Brain Tectal Tumors: A Flexible Approach

2018 ◽  
Vol 16 (3) ◽  
pp. E95-E100
Author(s):  
Alessandro Perin ◽  
Tommaso Francesco Galbiati ◽  
Cecilia Casali ◽  
Federico Giuseppe Legnani ◽  
Luca Mattei ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Good Prognosis ◽  
Endoscopic Biopsy ◽  
Third Ventriculostomy ◽  
Histopathological Diagnosis ◽  
Cerebrospinal Fluid Diversion ◽  
Oncological Patients ◽  
Slow Progression ◽  
Benign Histology ◽  
Midbrain Tumors

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.

Involution of enhancing intrinsic tectal tumors after endoscopic third ventriculostomy

1999 ◽  
Vol 91 (5) ◽  
pp. 863-866 ◽  
Author(s):  
Ahmed M. Alkhani ◽  
Frederick A. Boop ◽  
James T. Rutka
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Treatment Plan ◽  
Obstructive Hydrocephalus ◽  
Neurofibromatosis Type ◽  
Third Ventriculostomy ◽  
Unexpected Result ◽  
Imaging Studies ◽  
Content Type ◽  
Cerebrospinal Fluid Diversion

✓ For benign intrinsic tectal tumors causing triventricular obstructive hydrocephalus, cerebrospinal fluid diversion followed by neuroimaging is a widely accepted treatment plan. In this report, the authors describe two children with focal enhancing tectal lesions that caused acute, symptomatic hydrocephalus. One child had neurofibromatosis Type 1 (NF1). In both children the hydrocephalus was effectively treated by endoscopic third ventriculostomy. Following this procedure, serial imaging studies revealed not only that the ventriculomegaly had resolved, but also that the enhancing tectal tumors had regressed and disappeared over time. The time to complete involution of these tumors was 18 months for the child with NF1 and 12 months for the other child. To the authors' knowledge, this is the first report of the involution of enhancing tectal tumors after endoscopic third ventriculostomy. The possible mechanisms for this unexpected result are discussed.

scholarly journals Interhemispheric transcallosal transchoroidal approach to a pineal teratoma in a 15-year-old boy

2021 ◽  
Vol 5 (1) ◽  
pp. V5
Author(s):  
Giuseppe Cinalli ◽  
Maria Rosaria Scala ◽  
Alessandra Marini ◽  
Alessia Imperato ◽  
Giuseppe Mirone ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Complete Removal ◽  
Endoscopic Biopsy ◽  
Immature Teratoma ◽  
Third Ventriculostomy ◽  
Surgical Removal ◽  
Transcallosal Approach ◽  
Neurovascular Structures ◽  
Very High

In this video, the authors present an interhemispheric transcallosal transchoroidal approach to a pineal mass in a 15-year-old boy. He received emergency endoscopic third ventriculostomy (ETV), then an endoscopic biopsy that revealed an immature teratoma. Surgical removal was selected. The mass was located very high in the posterior third ventricle, hidden behind the splenium of the corpus callosum and the vein of Galen, so an interhemispheric transcallosal approach followed by a complete dissection of the whole choroidal fissure was chosen and allowed complete removal of the tumor. Microsurgical dissection is presented, showing clearly in detail all the neurovascular structures encountered. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2126.

scholarly journals Combined rigid and flexible endoscopy for tumors in the posterior third ventricle

2015 ◽  
Vol 122 (6) ◽  
pp. 1341-1346 ◽  
Author(s):  
Jonathan Roth ◽  
Shlomi Constantini
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Choroid Plexus Papilloma ◽  
Flexible Endoscopy ◽  
Endoscopic Biopsy ◽  
Third Ventriculostomy ◽  
Low Grade ◽  
Rigid Endoscope ◽  
Ventricular Tumors

OBJECT Tumors leading to occlusion of the sylvian aqueduct include those of pineal, thalamic, and tectal origins. These tumors cause obstructive hydrocephalus and thus necessitate a CSF diversion procedure such as an endoscopic third ventriculostomy (ETV), often coupled with an endoscopic biopsy (EBX). Lesions located posterior to the massa intermedia pose a technical challenge, as the use of a rigid endoscope for performing both an ETV and EBX is limited. The authors describe their experience using a combined rigid and flexible endoscopic procedure through a single bur hole for both procedures in patients with posterior third ventricular tumors. METHODS Since January 2012, patients with posterior third ventricular tumors causing hydrocephalus underwent dual ETV and EBX procedures using the combined rigid-flexible endoscopic technique. Following institutional review board approval, data from clinical, radiological, surgical, and pathological records were retrospectively collected. RESULTS Six patients 3.5–53 years of age were included. Lesion locations included pineal (n = 3), fourth ventricle (n = 1), aqueduct (n = 1), and tectum (n = 1). The ETV and EBX were successful in all cases. Pathologies included pilocytic astrocytoma, pineoblastoma, ependymoma Grade II, germinoma, low-grade glioneural tumor, and atypical choroid plexus papilloma. One patient experienced an immediate postoperative intraventricular hemorrhage necessitating evacuation of the clots and resection of the tumor, eventually leading to the patient's death. CONCLUSIONS The authors recommend using a combined rigid-flexible endoscope for endoscopic third ventriculostomy and biopsy to approach posterior third ventricular tumors (behind the massa intermedia). This technique overcomes the limitations of using a rigid endoscope by reaching 2 distant regions.

Endoscopic Third Ventriculostomy for Hydrocephalus Secondary to Extraventricular Obstruction in Thalamic Hemorrhage: A Case Series

2020 ◽  
Vol 19 (4) ◽  
pp. 384-392
Author(s):  
Hussein A Zeineddine ◽  
Antonio Dono ◽  
Ryan Kitagawa ◽  
Sean I Savitz ◽  
Huimahn Alex Choi ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Endoscopic Third Ventriculostomy ◽  
Case Series ◽  
External Ventricular Drainage ◽  
Tube Placement ◽  
Third Ventriculostomy ◽  
Shunt Placement ◽  
Cerebrospinal Fluid Diversion ◽  
Thalamic Hemorrhage ◽  
Gastrostomy Tube Placement

Abstract BACKGROUND Intracranial hemorrhage carries significant morbidity and mortality, particularly if associated with hydrocephalus. Management of hydrocephalus includes temporary external ventricular drainage, with or without shunting. Thalamic location is an independent predictor of mortality and increases the likelihood of shunt dependence. OBJECTIVE To determine whether endoscopic third ventriculostomy (ETV) can avoid the need for shunt placement and expedite recovery. METHODS We prospectively identified thalamic intracranial hemorrhage patients who developed acute hydrocephalus requiring cerebrospinal fluid diversion by extraventricular drain placement from November 2017 to February 2019. Patients who failed an extraventricular drain clamping trial were then evaluated for eligibility for an ETV procedure. Patients who underwent ETV were then followed up for the development of hydrocephalus, need for shunting, and length of stay in the intensive care unit. RESULTS Eight patients (7 males, 1 female) were prospectively enrolled. All patients underwent an ETV successfully. None of the patients required shunting. ETV was performed despite the presence of other factors that would have prevented shunt placement, including fever, leukocytosis, and gastrostomy tube placement. Seven patients who underwent ETV were evaluated at 3-mo follow-up and did not require shunting. CONCLUSION ETV is a safe and effective technique for the management of hydrocephalus resulting from an extraventricular obstruction in thalamic hemorrhage. It can avoid the need for permanent shunting in this patient population. Larger studies should be conducted to validate and further analyze this intervention.

Endoscopic Third Ventriculostomy

Neurosurgery ◽  
1990 ◽  
Vol 26 (1) ◽  
pp. 86-92 ◽  
Author(s):  
R. F. C. Jones ◽  
W. A. Stening ◽  
M. Brydon
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Late Onset ◽  
Surgical Techniques ◽  
Rapid Onset ◽  
Third Ventriculostomy ◽  
Significant Morbidity ◽  
Cerebrospinal Fluid Diversion ◽  
Noncommunicating Hydrocephalus ◽  
Chiari Malformations

Abstract Long-term extracranial shunting for hydrocephalus has numerous drawbacks related to shunt malfunction and infection. In some cases outcome has been very disappointing. We successfully managed 5 patients with acquired aqueductal stenoses with no significant morbidity by the use of an intracranial cerebrospinal fluid diversion, namely a third ventriculostomy. First advocated by Dandy, ventriculostomy was largely passed over in favor of extracranial procedures. With improved surgical techniques, however, ventriculostomy is now considered to be a viable alternative in selected cases. In a further 19 patients, we subsequently broadened our patient selection to include those with Arnold-Chiari malformations, congenital noncommunicating hydrocephalus, and tumors. Two thirds of these children remain without shunts and apart from 1 child developing hemiplegia postoperatively, there has been no significant morbidity. Although the best results have been seen in the late onset groups, even early onset, noncommunicating hydrocephalus has been successfully managed. Even in patients in whom third ventriculostomy has failed and who have subsequently required ventriculoperitoneal shunts, we anticipate that they will remain less dependent on shunts because their hydrocephalus is now communicating, which tends not to have such a rapid onset or extreme levels of raised intracranial pressure. (Neurosurgery 26:86-92, 1990)

Efficacy of simultaneous single-trajectory endoscopic tumor biopsy and endoscopic cerebrospinal fluid diversion procedures in intra- and paraventricular tumors

2011 ◽  
Vol 30 (4) ◽  
pp. E4 ◽  
Author(s):  
Aaron Mohanty ◽  
Vani Santosh ◽  
B. Indira Devi ◽  
Satyanarayana Satish ◽  
Arundhati Biswas
Keyword(s):  
Tumor Location ◽  
Endoscopic Biopsy ◽  
Third Ventriculostomy ◽  
Success Rates ◽  
Tumor Biopsy ◽  
Tissue Samples ◽  
Biopsy Procedure ◽  
Cerebrospinal Fluid Diversion ◽  
Csf Diversion ◽  
Rigid Rod

Object Intraventricular and paraventricular tumors resulting in hydrocephalus commonly require a CSF diversion procedure. A tumor biopsy can often be performed concurrently. Although the tissue samples obtained during endoscopic biopsy procedures are small, a diagnosis can be made in most cases. In the present study the authors analyzed the efficacy of concurrent endoscopic biopsy and CSF diversion procedures using a single bur hole and trajectory. Methods Eighty-seven patients with intraventricular and paraventricular tumors were treated with endoscopic biopsy and CSF diversion procedures using a rigid rod-lens endoscope or a rigid fiberscope during a 10-year period. All patients underwent a tumor biopsy and an endoscopic third ventriculostomy (ETV), aqueductal stenting (AS), or ventriculoperitoneal (VP) shunting, depending on the tumor location and site of obstruction. A single bur hole for both procedures was used in all patients. Results Among the 87 patients, the biopsy was diagnostic in 72 (83%) and merely suggestive in 7 (8%); in 8 patients (9%) the sample was nondiagnostic. Among the 22 patients who underwent an initial endoscopic biopsy and subsequent procedures, the specimen obtained at the second surgery was concordant with the initial endoscopic biopsy sample in 13 patients; it was somewhat similar in 4 patients. In the other 5 patients, either a microsurgical or stereotactic approach was used to correctly diagnose the pathology. Fifty-five patients were considered for endoscopic CSF diversion procedures; an ETV was performed in 52 patients and AS in 2. An ETV could not be performed in 3 patients for technical reasons. A VP shunt was inserted in 32 patients, with 25 undergoing shunt placement at the same time as the ETV and 7 at a later date. Significant bleeding was encountered in 3 patients during the tumor biopsy and in 1 patient during the ETV. The ETV failed in 1 patient during the follow-up, and a repeat ETV was required. Conclusions Endoscopic biopsy sampling and a concurrent CSF diversion procedure through a single bur hole and trajectory can be considered for intraventricular tumors. The overall success rates of 83% for the biopsy procedure and 86% for the ETV indicate that the procedures are beneficial in the majority of cases. A concordance rate of 75% was found in patients who underwent an initial biopsy procedure and a subsequent microsurgical approach for tumor excision.

scholarly journals Intratumoral Hemorrhage After Endoscopic Third Ventriculostomy for Obstructive Hydrocephalus Caused by Brain Tumors

2021 ◽  
Author(s):  
Akira Taguchi ◽  
Yasuyuki Kinoshita ◽  
Vishwa Jeet Amatya ◽  
Takeshi Takayasu ◽  
Motoki Takano ◽  
...  
Keyword(s):  
Obstructive Hydrocephalus ◽  
Patient Characteristics ◽  
Aqueductal Stenosis ◽  
Endoscopic Biopsy ◽  
Third Ventriculostomy ◽  
Histopathological Diagnosis ◽  
Intratumoral Hemorrhage ◽  
Minimal Invasiveness ◽  
Hemorrhagic Risk ◽  
Atypical Teratoid

Abstract IntroductionEndoscopic third ventriculostomy (ETV) for obstructive hydrocephalus and endoscopic biopsy (EB) for intra- and paraventricular tumors are recognized as standard therapies because of their minimal invasiveness. Although EB-associated hemorrhagic risk has been well documented, reports on the ETV-associated hemorrhagic risk are only few. Therefore, we conducted this retrospective study to review the incidence of hemorrhage due to EB and/or ETV in a single institution.Material and MethodsWe retrospectively reviewed data, including patient characteristics, procedure, pathological findings, and complications, including hemorrhage, of 100 patients with intra- and paraventricular tumors who underwent EB and/or ETV at our institution from 2000 to 2020.ResultsEB and ETV combined surgery (combined group), EB-alone surgery (EB-alone group), and ETV-alone surgery (ETV-alone group) were performed in 44 (44%), 24 (24%), and 32 (32%) patients, respectively, and all procedures were successful. The rates of definitive and suggestive diagnoses in EB were 76.5% and 23.5%, respectively. Adverse events were observed in six patients. An acute obstruction of the ETV stoma and a transient double vision were observed in the combined group. Two transient aqueductal stenosis/obstructions were recognized in the EB-alone group. Hemorrhage was observed in two patients in the ETV-alone group; these patients developed intratumoral hemorrhage despite ETV-alone surgery. Subsequently, these two patients underwent tumor removal, and the histopathological diagnosis was atypical teratoid/rhabdoid tumor (AT/RT) in both.ConclusionsFor obstructive hydrocephalus with AT/RTs, physicians must be aware of the risk of postoperative intratumoral hemorrhage after performing ETV.Trial registration numberE-2385 (2021/3/11)

Endoscopic Third Ventriculostomy in 250 Adults With Hydrocephalus

Neurosurgery ◽  
2015 ◽  
Vol 78 (1) ◽  
pp. 109-119 ◽  
Author(s):  
Walter Grand ◽  
Jody Leonardo ◽  
Andrea J. Chamczuk ◽  
Adam J. Korus
Keyword(s):  
Intraventricular Hemorrhage ◽  
Endoscopic Third Ventriculostomy ◽  
Pediatric Population ◽  
Adult Population ◽  
Residual Tumor ◽  
Normal Pressure ◽  
Third Ventriculostomy ◽  
Communicating Hydrocephalus ◽  
Cerebrospinal Fluid Diversion ◽  
Patient Selection Criteria

Abstract BACKGROUND: Endoscopic third ventriculostomy (ETV) has been used predominantly in the pediatric population in the past. Application in the adult population has been less extensive, even in large neurosurgical centers. To our knowledge, this report is one of the largest adult ETV series reported and has the consistency of being performed at 1 center. OBJECTIVE: To determine the efficacy, safety, and outcome of ETV in a large adult hydrocephalus patient series at a single neurosurgical center. In addition, to analyze patient selection criteria and clinical subgroups (including those with ventriculoperitoneal shunt [VPS] malfunction or obstruction and neurointensive care unit patients with extended ventricular drainage before ETV) to optimize surgical results in the future. METHODS: We conducted a retrospective review of adult ETV procedures performed at our center between 2000 and 2014. RESULTS: The overall rate of success (no further cerebrospinal fluid diversion procedure performed plus clinical improvement) of 243 completed ETVs was 72.8%. Following is the number of procedures with the success rate in parentheses: aqueduct stenosis, 56 (91%); communicating hydrocephalus including normal pressure hydrocephalus, nonnormal pressure hydrocephalus, and remote head trauma, 57 (43.8%); communicating hydrocephalus in postoperative posterior fossa tumor without residual tumor, 14 (85.7%); communicating hydrocephalus in subarachnoid hemorrhage without intraventricular hemorrhage, 23 (69.6%); obstruction from tumor/cyst, 42 (85.7%); VPS obstruction (diagnosis unknown), 23 (65.2%); intraventricular hemorrhage, 20 (90%); and miscellaneous (obstructive), 8 (50%). There were 9 complications in 250 intended procedures (3.6%); 5 (2%) were serious. CONCLUSION: Use of ETV in adult hydrocephalus has broad application with a low complication rate and reasonably good efficacy in selected patients.

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