Endoscopic Biopsy and Third Ventriculostomy for the Management of Pineal Region Tumors

2015 ◽  
Vol 83 (4) ◽  
pp. 543-547 ◽  
Author(s):  
Aminul I. Ahmed ◽  
Malik J. Zaben ◽  
Nijaguna V. Mathad ◽  
Owen C.E. Sparrow
Keyword(s):  
Pineal Region ◽  
Endoscopic Biopsy ◽  
Third Ventriculostomy ◽  
Pineal Region Tumors

scholarly journals The Role of Neuroendoscopy in the Treatment of Pineal Region Tumors

2018 ◽  
Vol 22 (2) ◽  
pp. 21-25
Author(s):  
Flávio Ramalho Romero ◽  
Eduardo De Freitas Bertolini ◽  
Adalberto Sestari ◽  
Sérgio Soares Guerrero ◽  
Ramon Barbalha Guerrero ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Pineal Region ◽  
Endoscopic Biopsy ◽  
Third Ventriculostomy ◽  
Tumor Biopsy ◽  
Pineal Tumors ◽  
Pineal Region Tumors ◽  
Therapeutic Outcomes ◽  
Initial Procedure

Object. The authors report their experience in six patients presenting with pineal tumors and associated hydrocephalus who underwent an endoscopic biopsy procedure and third ventriculostomy (ETV) in a single setting. The purpose of this report is to discuss the role of neuroendoscopic procedures in the management of pineal region tumors. Methods. A retrospective review of patients undergoing simultaneous ETV and tumor biopsy was ndertaken. Neuroendoscopic surgery was first applied for tumor debulking with tissue diagnosis and gross morphological analysis of the tumor and the intraventricular structures, followed by third ventriculostomy. Subsequent procedures were determined on the basis of verified individual tumors. Results. Over a 2-year interval, 6 patients underwent simultaneous ETV and tumor management. These patients ranged from 6 to 54 years of age (mean 24.3 years). All cases were completed without complications or the need for an additional CSF diversionary procedure within 6 months. The diagnostic yield of the biopsy was 100%. Favorable therapeutic outcomes were obtained in all cases of germinoma and pineoblastoma, with follow-up periods ranging from 6 to 24 months. Conclusion. The majority of our patients with dilated ventricles were treated satisfactorily with effective neuroendoscopic procedures as the initial procedure, avoiding unnecessary craniotomy and promising excellent therapeutic outcomes.

Endoscopic biopsy during third ventriculostomy in paediatric pineal region tumours

2008 ◽  
Vol 24 (11) ◽  
pp. 1323-1326 ◽  
Author(s):  
Yahia Z. Al-Tamimi ◽  
Deepti Bhargava ◽  
Surash Surash ◽  
Roberto E. Ramirez ◽  
Federica Novegno ◽  
...  
Keyword(s):  
Pineal Region ◽  
Endoscopic Biopsy ◽  
Third Ventriculostomy ◽  
Pineal Region Tumours

Efficacy of neuroendoscopic procedures in minimally invasive preferential management of pineal region tumors: a prospective study

2000 ◽  
Vol 93 (2) ◽  
pp. 245-253 ◽  
Author(s):  
Shizuo Oi ◽  
Masayoshi Shibata ◽  
Jiro Tominaga ◽  
Yumie Honda ◽  
Masaki Shinoda ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Prospective Study ◽  
Pineal Region ◽  
Third Ventriculostomy ◽  
Content Type ◽  
Pineal Region Tumors ◽  
Therapeutic Outcomes ◽  
Tumor Dissemination ◽  
Tumor Debulking ◽  
Fine Print

Object. This prospective study is based on a consecutive series of 20 patients with pineal region tumors who underwent minimally invasive preferential management. The purpose of this report is to discuss the role of neuroendoscopic procedures in the management of pineal region tumors.Methods. If the tumor markers α-fetoprotein and human chorionic gonadotropin were not detected in serum and there was significant ventricular dilation visualized on neuroimages, neuroendoscopic surgery was first applied for tumor debulking with tissue diagnosis and gross morphological analysis of the tumor and the intraventricular structures, followed by third ventriculostomy.Subsequent procedures were determined on the basis of verified individual tumors. For treatment of germinomas and pineoblastomas, if no tumor dissemination was confirmed by pre-, intra-, or postoperative findings, stereotactic radiotherapy or radiosurgery was performed after one course of chemotherapy with the ICE regimen (isofomid, cisplatin, and etoposide) and followed by two additional courses of chemotherapy. For treatment of malignant germ cell tumors, after extensive surgery, adjuvant chemotherapy with the ICE regimen was performed in three courses in all cases. Then radiotherapy was started using various methods, depending on the evidence of tumor dissemination. For treatment of teratomatous and neuroectodermal tumors other than pineoblastomas, extensive surgical removal was performed. As for adjuvant therapy, if the tumor was a low-grade glioma or if the patient was younger than 5 years of age, postoperative treatment did not include radiotherapy. If the tumor was a malignant teratoma or high-grade glioma, conventional focal radiotherapy was performed, followed by chemotherapy with ICE for 1 year.All but two treated patients had ventriculomegaly. Neuroendoscopic procedures were performed in six of 15 treated patients. Neuroendoscopic biopsy with tumor debulking offered enough material for tissue diagnosis, including immunohistochemical analysis and, in one case, revealed evidence of tumor dissemination undetectable on neuroimaging. With one exception, no shunt was required in any patient undergoing endoscopic third ventriculostomy. Stereotactic radiotherapy was performed in indicated cases. Favorable therapeutic outcomes were obtained in all cases of germinoma and pineoblastoma, with follow-up periods ranging from 24 months to 6.5 years.Conclusions. Our minimally invasive preferential regimen clarified the precise indication for neuroendoscopic procedures, and the majority of our patients with dilated ventricles and no evidence of tumor markers were treated satisfactorily with effective neuroendoscopic procedures as the initial procedure, avoiding unnecessary craniotomy and radiotherapy and promising excellent therapeutic outcomes. The treatment for malignant pineal region tumors remains a subject for further study.

Subarachnoid dissemination of intraventricular tumors following simultaneous endoscopic biopsy and third ventriculostomy

2010 ◽  
Vol 5 (1) ◽  
pp. 61-67 ◽  
Author(s):  
Neal Luther ◽  
William R. Stetler ◽  
Ira J. Dunkel ◽  
Paul J. Christos ◽  
John C. Wellons ◽  
...  
Keyword(s):  
High Risk ◽  
Mr Imaging ◽  
Third Ventricle ◽  
Tumor Resection ◽  
Pineal Region ◽  
Endoscopic Biopsy ◽  
Third Ventriculostomy ◽  
Leptomeningeal Disease ◽  
Leptomeningeal Dissemination ◽  
Subarachnoid Dissemination

Object Endoscopic biopsy with concomitant third ventriculostomy (ETV) is a well-established diagnostic and therapeutic maneuver in patients presenting with noncommunicating hydrocephalus resulting from a tumor of the pineal region or posterior third ventricle. Fenestration of the floor of the third ventricle theoretically provides a conduit for the subarachnoid dissemination of an intraventricular tumor. The aim of this study was to ascertain the rate of leptomeningeal dissemination following this surgical procedure. Methods The authors conducted a review of all patients for whom an ETV and simultaneous endoscopic biopsy procedure or tumor resection had been performed at their institutions between 1995 and 2008. Patients were divided into high or low risk groups by leptomeningeal metastatic potential based on pathology. All available postoperative clinical and radiographic data, including MR imaging of the brain and spinal cord, as well as CSF sampling were evaluated when available. A review of the literature was then conducted to establish rates of distant leptomeningeal dissemination for comparative purposes. Results Thirty-two patients satisfied the criteria for study inclusion. Pathology revealed that 22 had a high risk for leptomeningeal dissemination. New leptomeningeal disease (1 yolk sac tumor and 1 pineoblastoma) occurred in 2 patients. The median clinical and brain MR imaging follow-ups overall were 34 (range 2–103 months) and 38 months (range 1–94 months), respectively. Follow-up MR imaging of the spine was performed in 12 patients (median 7 months postoperation), and CSF was analyzed in 15 patients (median 1 month postoperation). A Kaplan-Meier survival analysis predicted a 2-year metastasis-free survival of 94.7% for high-risk patients. Baseline rates of dissemination when ETV was not performed were in general between 8 and 24% for various high-risk pathologies according to a literature review. Conclusions The rate of leptomeningeal metastasis of tumors in this biopsy and ETV study was not increased when compared with rates from large series in the literature.

Tuberculoma mimicking a pinealoma

1983 ◽  
Vol 59 (5) ◽  
pp. 875-878 ◽  
Author(s):  
Ian R. Whittle ◽  
John L. Allsop ◽  
Michael Besser
Keyword(s):  
Obstructive Hydrocephalus ◽  
Pineal Region ◽  
Subtotal Resection ◽  
Third Ventriculostomy ◽  
Antituberculous Therapy ◽  
Content Type ◽  
Pineal Region Tumors ◽  
Serial Ct ◽  
Cerebral Tuberculoma ◽  
Fine Print

✓ Computerized tomography (CT) revealed obstructive hydrocephalus and a pineal mass in a 14-year-old girl who presented with headaches and a Parinaud's syndrome. Although there was no major evidence of extracranial tuberculosis, and cerebrospinal fluid obtained during third ventriculostomy contained no leukocytes, suboccipital transtentorial biopsy of the lesion revealed it to be a tuberculoma. Serial CT scans showed resolution of the lesion following subtotal resection and antituberculous therapy. The implications of this case with regard to difficulties in the diagnosis of cerebral tuberculoma and the management of pineal region tumors are discussed.

scholarly journals Endoscopic third ventriculostomy and simultaneous tumor biopsy in pineal region tumors using the “Single Burr Hole” technique: An analysis of 34 cases

2020 ◽  
Vol 15 (4) ◽  
pp. 976
Author(s):  
AwadheshKumar Jaiswal ◽  
Gagandeep Attri ◽  
JaskaranSingh Gosal ◽  
Deepak Khatri ◽  
KuntalKanti Das ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Pineal Region ◽  
Burr Hole ◽  
Third Ventriculostomy ◽  
Tumor Biopsy ◽  
Pineal Region Tumors

scholarly journals Pineal region tumors: an optimal approach for simultaneous endoscopic third ventriculostomy and biopsy

2011 ◽  
Vol 30 (4) ◽  
pp. E3 ◽  
Author(s):  
Peter F. Morgenstern ◽  
Nathan Osbun ◽  
Theodore H. Schwartz ◽  
Jeffrey P. Greenfield ◽  
Apostolos John Tsiouris ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Diagnostic Yield ◽  
Anterior Commissure ◽  
Pineal Region ◽  
Third Ventriculostomy ◽  
Tumor Biopsy ◽  
Pineal Region Tumors ◽  
Trajectory Approach ◽  
Trajectory Group ◽  
Optimal Approach

Object Simultaneous endoscopic third ventriculostomy (ETV) and tumor biopsy is a widely accepted therapeutic and diagnostic procedure for patients with noncommunicating hydrocephalus secondary to a pineal region tumor. Multiple approaches have been advocated, including the use of a steerable fiberoptic or rigid lens endoscope via 1 or 2 trajectories. However, the optimal approach has not been established based on the individual anatomical characteristics of the patient. Methods A retrospective review of patients undergoing simultaneous ETV and tumor biopsy was undertaken. Preoperative MR images were examined to measure the width of the anterior third ventricle and maximal diameters of the tumor, Monro foramen (right), and massa intermedia. The distances between the tumor and massa intermedia, tumor and anterior commissure, midbrain and massa intermedia, and the dorsum sella and anterior commissure were also recorded. Single and dual trajectory approaches were compared using paired t-tests for each parameter. Results Over an 8-year interval, 15 patients underwent simultaneous ETV and tumor management. These patients ranged from 6 to 71 years of age (mean 36.7 years); 5 were younger than 18 years of age. Seven were treated using a dual trajectory approach, and 8 were treated using a single trajectory approach. All cases were completed without complications or the need for an additional CSF diversionary procedure within 6 months. The diagnostic yield at biopsy was 86.7%. There were no statistically significant differences between the single and dual trajectory groups for the measured parameters. However, the dual trajectory group demonstrated a larger anterior third ventricular diameter (1.43 vs 1.21 cm, p = 0.29). The single trajectory group trended toward a smaller tumor–anterior commissure interval (2.23 vs 2.51 cm, p = 0.24) and a larger dorsum sella–anterior commissure distance (1.67 vs 1.49 cm, p = 0.28). Conclusions These data confirm the safety and diagnostic efficacy of simultaneous ETV and biopsy for tumors of the pineal region. Although no statistically significant differences were seen in the authors' recorded measurements, several trends suggest a role for a tailored approach to selecting a single or dual trajectory approach when using a rigid endoscope.

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