scholarly journals Endoscopic Management of Intra Ventricular Tumours

2021 ◽  
Vol 3 (1(January-April)) ◽  
pp. e692021
Author(s):  
Giuseppe Cinalli
Keyword(s):  
Pediatric Patients ◽  
Complete Removal ◽  
Pineal Region ◽  
Histological Evaluation ◽  
Endoscopic Management ◽  
Biopsy Forceps ◽  
Pineal Region Tumors ◽  
Ultrasonic Aspirator ◽  
Duration Of Surgery ◽  
Intraventricular Tumors

Objective:  Neuroendoscopic removal of intraventricular tumors is difficult and time consuming because of the lack of an effective decompression system that can be used through the working channel of the endoscope. The authors report on the utilization of an endoscopic ultrasonic aspirator in the resection of intraventricular tumors. Methods: Seventeen pediatric patients (14 male, 3 female), ages 1-15 years old, underwent surgery via a purely endoscopic approach using a Gaab rigid endoscope and endoscopic ultrasonic aspirator. Ten patients presented with an intraventricular tumor, three with paraventricular, and 4 with suprasellar lesions. Histology analysis showed 6/17 glial tumors, 3/17 with subependymal giant cell astrocytomas (associated with tuberous sclerosis), two cases presented with intraventricular metastases from high-grade tumors (medulloblastoma, atypical teratoid rhabdoid tumor), 4/17 with suprasellar tumors (2 craniopharyngiomas and 2 optic pathway gliomas), and two with pineal region tumors (1 immature teratoma, 1 PNET). In all patients, the endoscopic trajectory and ventricular access were guided by electromagnetic neuronavigation. Fifteen patients underwent surgery via a precoronal bur hole while supine. In 1 case, surgery was performed through a frontal anterior bur hole and one patient underwent surgery via a posterior parietal approach to the trigone while in a lateral position. The endoscopic technique consisted of visualization of the tumor, ventricular washing to dilate the ventricles and to control bleeding, obtaining a tumor specimen with biopsy forceps, and ultrasonic aspiration of the tumor. Bleeding was controlled with irrigation, monopolar coagulation, and a thulium laser. Results/Discussion: In 9 cases, the resection was total or near total (more than 90% of lesion removed). In 8 cases, the resection was partial or biopsy. Histological evaluation of the collected material (withdrawn using biopsy forceps and aspirated with an ultrasonic aspirator) was diagnostic in all cases. The duration of surgery ranged from 30 to 120 minutes. One case was complicated by subdural hygroma requiring a subduro-peritoneal shunt implant. The dry field technique was used in cases with persistence of bleeding. Conclusion: Patients harboring intraventricular tumors are in most cases ideal candidates for endoscopy biopsy/resection. In this series, endoscopic ultrasonic aspiration proved to be a safe and reliable method for achieving extensive decompression or complete removal in the management of intra- and/or paraventricular lesions in pediatric patients.

scholarly journals Initial experience with endoscopic ultrasonic aspirator in purely neuroendoscopic removal of intraventricular tumors

2017 ◽  
Vol 19 (3) ◽  
pp. 325-332 ◽  
Author(s):  
Giuseppe Cinalli ◽  
Alessia Imperato ◽  
Giuseppe Mirone ◽  
Giuliana Di Martino ◽  
Giancarlo Nicosia ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Complete Removal ◽  
Lateral Position ◽  
Histological Evaluation ◽  
Low Grade ◽  
Biopsy Forceps ◽  
Pineal Tumors ◽  
Ultrasonic Aspirator ◽  
Duration Of Surgery ◽  
Intraventricular Tumors

OBJECTIVE Neuroendoscopic removal of intraventricular tumors is difficult and time consuming because of the lack of an effective decompression system that can be used through the working channel of the endoscope. The authors report on the utilization of an endoscopic ultrasonic aspirator in the resection of intraventricular tumors. METHODS Twelve pediatric patients (10 male, 2 female), ages 1–15 years old, underwent surgery via a purely endoscopic approach using a Gaab rigid endoscope and endoscopic ultrasonic aspirator. Two patients presented with intraventricular metastases from high-grade tumors (medulloblastoma, atypical teratoid rhabdoid tumor), 2 with subependymal giant cell astrocytomas (associated with tuberous sclerosis), 2 with low-grade intraparaventricular tumors, 4 with suprasellar tumors (2 craniopharyngiomas and 2 optic pathway gliomas), and 2 with pineal tumors (1 immature teratoma, 1 pineal anlage tumor). Hydrocephalus was present in 5 cases. In all patients, the endoscopic trajectory and ventricular access were guided by electromagnetic neuronavigation. Nine patients underwent surgery via a precoronal bur hole while supine. In 2 cases, surgery was performed through a frontal bur hole at the level of the hairline. One patient underwent surgery via a posterior parietal approach to the trigone while in a lateral position. The endoscopic technique consisted of visualization of the tumor, ventricular washing to dilate the ventricles and to control bleeding, obtaining a tumor specimen with biopsy forceps, and ultrasonic aspiration of the tumor. Bleeding was controlled with irrigation, monopolar coagulation, and a thulium laser. RESULTS In 7 cases, the resection was total or near total (more than 90% of lesion removed). In 5 cases, the resection was partial. Histological evaluation of the collected material (withdrawn using biopsy forceps and aspirated with an ultrasonic aspirator) was diagnostic in all cases. The duration of surgery ranged from 30 to 120 minutes. One case was complicated by subdural hygroma requiring a subduro-peritoneal shunt implant. CONCLUSIONS In this preliminary series, endoscopic ultrasonic aspiration proved to be a safe and reliable method for achieving extensive decompression or complete removal in the management of intra- and/or paraventricular lesions in pediatric patients.

scholarly journals Is jumbo biopsy forceps comparable to cold snare for diminutive colorectal polyps? – a meta-analysis

2021 ◽  
Vol 09 (01) ◽  
pp. E9-E13
Author(s):  
Sachin Srinivasan ◽  
Peter D. Siersema ◽  
Madhav Desai
Keyword(s):  
Meta Analysis ◽  
Complete Removal ◽  
Colorectal Polyps ◽  
Comparable Efficacy ◽  
Incomplete Resection ◽  
Complication Rates ◽  
Biopsy Forceps ◽  
Significant Difference ◽  
Leave One Out ◽  
Endoscopic Assessment

Abstract Background and study aims Diminutive colorectal polyps are increasingly being detected and it is not clear whether jumbo biopsy forceps (JBF) has comparable efficacy to that of cold snare polypectomy (CSP) for management of these lesions. Methods An electronic literature search was performed for studies comparing resection rates of JBF and CSP for diminutive polyps (≤ 5 mm). The primary outcome was incomplete resection rate (IRR). Secondary outcomes included failure of tissue retrieval and complication rates (post-polypectomy bleeding, perforation etc.). Leave-one-out analysis was performed to examine the disproportionate role of any of the studies. Meta-analysis outcomes and heterogeneity (I2) were computed using Comprehensive meta-analysis software. Results A total of 4 studies (3 randomized controlled trials and 1 retrospective study) with 407 patients and 569 total polyps (mean size of 3.62 mm) was included for analysis. IRR of JBF was slightly higher than that of CSP (10.2 % vs 7.2 %) but this was not statistically significantly different (Pooled OR 1.76; 95 % CI 0.94–3.28; I2 = 0). Leave-one-out analysis showed no significant difference in the pooled OR comparison either. Two of the 4 studies reported 0 % failure of tissue retrieval for JBF and 1 % and 4.3 % for CSP. There were no complications for either group from the 2 studies that reported this outcome. The quality of the included studies was moderate to high. Conclusions This systematic review with only limited data shows that JBF and CSP are not statistically different in completely removing diminutive polyps, although careful endoscopic assessment is needed to ensure complete removal of all polyp tissue.

CT and MR of pineal region tumors

1994 ◽  
Vol 12 (1) ◽  
pp. 17-24 ◽  
Author(s):  
Athanasios D. Gouliamos ◽  
Angelos E. Kalovidouris ◽  
Grigoris K. Kotoulas ◽  
Alexandra K. Athanasopoulou ◽  
John R. Kouvaris ◽  
...  
Keyword(s):  
Pineal Region ◽  
Pineal Region Tumors

scholarly journals Meningiomas of pineal region in children

2007 ◽  
Vol 65 (4a) ◽  
pp. 1000-1006 ◽  
Author(s):  
Hamilton Matushita ◽  
Fernando Campos Pinto ◽  
José Píndaro Pereira Plese
Keyword(s):  
Clinical Presentation ◽  
Complete Removal ◽  
Pineal Region ◽  
Total Resection ◽  
Long Term Follow Up ◽  
One Year ◽  
Velum Interpositum ◽  
Transtentorial Approach

Meningiomas are uncommon tumors in children and either more rarely encountered in the pineal region. We report two cases of meningioma of the pineal region in children. One of these cases was a five years-old girl and the other a one year-old boy. No specific clinical presentation or tomographic examinations findings was identified before treatment, suggestive of a diagnosis of menigioma. The clinical and laboratory features were very similar to the most common tumors of the pineal region. Prior to the surgery, the histology of these tumors was not suspected. Both patients underwent direct surgery and complete removal was achieved by a suboccipital transtentorial approach. The tumors originated from velum interpositum in both cases. At the follow up, one case presented with recurrence six years later, and she underwent a reoperation with total resection without morbidity. Long-term follow up presented no other recurrences.

scholarly journals Interhemispheric transcallosal intervenous approach to a pineal region tumor

2021 ◽  
Vol 5 (1) ◽  
pp. V11
Author(s):  
Daniel A. Donoho ◽  
Guillermo Aldave
Keyword(s):  
Extent Of Resection ◽  
Pineal Region ◽  
Cerebral Veins ◽  
Surgical Morbidity ◽  
Pineal Tumors ◽  
Pineal Region Tumor ◽  
Pineal Region Tumors ◽  
Transcallosal Approach ◽  
Formidable Challenge ◽  
The Right

Pineal region tumors represent a formidable challenge to the neurosurgeon. Choosing the right approach is key to optimizing the extent of resection and minimizing surgical morbidity. In this video, the authors show an interhemispheric transcallosal approach to a pineal region tumor in a 15-year-old boy. The advantage of this corridor over posterior approaches is that it provides a nice view of the tumor plane with the venous complex, especially while dissecting tumor from the anterior aspect of the internal cerebral veins on their vertical path. Thus, this approach represents a safe and effective alternative for selected pineal tumors. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2120.

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