balossier
- Service de neurochirurgie, CHRU de Lille, 59037 Lille, France; Service de neurochirurgie, CHU de Caen, 14000 Caen, France.
| | - S Blond
- Service de neurochirurgie, CHRU de Lille, 59037 Lille, France.
| | - G Touzet
- Service de neurochirurgie, CHRU de Lille, 59037 Lille, France
| | - M Lefranc
- Service de neurochirurgie, CHU d'Amiens, 80000 Amiens, France
| | | | - C-A Maurage
- Laboratoire d'anatomo-pathologie, CHRU de Lille, 59037 Lille, France
| | - N Reyns
- Service de neurochirurgie, CHRU de Lille, 59037 Lille, France
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