scholarly journals STMO-08 Validation of the endoscopic 5-ALA fluorescence diagnosis for intraventricular tumors

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii10-ii10
Author(s):  
Masahiro Nonaka ◽  
Junichi Takeda ◽  
Tetsuo Hashiba ◽  
Akio Asai
Keyword(s):  
Brain Tumors ◽  
Germ Cell ◽  
Lateral Ventricle ◽  
Third Ventricle ◽  
Germ Cell Tumors ◽  
Metastatic Brain Tumors ◽  
Fluorescence Diagnosis ◽  
The Third ◽  
Pilocytic Astrocytomas ◽  
Intraventricular Tumors

Abstract Intraoperative 5-ALA fluorescence diagnosis (PDD) has been shown to improve tumor resection rates in surgery for malignant glioma. Recently, the usefulness of PDD has been reported in tumors other than malignant glioma. However, the fluorescence of intraventricular tumors is not easy to observe under the microscope, because excitation light could not reach enough to the deepest part of the brain. Therefore, we performed endoscopic 5-ALA fluorescence diagnosis of intraventricular tumors and evaluated its usefulness. Ten cases of intraventricular tumors were included in the study. There were 3 germ cell tumors, 2 metastatic brain tumors, 2 pilocytic astrocytomas, 1 malignant lymphoma, 1 subependymoma, and 1 medulloblastoma (recurrent). The tumors were located in the third ventricle in four cases, the lateral ventricle in three cases, the lateral ventricle and the third ventricle in two cases, and the aqueduct in one case. Tumor removal was performed in 6 cases and tumor biopsy in 4 cases. Intraoperative fluorescence could be observed in eight cases: three germ cell tumors, two metastatic brain tumors, two pilocytic astrocytomas, and one malignant lymphoma. Subependymoma and medulloblastoma did not show fluorescence. Among the cases with confirmed fluorescence, the fluorescent sites were targeted for biopsies for germ cell tumors and malignant lymphomas. For metastatic brain tumors and pilocytic astrocytomas, the extent of removal was determined at the time of removal, and the presence of residual tumor was confirmed by fluorescence after removal. Endoscopic 5-ALA fluorescence diagnosis for intraventricular tumors was useful in determining the target of biopsy or the extent of excision and in assessing residual tumors.

scholarly journals Mature Teratoma in the Third Ventricle: A Case Report and Review of the Literature

2021 ◽  
pp. 1-4
Author(s):  
Yanire Sánchez Medina ◽  
Yanire Sánchez Medina ◽  
Eric Robles Hidalgo ◽  
Jaime Domínguez Baez ◽  
Luis Gómez Perals
Keyword(s):  
Case Report ◽  
Germ Cell ◽  
Third Ventricle ◽  
Mature Teratoma ◽  
Germ Cell Tumors ◽  
Optic Chiasm ◽  
Pineal Region ◽  
The Third ◽  
Histopathologic Evaluation ◽  
Cell Layers

Introduction: Germ Cell Tumors (GCT) represent less than 4% of primary brain tumors. They comprise Germaniums, Non-Germinomatous Germ Cell Tumors and Teratomas. Teratomas represent less than 20% of intracranial GCT. They are tumors of multipotential cells derived from all 3 germ cell layers, frequently arising in midline structures, most commonly in the pineal and suprasellar regions, with a clear excess of male cases and frequently found in children and young adults. We report a case of a mature teratoma in the third ventricle in a 37-year-old male. Case Report: We report a case of a 37-year-old male with a history of headache lasting up to 9 days and refractory to pharmacological treatment. The CT scan revealed a 20mm round hypodense lesion in the anterior third ventricle, with a punctate hyperdensity in the inferior pole causing biventricular hydrocephalus with no periventricular lucency and the MRI showed a well-defined encapsulated mass lesion attached to the roof of the third ventricle, isointense in T1WI with circumferential enhancement and hyperintense in T2WI. Gross total resection was performed. Histopathologic evaluation revealed a mature teratoma. There was no evidence of recurrence on follow up MRI at 2 years. Conclusion: Intracranial teratomas typically originate in midline structures from optic chiasm to pineal region. Presentation after the first two decades of life is exceptional. Complete surgical resection is the only curative treatment for pure mature teratomas. We report the case of a mature teratoma in a 37-year-old male with unusual radiological findings.

scholarly journals Intracranial Germ Cell Tumors: Spectrum of Disease in an Indian Cohort and Management Strategies

2018 ◽  
Vol 09 (03) ◽  
pp. 291-297 ◽  
Author(s):  
Tushar Deepak Borde ◽  
Arivazhagan Arimappamagan ◽  
Dwarakanath Srinivas ◽  
K. V. L. Narasinga Rao ◽  
B. Indira Devi ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Germ Cell ◽  
Third Ventricle ◽  
Management Strategies ◽  
Germ Cell Tumors ◽  
Pediatric Brain Tumors ◽  
Third Ventriculostomy ◽  
Histopathological Diagnosis ◽  
Common Location ◽  
Pediatric Brain

ABSTRACT Background: Germ cell tumors (GCTs) represent approximately 3% of primary pediatric brain tumors in the West, whereas in Asia, they constitute between 8% and 15% of pediatric brain tumors. Methods: We retrospectively studied all patients with intracranial GCT managed at our institute from January 1998 to December 2013. The clinical data and radiological data were analyzed. Results: Forty-eight patients with intracranial GCT including 36 males and 16 females formed the cohort. The proportion of GCT in our study was 0.29%. The mean age was 16.5 ± 2.5 years. Germinomas constituted 56.3% and nongerminomatous GCTs constituted 43.7% of all the tumors. The most common location was posterior third ventricle (58.3%) followed by suprasellar (22.9%). Histopathological diagnosis was obtained in almost all patients (96%). Surgical procedures included tumor decompression (71.7%), stereotactic biopsy (13%), and endoscopic third ventriculostomy and biopsy (15%). Patient's age, location of the tumor, and histology did not influence the survival. Women with GCTs had poorer survival when compared to men. Conclusions: The present study documented a lower hospital-based incidence of GCT in Indian cohort. A multidisciplinary approach including surgical strategy based on location, appropriate radiation planning, and chemotherapy is needed for effective treatment and improved outcomes.

scholarly journals P14.50 Clinicopathological spectrum of intracranial germ cell tumors: an Indian tertiary cancer center experience

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii78-iii78
Author(s):  
A Sahay ◽  
G Chinnaswamy ◽  
V Bhat ◽  
V Patil ◽  
T Gupta ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Germ Cell ◽  
Tumor Markers ◽  
Posterior Fossa ◽  
Germ Cell Tumors ◽  
Clinicopathological Features ◽  
Spinal Tumors ◽  
Equal Distribution ◽  
Pineal Tumors ◽  
Intracranial Germ Cell Tumors

Abstract BACKGROUND Incidence of intracranial germ cell tumors (ICGCT) in Western literature is low (0.3–0.6 %) as compared to East Asia (3–4 %), & their clinicopathological features are well documented. However, there are scant studies on ICGCT from India. MATERIAL AND METHODS Retrospective observational study of all ICGCT histologically diagnosed in our hospital from 2007–2018. Metastasis were excluded. Clinicopathological features were retrieved from hospital’s electronic medical records. RESULTS We diagnosed 82 primary ICGCT, forming approx. 0.54 % of all primary brain tumors, & 3.5% of pediatric brain tumors. Age range: 2 months-32 yrs (Median age 14 yrs). M:F ratio: 1.82:1 (53M,29F). Nearly 80% patients were pediatric (<18 yrs), & 8 very young (<3 yrs, 7M1F). Majority were suprasellar & pineal (31/82, 37% each), with one bifocal presentation. Other rarer sites: posterior fossa (4), midbrain (1), corpus callosum (1) & 11 non midline (4 thalamic, 4 frontal, 2 cerebellar, 1 CP angle). Predominant histology was germinoma (G) (51/82, 62%), while non germinomatous (NGGCT) were 31/82 (38%), of which 9 were mixed. Pure teratoma were 11 (9 immature (IT), 2 mature), & 5 pure yolk sac tumor (YST). Interestingly, all very young age group patients (<3 yrs), showed only NGGCT histology (5/8 IT, 3/8 pure YST). In contrast, G histology formed nearly 70% of all patients >3 yrs. Females were associated mainly with G (21/29, 72%). NGGCT were predominantly seen in males (M:F=2.9:1). Also, pure IT (9) were seen only in males. Posterior fossa tumors were all IT (4/4). Spinal tumors were NGGCT (1 mature teratoma, 1 YST). Majority of suprasellar tumors (25/31, 80.6%), other midline locations like corpus callosal, midbrain, & all thalamic tumors were G. However, pineal tumors showed equal distribution of G (15/31) & NGGCT (16/31). Spine screening was positive in 8 patients (6 G, 2 IT)- 7 on MRI and 1 only on CSF cytology. Serum tumor markers were raised in 13/54 cases- 6/34G(17.6%), vs 7/20 NGGCT (35%). CSF tumor markers were raised in 14/34-10/23 G (43.4%), vs 4/11 NGGCT (36.3%). Follow up was available for 37 patients (Duration 3 months-10 yrs, median 2 yrs). On f/u 6/15 (40%) NGGCT showed progression/death, while only 2/32 G relapsed (6.5%). Four deaths in G group were not directly attributable to the tumor. CONCLUSION Frequency of ICGCT in our hospital similar to western data rather than Asian, albeit with less striking male preponderance. ICGCT were tumors of 2nd decade & majority occurred in pineal/suprasellar areas. About 2/3rd were pure G on histology, and showed good prognosis. NGGCT were common in infants, males and in posterior fossa. IT were seen exclusively in males and pure YST mainly in males. Although majority of ICGCT are in midline, rarely non midline involvement also occurs, and it’s essential to exclude metastasis before considering primary ICGCT. Expectedly, NGGCT showed poorer prognosis, compared to pure germinomas.

Lateral Ventricle Choroid Plexus Papilloma Extending into the Third Ventricle

2004 ◽  
Vol 40 (6) ◽  
pp. 314-316 ◽  
Author(s):  
Federico Di Rocco ◽  
Massimo Caldarelli ◽  
Giovanni Sabatino ◽  
Gianpiero Tamburrini ◽  
Concezio Di Rocco
Keyword(s):  
Choroid Plexus ◽  
Lateral Ventricle ◽  
Third Ventricle ◽  
Choroid Plexus Papilloma ◽  
The Third ◽  
Plexus Papilloma

Primary chemotherapy for intracranial germ cell tumors: Results of the third international CNS germ cell tumor study

2010 ◽  
Vol 54 (3) ◽  
pp. 377-383 ◽  
Author(s):  
Nasjla Saba da Silva ◽  
Andrea M. Cappellano ◽  
Blanca Diez ◽  
Sergio Cavalheiro ◽  
Sharon Gardner ◽  
...  
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumor ◽  
Germ Cell Tumors ◽  
Cell Tumor ◽  
Primary Chemotherapy ◽  
The Third ◽  
Tumor Study ◽  
Intracranial Germ Cell Tumors ◽  
Cns Germ Cell Tumor

INTRAOPERATIVE DIRECT THIRD VENTRICULOSTOMY AND AQUEDUCTAL STENTING IN DEEP-SEATED MIDLINE BRAIN TUMOR SURGERY

Neurosurgery ◽  
2009 ◽  
Vol 64 (2) ◽  
pp. 256-267 ◽  
Author(s):  
David I. Pitskhelauri ◽  
Alexander N. Konovalov ◽  
Valeri N. Kornienko ◽  
Natalia K. Serova ◽  
Nikita V. Arutiunov ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Pineal Region ◽  
Third Ventriculostomy ◽  
Success Rates ◽  
Tumor Removal ◽  
The Third ◽  
Total Tumor Removal ◽  
Ventricular Shunting

Abstract OBJECTIVE Surgical resection of deep-seated midline brain tumors does not always resolve obstruction of cerebrospinal fluid pathways, and an additional operation—ventricular shunting—is required. To prevent postoperative obstructive hydrocephalus, we combine tumor removal and internal ventricular shunting in 1 stage. METHODS Between 2000 and 2006, 82 patients with deep-seated midline brain tumors (tumors of the third ventricle, pineal region, thalamus, upper brainstem, and superior half of the fourth ventricle) underwent 84 tumor resections with intraoperative internal ventricular shunting. Two types of intraoperative shunting were performed: direct third ventriculostomy with fenestration of the premammillary membrane of the third ventricle floor and Liliequist's membrane, 53 operations; and aqueductal stenting, 30 operations. In 1 patient, third ventriculostomy and aqueductal stenting were performed simultaneously. RESULTS As most of the tumors had an infiltrative growth pattern, gross total tumor removal was achieved in only 31% of patients in this series. There were no fatal outcomes related to the surgery. Follow-up data were collected in 73 patients (89%) and ranged from 2 to 68 months (median, 16 months). Additional shunting because of inadequate function of stoma or stent was performed in 13 patients at various times after surgery (median, 30 days). The Kaplan-Meier survival analysis demonstrated that at 12 and 24 months the intraoperative direct third ventriculostomy success rates were 67 and 61%, respectively; aqueductal stenting success rates were 93% at both 12 and 24 months. CONCLUSION Intraoperative direct third ventriculostomy and aqueductal stenting under direct visual control were found to be reliable methods of hydrocephalus management in patients with deep-seated midline brain tumors.

Unilateral Hydrocephalus

1940 ◽  
Vol 86 (363) ◽  
pp. 591-601
Author(s):  
R. M. Stewart
Keyword(s):  
Lateral Ventricle ◽  
Third Ventricle ◽  
Spinal Fluid ◽  
Entire Body ◽  
Foramen Of Monro ◽  
Small Aperture ◽  
Partial Closure ◽  
The Third ◽  
Inflammatory Conditions ◽  
Internal Hydrocephalus

A single small aperture connecting each lateral ventricle with the dorsocephalic portion of the third ventricle provides the sole means of escape for cerebro-spinal fluid, and consequently it follows that any interference with its patency will seriously retard the outward flow of ventricular fluid. Complete, or even partial, closure of the foramen leads to a rapid increase in the volume and pressure of imprisoned ventricular fluid so that a condition of internal hydrocephalus is soon established. Usually both foramina are occluded, the hydrocephalus being therefore bilateral and the ventricles more or less symmetrically enlarged. In rare instances, however, only one foramen is obstructed, in which case the dilatation will, of course, be confined to the ipsilateral ventricle. Unilateral hydrocephalus of this obstructive type is commonly caused by inflammatory conditions in the neighbourhood of the foramen, or by pedunculated tumours attached to the choroid plexus which enjoy a degree of movement sufficient to permit intermittent or permanent blockage of the foramen of Monro. It is, however, possible to find examples of unilateral hydrocephalus in which the outflow of cerebro-spinal fluid through the foramen of Monro is unimpeded, and in these the cause of the ventricular dilatation is to be sought in some diseased condition of the cerebral wall which has become so weakened as to be unable to resist even normal ventricular pressure. Such expansion may be either limited to one part of the lateral ventricle, or general, involving the entire body with its horns.

Migrating Lateral Ventricle Choroid Plexus Cyst into the Fourth Ventricle Causing Acute Hydrocephalus

2021 ◽  
Author(s):  
Lacey M. Carter ◽  
Benjamin Cornwell ◽  
Naina L. Gross
Keyword(s):  
Cerebrospinal Fluid ◽  
Choroid Plexus ◽  
Lateral Ventricle ◽  
Fourth Ventricle ◽  
Third Ventricle ◽  
Neurological Deficits ◽  
Cerebral Aqueduct ◽  
Outflow Obstruction ◽  
The Third ◽  
Choroid Plexus Cyst

AbstractChoroid plexus cysts consist of abnormal folds of the choroid plexus that typically resolve prior to birth. Rarely, these cysts persist and may cause outflow obstruction of cerebrospinal fluid. We present a 5-month-old male born term who presented with lethargy, vomiting, and a bulging anterior fontanelle. Magnetic resonance imaging showed one large choroid plexus cyst had migrated from the right lateral ventricle through the third ventricle and cerebral aqueduct into the fourth ventricle causing outflow obstruction. The cyst was attached to the lateral ventricle choroid plexus by a pedicle. The cyst was endoscopically retrieved from the fourth ventricle intact and then fenestrated and coagulated along with several other smaller cysts. Histologic examination confirmed the mass was a choroid plexus cyst. The patient did well after surgery and did not require any cerebrospinal fluid diversion. Nine months after surgery, the patient continued to thrive with no neurological deficits. This case is the first we have found in the literature of a lateral ventricular choroid plexus cyst migrating into the fourth ventricle and the youngest of any migrating choroid plexus cyst. Only three other cases of a migrating choroid plexus cyst have been documented and those only migrated into the third ventricle. New imaging advances are making these cysts easier to identify, but may still be missed on routine sequences. High clinical suspicion for these cysts is necessary for correct treatment of this possible cause of hydrocephalus.

Sign in / Sign up

Export Citation Format

Share Document