P14.89 Papillary tumor of the pineal region: three cases from a single institution

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii55-ii55
Author(s):  
F Yorio ◽  
I J Ujhelly ◽  
B Calabrese ◽  
A Cervio ◽  
A Muggeri
Keyword(s):  
Imaging Finding ◽  
Magnetic Resonance Imaging Finding ◽  
Distant Recurrence ◽  
Pineal Region ◽  
Third Ventriculostomy ◽  
Papillary Tumor ◽  
Tumor Biopsy ◽  
Fourth Decade ◽  
Standardized Treatment ◽  
Clinical Records

Abstract BACKGROUND Papillary tumors of the pineal region are highly unusual lesions of unknown incidence. These are neuroepithelial tumors with papillary and solid areas. There is no standardized treatment because of the difficulty to make randomized prospective trials due to its rarity. We report three patients with papillary tumor of the pineal region. MATERIAL AND METHODS Retrospective review of the clinical records of patients with papillary tumor of the pineal region at a tertiary neurological center in Buenos Aires, Argentina was done between 2/2012-04/2021. Clinical characteristics, imaging, pathology, treatment and follow-up data were obtained. RESULTS Two patients were male and one female. All three patients were adults, two in the fourth decade of life and one in the seventh. Clinical presentation included headache along with either visual symptoms, gait disturbance, or both. Imaging workup included brain and spinal magnetic resonance imaging, finding expanding lesions in the pineal region, hyperintense in FLAIR/T2 sequences, with gadolinium enhancement in T1 with contrast sequence and variable degrees of hydrocephalus. Spinal lesions were not found in these patients. Cerebrospinal fluid cytology was negative in all cases. Tumor biopsy was the initial approach in all cases. Two patients underwent an initial third ventriculostomy procedure but all were submitted to a supracerebellar infratentorial approach for major resection. Posterior treatment included chemoradiotherapy with temozolomide. One patient had a distant recurrence after seven years with and remained with stable disease for two more years, and the other two patients are under control with no recurrence after 2 and 2.5 years respectively. CONCLUSION Papillary tumors in the pineal regions are aggressively treated as recurrence is very frequent regarding previous reports (> 70%). Total resection is the only predictive factor associated to better outcome, however, more information is needed in order to achieve treatment consensus.

One- vs Two-Burr-Hole Technique for Combined Endoscopic Third Ventriculostomy and Pineal Region Biopsy: Volumetric Analysis of Brain at Risk

2020 ◽  
Vol 19 (2) ◽  
pp. 175-180
Author(s):  
Brandon D Liebelt ◽  
Fangxiang Chen ◽  
Antonio Biroli ◽  
Xiaochun Zhao ◽  
Peter Nakaji
Keyword(s):  
At Risk ◽  
Endoscopic Third Ventriculostomy ◽  
Brain Parenchyma ◽  
Pineal Region ◽  
Burr Hole ◽  
Third Ventriculostomy ◽  
Tumor Biopsy ◽  
Burr Holes ◽  
The Brain ◽  
The Ideal

Abstract BACKGROUND Pineal region tumors are associated with the ventricular system. Endoscopic third ventriculostomy (ETV) is often performed at the same time as tumor biopsy. OBJECTIVE To investigate the volume of brain possibly undergoing injury and forniceal stretching during ETV and tumor biopsy. METHODS We performed a retrospective review of preoperative magnetic resonance imagings (MRIs) and computed tomography (CTs) of patients with pineal region masses and used volumetric image-guided navigation to simulate a 1-burr-hole vs a 2-burr-hole approach through the brain parenchyma. We compared the volumes of parenchyma and fornix at the risk of injury. RESULTS The ideal entry point for ETV using 2 burr holes was a mean ± standard deviation (SD) of 25.8 ± 6 mm from the midline and 11.4 ± 9 mm behind the coronal suture. The ideal entry point using 2 burr holes for tumor biopsy was 25.7 ± 8 mm from the midline and 53.7 ± 14 mm anterior to the coronal suture. With 1 burr hole, the mean ± SD volume of brain parenchyma at risk was 852 ± 440 mm3. The volume of brain parenchyma at risk with 2 burr holes was 2159 ± 474 mm3 (P < .001; paired t-test). The use of 1 burr hole predisposed the fornix to 14 ± 3 mm of possible stretch, which was minimized with the 2-burr-hole approach. CONCLUSION Using 1 burr hole for both the ETV and tumor biopsy is less likely to traumatize the brain parenchyma than using 2 burr holes. However, 1 burr hole predisposes the fornix to stretch injury. We recommend tailoring the entry to each patient according to their anatomy rather than using a 1-size-fits-all approach.

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

2015 ◽  
Vol 12 (3) ◽  
pp. 231-238 ◽  
Author(s):  
Kyle W Eastwood ◽  
Vivek P Bodani ◽  
James M Drake
Keyword(s):  
Software Package ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Three Dimensional ◽  
Pineal Region ◽  
Third Ventriculostomy ◽  
Tumor Biopsy ◽  
Foramen Of Monro ◽  
Tumor Margin ◽  
Pineal Region Tumor

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.

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.

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.

scholarly journals Neuroendoscopic followed by microsurgical approach for the treatment of pilocytic astrocytoma of the pineal region

2021 ◽  
Vol 3 (3(September-December)) ◽  
pp. e882021
Author(s):  
Leopoldo Mandic Furtado ◽  
José Aloysio Da Costa Val Filho ◽  
François Dantas ◽  
Camila Moura De Sousa
Keyword(s):  
Pilocytic Astrocytoma ◽  
Obstructive Hydrocephalus ◽  
Pineal Region ◽  
Third Ventriculostomy ◽  
Low Grade ◽  
Anatomical Landmarks ◽  
Tumor Biopsy ◽  
Life Threatening ◽  
Microsurgical Approach ◽  
Supracerebellar Infratentorial Approach

Pilocytic astrocytoma is a low-grade tumor that can affect the pineal region and has a potential life-threatening presentation with obstructive hydrocephalus. This video presents the case of a child who underwent an endoscopic third ventriculostomy with tumor biopsy and for whom a supracerebellar infratentorial approach was chosen after confirmation of the diagnosis of a pilocytic astrocytoma. Herein, we discuss the technical details of both procedures, such as the single burr hole in the neuroendoscopic approach, the ventricular landmarks and identification of the venous sinus through neuronavigation, the anatomical landmarks during the supracerebellar infratentorial approach, and the use of ultrasonographic aspiration.

Microsurgical Resection of Posterior Third Ventricular/Pineal Region Papillary Tumor Via Supracerebellar Infratentorial Approach: 3-Dimensional Operative Video

2018 ◽  
Vol 15 (6) ◽  
pp. E87-E87
Author(s):  
Sima Sayyahmelli ◽  
Ihsan Dogan ◽  
Mustafa K Başkaya
Keyword(s):  
Third Ventricle ◽  
Pineal Region ◽  
Direct Access ◽  
Third Ventriculostomy ◽  
Papillary Tumor ◽  
Pineal Region Tumor ◽  
3 Dimensional ◽  
History Of ◽  
Supracerebellar Infratentorial Approach ◽  
Microsurgical Resection

Abstract The posterior third ventricle and pineal region can harbor different pathologies. The supracerebellar infratentorial approach allows a direct access to the pineal region and posterior third ventricle and provides wide exposure of the arachnoid planes and deep venous system.  In this 3-dimensional video, we present a patient with posterior third ventricular/pineal region tumor who underwent microsurgical resection via supracerebellar infratentorial approach. The patient is a 28-year-old woman with history of hydrocephalus who underwent endoscopic third ventriculostomy and biopsy at an outside hospital. The histopatology of the tumor was papillary tumor of the pineal region. The patient was referred for further surgical resection due to enlargement of her tumor on follow-up radiological imaging. The surgery and the patient's postoperative course were uneventful and the patient remained unchanged in the postoperative period.  The important steps of the surgical approach and microsurgical resection are demonstrated in this 3-dimensional surgical video. The patient consented to publication of her images.

scholarly journals Upward ballooning of the third ventricle floor in a patient with slit ventricle syndrome: A unique magnetic resonance imaging finding

2016 ◽  
Vol 30 (1) ◽  
pp. 62-64 ◽  
Author(s):  
Junya Yamaguchi ◽  
Tadashi Watanabe ◽  
Yuichi Nagata ◽  
Tetuya Nagatani ◽  
Yukio Seki
Keyword(s):  
Magnetic Resonance ◽  
Imaging Finding ◽  
Third Ventricle ◽  
Magnetic Resonance Imaging Finding ◽  
Third Ventriculostomy ◽  
Slit Ventricle Syndrome ◽  
The Third ◽  
Anatomical Change ◽  
Slit Ventricle ◽  
Third Ventricle Floor

Slit ventricle syndrome (SVS) is a well-known chronic complication of ventriculoperitoneal shunt (VPS) placement. In this report, we describe a unique anatomical change that we observed on the magnetic resonance (MR) images of the brain acquired from a patient with SVS. The patient was a 40-year-old woman who had undergone VPS placement at 3 months of age. A computed tomography scan of her brain revealed a slit-like ventricle. In addition, an MR image of her brain revealed upward ballooning of the third ventricle floor, which returned to normal after a lumbar puncture. This anatomical change resulted from the pressure gradient between the intra- and extraventricular spaces. We believe our findings will further our understanding of the pathogenesis of SVS. Moreover, we hope our findings will help clinicians to select endoscopic third ventriculostomy as the primary surgical approach in patients with this particular SVS pathogenesis in order to avoid complications.

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