Tumors of the Lateral Ventricle and the Pineal Region

Abstract The results of endoscopic biopsy in 21 cases of intraventricular tumor are presented. The details of the equipment are given. Of the 21 tumors biopsied, there were 9 in the lateral ventricle, 2 in the thalamus, 6 in the anterior portion of the 3rd ventricle, and 4 in the pineal region. A correct histological diagnosis was made in 11 cases (52.4%). No serious complications were noted. The value of the procedure is discussed.

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Flexible endoscopy for management of intraventricular brain tumors in patients with small ventricles

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.7.peds13648 ◽

2014 ◽

Vol 14 (5) ◽

pp. 490-494 ◽

Cited By ~ 7

Author(s):

Hideki Ogiwara ◽

Nobuhito Morota

Keyword(s):

Brain Tumors ◽

Endoscopic Surgery ◽

Retrospective Review ◽

Lateral Ventricle ◽

Fourth Ventricle ◽

Flexible Endoscopy ◽

Pineal Region ◽

Flexible Endoscope ◽

Suprasellar Region ◽

Occipital Horn

Object Endoscopic surgery is generally withheld in patients with small ventricles due to difficulties in ventricular cannulation and intraventricular manipulation. The effectiveness of flexible endoscopy for management of intraventricular brain tumors in patients with small ventricles was evaluated. Methods Forty-five patients who underwent endoscopic surgery with a flexible endoscope for intraventricular brain tumors were divided into small-ventricle and ventriculomegaly groups according to the frontal and occipital horn ratio (FOR). Retrospective review of these cases was performed and achievement of surgical goals and morbidity were assessed. Results Among the 45 patients, there were 14 with small ventricles and 31 with ventriculomegaly. In the smallventricle group, targeted tumors were located in the suprasellar region in 12 patients and in the pineal region in 2. In the ventriculomegaly group, tumors were located in the pineal region in 15 patients, in the suprasellar region in 9, in the lateral ventricle in 4, in the midbrain in 2, and in the fourth ventricle in 1. In the small-ventricle group, ventricular cannulation was successful and the surgical goals were accomplished in all patients. In ventriculomegaly group, sampling of the tumor was not diagnostic due to intraoperative hemorrhage in 1 patient. There were no significant differences in the rate of achieving the surgical goals or the morbidity between the 2 groups. Conclusions Endoscopic surgery using a flexible endoscope is useful for management of intraventricular brain tumors in patients with small ventricles. A flexible endoscope allows excellent maneuverability in introducing the device into the lateral ventricle and manipulating through small ventricles.

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Microsurgery of the Third Ventricle: Part 1

Neurosurgery ◽

10.1227/00006123-198103000-00006 ◽

1981 ◽

Vol 8 (3) ◽

pp. 334-356 ◽

Cited By ~ 92

Author(s):

Isao Yamamoto ◽

Albert L. Rhoton ◽

David A. Peace

Keyword(s):

Lateral Ventricle ◽

Anterior Part ◽

Third Ventricle ◽

Posterior Part ◽

Posterior Wall ◽

Pineal Region ◽

Circle Of Willis ◽

Cerebral Vein ◽

Foramen Of Monro ◽

3Rd Ventricle

Abstract The 3rd ventricle is one of the most surgically inaccessible areas in the brain. It is impossible to reach its cavity without incising some neural structures. Twenty-five cadaveric brains were examined in detail to evaluate the surgically important relationships of the walls of the 3rd ventricle. The routes through which the 3rd ventricle can be reached are: (a) from above, through the foramen of Monro and the roof after entering the lateral ventricle through the corpus callosum or the cerebral cortex; (b) from anterior, through the lamina terminalis; (c) from below, through the floor if it has been stretched by tumor; and (d) from posterior, through the pineal region or from the posterior part of the lateral ventricle through the crus of the fornix. The posterior part of the circle of Willis and the basilar artery are intimately related to the floor, the anterior part of the circle of Willis and the anterior cerebral and anterior communicating arteries are related to the anterior wall, and the posterior cerebral artery supplies the posterior wall. The deep cerebral venous system is intimately related to the 3rd ventricle; the internal cerebral vein is related to the roof, and the basal vein is related to the floor. The junction of these veins with the great vein forms a formidable obstacle to the operative approach to the pineal gland and the posterior part of the 3rd ventricle.

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Endoscopic biopsy of brain tumors in children: diagnostic success and utility in guiding treatment strategies

Journal of Neurosurgery Pediatrics ◽

10.3171/2009.10.peds09172 ◽

2010 ◽

Vol 5 (3) ◽

pp. 255-262 ◽

Cited By ~ 39

Author(s):

Edward S. Ahn ◽

Liliana Goumnerova

Keyword(s):

Brain Tumors ◽

Tumor Marker ◽

Lateral Ventricle ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Pineal Region ◽

Endoscopic Biopsy ◽

Neurological Deficits ◽

Third Ventriculostomy ◽

Consecutive Series

Object Endoscopic biopsy is an important minimally invasive method of diagnosis in the initial management of lesions in children with intraventricular and periventricular tumors. The procedure can be performed in conjunction with CSF-diverting procedures for obstructive hydrocephalus. The authors present their single-institution experience in a predominantly pediatric series with respect to diagnostic efficacy, utility in guiding treatment plans, and safety. Methods A retrospective review was conducted in a consecutive series of patients who underwent endoscopic biopsy of brain tumors during a 13-year period. Results There were 33 endoscopic biopsies in 31 patients (16 males and 15 females). The average age of the patients was 11.3 years, with a mean follow-up duration of 2.4 years. The majority of biopsies were performed in conjunction with CSF-diverting procedures, such as endoscopic third ventriculostomy or fenestration of the septum pellucidum. Overall, 23 (70%) of 33 biopsies were diagnostic, with results that directed subsequent treatment. When stratified by tumor location, biopsy samples obtained in the lateral ventricle or pineal region were more favorable toward a successful diagnosis than those in the thalamus or tectal region. In 4 cases, elevated CSF tumor marker levels led to modification of the diagnosis and appropriate adjustment of treatment. The endoscopic third ventriculostomy success rate was 82.4%. There were 2 major complications (6.1%), which resulted in neurological deficits. There were no procedure-related deaths. Conclusions Endoscopic biopsy is an effective means of diagnosis of brain tumors in children. The diagnostic power may be more favorable with tumors in the lateral ventricle or pineal region. Collection of CSF during the procedure for tumor marker analysis is an integral component of diagnosis.

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