Endoscopic options in management of posterior third ventricular tumors

Kumar, Santhosh; Mohanty, Aaron; Santosh, Vani; S, Satish; Devi, Bhagavatula Indira; Praharaj, S. S.; Kolluri, Sastry

doi:10.1007/s00381-007-0371-0

Cited by 21 publications

(5 citation statements)

References 58 publications

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“…Moreover, they offer higher quality endoscopic images which enable obtaining samples from various regions of the exposed tumor surface. [ 4 24 25 39 ] Notably, however, no prospective assessment of the comparative diagnostic yields of lenscopes versus fiberscope endoscopic brain tumor biopsy has been carried out yet. Based on our analysis of the literature, a conclusion in favor of using a lenscope to obtain biopsy of brain tumors can clearly be drawn.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic biopsy of brain tumors: Does the technique matter?

et al. 2014

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Background:Endoscopic biopsy of brain tumors is an important part of the armamentarium of management of intra- and periventricular tumors that is generally considered an acceptable and, in some situations, a preferred method for tissue sampling. The diagnostic yield of the procedure has been variably reported. Technical aspects of the procedure should undoubtedly reflect on its success rate and accuracy. Such impact on diagnostic yield of endoscopic brain biopsy is infrequently discussed in the literature.Methods:A search of the medical literature was conducted for publications on endoscopic brain biopsy. These reports were analyzed regarding the various technical aspects.Results:In the 43 publications analyzed, lenscopes were exclusively used in 22 reports and a tissue diagnosis was possible in 362 out of 387 endoscopic biopsies with a diagnostic yield of 93.54%. Only fiberscopes were used in 8 reports and a tissue diagnosis was possible in 100 out of 132 endoscopic biopsies with a diagnostic yield of 75.76%. The diagnostic yield in the mixed and unspecified groups was 88.95 and 88.04%, respectively. Very few details on the histopathological methods and tumor molecular genetics could be found.Conclusion:Endoscopic biopsy of brain tumors has a higher diagnostic yield when lenscopes are used. Neuronavigation seems to add to the diagnostic accuracy of the procedure. Studies detailing molecular genetic features of biopsied tumors are necessary in the future.

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Section: Discussionmentioning

confidence: 99%

Endoscopic biopsy of brain tumors: Does the technique matter?

et al. 2014

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“…Endoscopic third ventriculostomy, as performed for two of our patients, is presently recommended as the procedure of choice for CSF diversion. [4041] It avoids the complications of shunt malfunction and infection; it also avoids peritoneal seeding of the malignant TPTVR; CSF may be obtained for tumor marker study; and usually both CSF diversion as well as tumor biopsy may be undertaken at the same sitting. The disadvantages of an endoscopic biopsy are the risk of bleeding from a vascular tumor or ventricular ependyma while obtaining a biopsy and the failure to obtain a representative sample of tumor tissue due to the extreme variability of the its character in different parts of the tumor substance.…”

Section: Discussionmentioning

confidence: 99%

Tumors of the posterior third ventricular region in pediatric patients: The Indian perspective and a review of literature

et al. 2011

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Background:Diverse tumors in the posterior third ventricular region (TPTVR) frequently occur in children. A decade's experience with pediatric TPTVR is presented, focusing on the Indian perspective.Materials and Methods:25 children (age range: 3-18 years; mean age: 13.32 years; presentation range: 7 days-2.5 years) had clinico-radiological assessment with contrast computed tomography (CT) and magnetic resonance imaging (MRI). The ventricular/lumbar cerebrospinal fluid (CSF) alpha feto protein (AFP)/beta human chorionic gonadotrophin (HCG) estimation was done when radiological suspicion of a germ cell tumor was present. Extent of resection was deemed partial when some tumor mass remained at the end of surgery, near total when <10% was retained over vital neurovascular structures, and total when complete resection was attained.Results:Operations included infratentorial supracerebellar approach (n = 12), occipito-transtentorial approach (n = 2), endoscopic biopsy and third ventriculostomy (n = 1), frontal parasagittal craniotomy, interhemispheric transcallosal subchoroidal approach (n = 2), middle temporal gyrus transcortical transventricular approach (n = 1), fronto-temporo-zygomatic combined transylvian and subtemporal approach (n = 1) and right ventriculoperitoneal shunt and stereotactic biopsy (n = 1). Only CSF diversion was performed for five patients with a small TPTVR. CSF diversion was required in 12 (48%) patients. Tumor pathology included pinealoblastoma (n = 4; one with pineocytic differentiation), nongerminomatous germ cell tumor (NGGCT; n = 3), germinoma (n = 3), pilocytic astrocytoma (n = 2), epidermoid (n = 3) and primitive neuroectodermal tumor (PNET), fibrillary astrocytoma, glioblastoma, teratoma, and meningioma (n = 1, respectively). A patient with neurocysticercosis was diagnosed solely on MRI (four did not undergo biopsy). Fractionated radiotherapy was administered in 13 patients with primary pineal tumors, PNET, NGGCT, fibrillary astrocytoma and glioblastoma. Extent of excision was total in 10 (40%), near total in 5 (20%), partial in 3 (12%) and a biopsy in 2 (8%) patients.Conclusions:Histopathologic characterization of TPTVR is essential prior to their further management. Benign lesions often have a good prognosis following gross total surgical resection. Pure germinomas are highly susceptible to radiotherapy. NGGCTs often have malignant components that require adjuvant therapy following surgery. The advancements in microsurgical techniques have led to gratifying perioperative results in these deep-seated lesions.

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“…9,20,32,35,36,38,44,[50][51][52][53][54][55][56] Endoscopic third ventriculostomy (ETV) and tumor biopsy have transformed pineal region tumor management, offering both diagnosis and treatment, especially for noncommunicating hydrocephalus cases, with direct visualization aiding in identifying malignant dissemination not visible on preoperative MRI scans and achieving diagnostic rates as high as 100%. [57][58][59] Surgical approaches to tumor biopsy involve various techniques such as single or dual burr holes, where rigid endoscopes are favored for larger biopsy forceps and flexible ones for addressing trajectory issues 25,[60][61][62][63][64] . Sequential CSF collection, ETV, and biopsy are recommended in individualized procedures to minimize bleeding that might obscure landmarks.…”

Section: Treatment Modalities and Prognosismentioning

confidence: 99%

Pineal Apoplexy: Highlighting the Causes, Treatment, and Outcome

Atallah,

Chaurasia,

Badary

et al. 2024

J Neurol Surg A Cent Eur Neurosurg

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Background Pineal apoplexy, alternatively referred to as pineal hemorrhage or pineal gland hemorrhagic stroke, is an infrequent pathologic condition characterized by bleeding within the pineal gland. In this review, we encompass the primary factors contributing to this uncommon ailment. Methods The retrieval of pertinent research, including patients with pineal apoplexy, was conducted through PubMed, Google Scholar, and Scopus databases. This study exclusively incorporated comprehensive articles written in the English language. The search encompassed the MeSH terms “pineal apoplexy” and “pineal hemorrhage.” Results A total of 41 articles were identified, encompassing a collective sample size of 57 patients. The median age of the patients in the study was 30 years, with a range spanning from 1 to 73 years. There were 27 males, representing 47.4% of the participants. The study identified the most often reported symptoms as headache (49; 86%), nausea/vomiting (19; 33.3%), and Parinaud's syndrome (16; 28.1%). The treatment options encompass several approaches, including open resection, shunting, ventriculostomy, endoscopic aspiration, and conservative care. In the conducted study, a notable number of patients, amounting to 45 cases (78.9%), indicated an amelioration of their symptoms upon their discharge. Conclusion Data from a cohort of 57 cases provide insights into symptoms, lesions, treatments, and outcomes. Management approaches range from conservative measures to surgical interventions, with prognosis hinged on timely intervention. This investigation serves as a valuable resource for clinicians and researchers, underscoring the need for early diagnosis before permanent neurologic dysfunction happens and tailored treatments for optimal outcomes in pineal apoplexy cases.

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Endoscopic options in management of posterior third ventricular tumors

Abstract: The high yield of endoscopic biopsy (100%) and success of ETV (91%) emphasizes its role in management of the diverse group of PTV lesions in arriving at the optimal definitive management.

Cited by 21 publications

References 58 publications

Endoscopic biopsy of brain tumors: Does the technique matter?

Endoscopic biopsy of brain tumors: Does the technique matter?

Tumors of the posterior third ventricular region in pediatric patients: The Indian perspective and a review of literature

Pineal Apoplexy: Highlighting the Causes, Treatment, and Outcome

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