scholarly journals Endoscopic resection of a low-grade ependymoma of the pineal region

2021 ◽  
Vol 12 ◽  
pp. 279
Author(s):  
Claudio Schonauer ◽  
Gianpaolo Jannelli ◽  
Enrico Tessitore ◽  
Adrien Thomas May ◽  
Ramona Guatta ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Continuous Wave ◽  
Obstructive Hydrocephalus ◽  
External Ventricular Drain ◽  
Residual Tumor ◽  
Third Ventriculostomy ◽  
Low Grade ◽  
Endoscopic Removal ◽  
Transcallosal Approach ◽  
Frontal Horn

Background: Full endoscopic resection of solid brain tumors represents a challenge for neurosurgeons. This can be achieved with modern technology and advanced surgical tools. Case Description: A 23-years-old male was referred to our unit with raised intracranial pressure. Head computed tomography and magnetic resonance imaging (MRI) revealed obstructive hydrocephalus and a third ventricle lesion. Endoscopic third ventriculostomy and biopsy were performed, a left frontal external ventricular drain was left in place. A second-look surgery for endoscopic removal was planned. Decision to proceed with an endoscopic removal was supported by the following characteristics found during the first surgery: tumor exophytic, soft texture, scarce vascularity, and low-grade appearance. A rescue strategy for microscopic resection via transcallosal approach was decided. A straight trajectory to the tumor was planned with navigation. A further anterior left frontal burr-hole was performed, and the ventricular system was entered via the left frontal horn. Resection was carried out alternating laser for hemostasis and cutting, endoscopic ultrasonic aspirator, and endoscopic forceps for piecemeal resection. Laser hemostasis and cutting (1 Watt power at tip, continuous wave mode) were useful at the ventricular wall-tumor interface. Relevant landmarks guided the approach and the resection (foramen of Monro, mammillary bodies, aqueduct, pineal and suprapineal recess, and posterior commissure). The surgery was carried uneventfully. Histopathology confirmed a lowgrade ependymoma. Post-operative MRI showed residual tumor within the lower aqueduct. At 3 years follow-up, residual tumor is stable. Conclusion: In selected cases, endoscopic resection for third ventricular tumors is feasible and safe, and represents a valid alternative to microsurgical approaches.

scholarly journals Adult gangliocytoma arising within the lateral ventricle: A case report and review of the literature

2022 ◽  
Vol 13 ◽  
pp. 11
Author(s):  
Norah Alarifi ◽  
Marc R. Del Bigio ◽  
Jason Beiko
Keyword(s):  
Lateral Ventricle ◽  
Obstructive Hydrocephalus ◽  
World Health ◽  
Pathological Examination ◽  
Low Grade ◽  
Foramen Of Monro ◽  
Transcallosal Approach ◽  
Pediatric Age Group ◽  
Frontal Horn ◽  
Cns Neoplasms

Background: Gangliocytomas are rare neuronal tumors with an incidence of <1% of all central nervous system (CNS) neoplasms. They occur mostly in the pediatric age group, localizing within the cerebral cortex, most often the temporal lobe. Case Description: We report a case of an intracranial gangliocytoma arising within the lateral ventricle in a 66-year-old female. Magnetic resonance imaging of the brain showed a diffusely enhancing lobulated mass situated within the frontal horn of the right lateral ventricle with extension into the foramen of Monro and obstructive hydrocephalus. The patient underwent an interhemispheric transcallosal approach with gross total resection and relief of her hydrocephalus. Pathological examination showed clusters of highly pleomorphic neuron-like cells without evidence of neoplastic glial cells. Histopathological and immunohistochemistry findings were consistent with the diagnosis of gangliocytoma (World Health Organization Grade 1). Conclusion: Gangliocytomas are rare low-grade CNS neoplasms that can present in an older population within unusual locations and should be included within the differential whenever a suspicious lesion is encountered.

Endoscopic Third Ventriculostomy before Posterior Fossa Tumor Surgery in Adult Patients

2017 ◽  
Vol 79 (02) ◽  
pp. 123-129 ◽  
Author(s):  
Ahmed El Damaty ◽  
Jotham Manwaring ◽  
Ehab El Refaee ◽  
Steffen Fleck ◽  
Michael Fritsch ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Obstructive Hydrocephalus ◽  
External Ventricular Drain ◽  
Clinical Signs ◽  
Adult Patients ◽  
Posterior Fossa Tumor ◽  
Third Ventriculostomy ◽  
Tumor Surgery ◽  
Posterior Fossa Tumors ◽  
Asymptomatic Patients

Objective Obstructive hydrocephalus in patients with posterior fossa tumors is frequently seen. Treatment options include immediate tumor removal or prior cerebrospinal fluid (CSF) diversion procedures. The necessity and feasibility of an ETV in these situations has not yet been proven in adult patients. Methods We retrospectively reviewed our prospectively maintained database for ETVs before surgery of posterior fossa tumors in adults. The primary focus of data analyses was the question of whether the ETV was suitable to treat the acute situation of hydrocephalus without an increased rate of complications due to the special anatomical situation with a posterior fossa tumor. We also analyzed whether any further CSF diverting procedures were necessary. Results A total of 40 adult patients who underwent an ETV before posterior fossa tumor surgery were analyzed. Overall, 33 patients (82.5%) had clinical signs of hydrocephalus, and all of them improved in their clinical course after ETV. Seven patients (17.5%) did not demonstrate clinical signs of hydrocephalus, but ETV was performed with prophylactic or palliative intent in six patients and one patient, respectively. No complications were observed due to ETV itself. No permanent shunting procedure was necessary in a mean follow-up of 76.5 months. Early additional CSF diverting procedures (redo ETV, external ventricular drain) were performed in five patients (12.5%). Conclusion The present series confirms the feasibility and safety of ETV before posterior fossa tumor surgery in adult patients. If patients had symptomatic hydrocephalus before tumor surgery, an ETV can be performed, followed by early elective tumor surgery. A prophylactic ETV in asymptomatic patients is not advised. Early elective tumor surgery should be performed in these patients.

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.

Completely endoscopic resection of intraparenchymal brain tumors

2009 ◽  
Vol 110 (1) ◽  
pp. 116-123 ◽  
Author(s):  
Amin B. Kassam ◽  
Johnathan A. Engh ◽  
Arlan H. Mintz ◽  
Daniel M. Prevedello
Keyword(s):  
Endoscopic Resection ◽  
Image Guidance ◽  
Brain Lesion ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Neurological Deficits ◽  
Endoscopic Removal ◽  
Cavernous Malformations ◽  
Novel Technique ◽  
Brain Tumor Resection

Object The authors introduce a novel technique of intraparenchymal brain tumor resection using a rod lens endoscope and parallel instrumentation via a transparent conduit. Methods Over a 4-year period, 21 patients underwent completely endoscopic removal of a subcortical brain lesion by means of a transparent conduit. Image guidance was used to direct the cannulation and resection of all lesions. Postoperative MR imaging or CT was performed to assess for residual tumor in all patients, and all patients were followed up postoperatively to assess for new neurological deficits or other surgical complications. Results The histopathological findings were as follows: 12 metastases, 5 glioblastomas, 3 cavernous malformations, and 1 hemangioblastoma. Total radiographically confirmed resection was achieved in 8 cases, near-total in 6 cases, and subtotal in 7 cases. There were no perioperative deaths. Complications included 1 infection and 1 pulmonary embolus. There were no postoperative hematomas, no postoperative seizures, and no worsened neurological deficits in the immediate postoperative period. Conclusions Fully endoscopic resection may be a technically feasible method of resection for selected subcortical masses. Further experience with this technique will help to determine its applicability and safety.

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.

scholarly journals Endoscopic Third Ventriculostomy: Our Experience of Consecutive 50 Cases at a Tertiary Care Center

2022 ◽  
Author(s):  
Ramesh Chandra Venkata Vemula ◽  
BCM Prasad ◽  
Kunal Kumar
Keyword(s):  
Success Rate ◽  
Endoscopic Third Ventriculostomy ◽  
Perioperative Complications ◽  
Obstructive Hydrocephalus ◽  
Care Center ◽  
External Ventricular Drain ◽  
Tertiary Care ◽  
Third Ventriculostomy ◽  
Magnetic Resonance Imaging Scan ◽  
Case Selection

Abstract Objective The aim of this study was to do a retrospective analysis of the various neurosurgical pathologies where endoscopic third ventriculostomy (ETV) was used and to evaluate the outcome and prognosis. Methods The retrospective data collection was done for the patients who underwent ETV with or without other adjunct procedures; the results were prepared for clinical presentation, diagnosis, surgical approach, and surgical goal; and success rate and prognosis were analyzed and compared with other studies. Results A total of 50 patients were included in the study, with overall success rate of ETV as 88%; aqueductal stenosis was the most common indication where ETV was used; headache and vomiting were the most common presenting complaints followed by ataxia and visual blurring; and ETV provided flexibility in its use with biopsy, abscess drainage, temporary external ventricular drain placement, etc. Conclusion ETV being superior to ventriculo-peritoneal shunt for obstructive hydrocephalus provides flexibility in its use and possibly is a useful adjunct to prevent postoperative hydrocephalus after endoscopic intraventricular surgery; proper case selection in accordance to ETV success score yields a better success rate. In experienced hands with proper precautions, perioperative complications can be kept at minimum. Wherever possible, in cases of obstructive hydrocephalus, especially in patients >1 year of age, ETV should be the treatment of choice. We recommend a proper case selection, including preoperative detailed reading of sagittal magnetic resonance imaging scan, to improve the success rate with less complication.

MULTIFOCAL COMPLEX GLIONEURONAL TUMOR IN AN ELDERLY MAN

Neurosurgery ◽  
2009 ◽  
Vol 64 (6) ◽  
pp. E1193-E1195 ◽  
Author(s):  
Jian-Qiang Lu ◽  
Bernd W. Scheithauer ◽  
Pranshu Sharma ◽  
James N. Scott ◽  
Ian F. Parney ◽  
...  
Keyword(s):  
Obstructive Hydrocephalus ◽  
External Ventricular Drain ◽  
Third Ventricle ◽  
Glioneuronal Tumor ◽  
Third Ventriculostomy ◽  
Magnetic Resonance Imaging Scan ◽  
Dysembryoplastic Neuroepithelial Tumor ◽  
Histological Features ◽  
The Third ◽  
Glioneuronal Tumors

Abstract OBJECTIVE The clinicopathological spectra of a dysembryoplastic neuroepithelial tumor (DNT) and a rosette-forming glioneuronal tumor (RGNT) are expanding. We report here the autopsy findings of a case of complex glioneuronal tumor with combined histological features of both a DNT and an RGNT. CLINICAL PRESENTATION A 79-year-old man presented with a 1-month history of confusion and gait difficulties. A magnetic resonance imaging scan revealed obstructive hydrocephalus attributed to a mass in the posterior third ventricle. INTERVENTION A third ventriculostomy was performed. Postoperatively, the mass remained unchanged in size for more than 14 months. Thirty-eight months after his initial manifestations, he experienced minor head trauma and was then hospitalized. Despite placement of an external ventricular drain and other supportive treatment, he deteriorated and died. A full autopsy was performed, with emphasis on the brain. The mass lesion and a few independent microfoci situated primarily around the third ventricle showed histological features of pilocytic astrocytoma with recurrent hemorrhage. Far more numerous were microfoci with histological features of a DNT, including floating neurons, as well as typical RGNT-associated, synaptophysin-positive rosettes and perivascular pseudorosettes. CONCLUSION The advanced age of the patient, the coexisting histological features of the DNT and RGNT, and the distinctive anatomic distribution of the lesions, being centered on the third ventricle, may lend insight into the histogenetic relationship of a DNT, an RGNT, and mixed glioneuronal tumors.

scholarly journals Endoscopic third ventriculostomy

2012 ◽  
Vol 03 (02) ◽  
pp. 163-173 ◽  
Author(s):  
Yad Ram Yadav ◽  
Vijay Parihar ◽  
Sonjjay Pande ◽  
Hemant Namdev ◽  
Moneet Agarwal
Keyword(s):  
Magnetic Resonance ◽  
Subarachnoid Space ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
External Ventricular Drain ◽  
Third Ventriculostomy ◽  
Type I ◽  
Slit Ventricle Syndrome ◽  
Prepontine Cistern ◽  
Operative Care

ABSTRACTEndoscopic third ventriculostomy (ETV) is considered as a treatment of choice for obstructive hydrocephalus. It is indicated in hydrocephalus secondary to congenital aqueductal stenosis, posterior third ventricle tumor, cerebellar infarct, Dandy-Walker malformation, vein of Galen aneurism, syringomyelia with or without Chiari malformation type I, intraventricular hematoma, post infective, normal pressure hydrocephalus, myelomeningocele, multiloculated hydrocephalus, encephalocele, posterior fossa tumor and craniosynostosis. It is also indicated in block shunt or slit ventricle syndrome. Proper Pre-operative imaging for detailed assessment of the posterior communicating arteries distance from mid line, presence or absence of Liliequist membrane or other membranes, located in the prepontine cistern is useful. Measurement of lumbar elastance and resistance can predict patency of cranial subarachnoid space and complex hydrocephalus, which decides an ultimate outcome. Water jet dissection is an effective technique of ETV in thick floor. Ultrasonic contact probe can be useful in selected patients. Intraoperative ventriculo-stomography could help in confirming the adequacy of endoscopic procedure, thereby facilitating the need for shunt. Intraoperative observations of the patent aqueduct and prepontine cistern scarring are predictors of the risk of ETV failure. Such patients may be considered for shunt surgery. Magnetic resonance ventriculography and cine phase contrast magnetic resonance imaging are effective in assessing subarachnoid space and stoma patency after ETV. Proper case selection, post-operative care including monitoring of ICP and need for external ventricular drain, repeated lumbar puncture and CSF drainage, Ommaya reservoir in selected patients could help to increase success rate and reduce complications. Most of the complications develop in an early post–operative, but fatal complications can develop late which indicate an importance of long term follow up.

scholarly journals Comparative analysis of endoscopic third ventriculostomy trajectories in pediatric cases

2015 ◽  
Vol 16 (6) ◽  
pp. 626-632 ◽  
Author(s):  
Zsolt Zador ◽  
David J. Coope ◽  
Ian D. Kamaly-Asl
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Three Dimensional ◽  
Internal Capsule ◽  
Entry Point ◽  
Third Ventriculostomy ◽  
Frontal Horn ◽  
Entry Points ◽  
Mri Scans ◽  
Ventricle Size

OBJECT Endoscopic third ventriculostomy (ETV) has become a widely used method for CSF diversion when treating obstructive hydrocephalus. There are multiple recommendations on the transcortical ETV entry points, and some are specifically designed to provide a trajectory that avoids displacement to the eloquent periventricular structures. However, the morphology of the ventricular system is highly variable in hydrocephalus, and therefore a single best ETV trajectory may not be applicable to all cases. In the current study, 3 frequently quoted ETV entry points are compared in a cohort of pediatric cases with different degrees of ventriculomegaly. METHODS The images of 30 consecutive pediatric patients with varying degrees of ventriculomegaly were reviewed. Three-dimensional models were created using radiological analysis of anatomical detail and preoperative MRI scans in order to simulate 3 frequently quoted ETV trajectories for rigid neuroendoscopes. These trajectories were characterized based on the frequency and depth of tissue displacement to structures such as the fornix, caudate nucleus, genu of the internal capsule, and thalamus. The results are stratified based on ventricle size using the frontal horn ratio (FHR). RESULTS Eloquent areas were displaced in nearly all analyzed entry points (97%–100%). Stratifying the data based on ventricle size revealed that 1) lateral structures were more likely to be displaced in cases of intermediate ventriculomegaly (FHR < 0.4) using all 3 trajectories, whereas 2) the fornix was less likely to be displaced using more posteriorly placed trajectories for severe ventriculomegaly (FHR > 0.4). Allowing for minimal (2.4 mm) tissue displacement, a more posterior entry point was less traumatic for severe ventriculomegaly. CONCLUSIONS There is no single best ETV trajectory that fully avoids displacement of the eloquent periventricular structures. Larger ventricles require a more posteriorly placed entry point in order to reduce injury to the eloquent structures, and intermediate ventricles would dictate a medial entry point. These results suggest that the optimal entry point should be selected on a case-by-case basis after incorporating ventricle size.

ENDOSCOPIC RESECTION OF LOW GRADE DYSPLASIA IN BARRETT’S OESOPHAGUS: A RETROSPECTIVE STUDY ABOUT 61 PATIENTS

2020 ◽  
Author(s):  
Fabrice Caillol ◽  
Arthur Falque ◽  
Margherita Pizzicannella ◽  
Christian Pesenti ◽  
Jean Philippe Ratone ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Endoscopic Resection ◽  
Barrett’S Oesophagus ◽  
Low Grade ◽  
Barrett's Oesophagus ◽  
Low Grade Dysplasia
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