Initial endoscopic management of pineal region tumors and associated hydrocephalus: clinical series and literature review

Yamini, Bakhtiar; Refai, Daniel; Rubin, Charles M.; Frim, David M.

doi:10.3171/ped.2004.100.5.0437

Cited by 84 publications

(71 citation statements)

References 17 publications

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“…6 Neuroendoscopic biopsy is characterized by the lowest level of accuracy because of the small quantity of biopsy material extracted. 47 In the present study, mixed intracranial GCTs were present with a high rate of 64.3%. Seven biopsies were performed-3 via a stereotactic approach and 4 via an endoscopic approach.…”

Section: Indications For Surgical Removal Of Intracranial Teratomasmentioning

confidence: 77%

Intracranial teratomas in children: the role and timing of surgical removal

Noudel

Vinchon

Dhellemmes

et al. 2008

PED

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Object In this study, the authors report their experience with the surgical treatment of intracranial teratomas with an emphasis on the indications for delayed resection after oncological treatment. Methods The authors retrospectively reviewed the cases of 14 children with intracranial teratomas. The mean age at diagnosis was 10.5 years (range 2 days–18 years), and 11 patients were male. The final histological analysis revealed pure mature teratoma in 5 cases, mixed teratoma with germinoma in 3 cases, and nongerminomatous malignant germ cell tumor in 6 cases. Thirteen patients underwent tumor resection, and these patients were divided into 2 subgroups according to the timing of surgery. In Group A, 10 patients underwent resection as the primary treatment because no tumor markers were detected in 4 patients, a teratomatous component was revealed on biopsy sampling in 3 patients, and a large tumor volume in 3 patients. In Group B, 3 patients underwent removal of residual pure mature teratoma after oncological treatment. Results Seven of the 8 patients (87.5%) with pure mature teratomas or with mixed teratoma and germinoma are currently alive (mean follow-up of 9 years); the eighth patient died of postoperative meningitis. Two of the 6 patients (33%) with mixed nongerminomatous malignant germ cell tumors died of tumor progression regardless of the timing of surgery. Conclusions The results of this study support the belief that microsurgical removal is the only effective treatment for intracranial teratomas. Surgery may be performed as the primary therapy when there is evidence of a noninvasive teratoma, and as a secondary therapy if there is only a partial response to neoadjuvant therapy or if progression is observed in mixed malignant germ cell tumors.

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Section: Indications For Surgical Removal Of Intracranial Teratomasmentioning

confidence: 77%

Intracranial teratomas in children: the role and timing of surgical removal

Noudel

Vinchon

Dhellemmes

et al. 2008

PED

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“…The role of ETV is well established, and its success in the treatment of obstructive hydrocephalus due to intracranial tumours is recognised both in paediatric patients (as described in recent articles by Wong et al [78], Di Rocco et al [79], and other authors [21,[80][81][82]) and adults [83,84].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic third ventriculostomy in the management of hydrocephalus: Outcome analysis of 168 consecutive procedures

Salvador

Oliveira

Pereira

et al. 2014

Clinical Neurology and Neurosurgery

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a b s t r a c tBackground: Endoscopic third ventriculostomy (ETV) is the treatment of choice for obstructive hydrocephalus, but the outcome is still controversial in terms of age and aetiology. Methods: Between 1998 and 2011, 168 consecutive procedures were performed in 164 patients, primarily children (56% < 18 years of age and 35% < 2 years of age). The causes of obstructive hydrocephalus included tumoural pathology, Chiari malformation, congenital obstruction of the aqueduct, post-infectious and post-haemorrhagic membranes, and ventriculo-peritoneal shunt (VPS) malfunctions. Successful ETV was defined by the resolution of symptoms and the avoidance of a shunt. Results: ETV was successful in 75.6% of patients, but 19% of the patients required VPS in the first month after ETV, and 5.4% required a VPS more than one month after ETV. Four patients were ultimately submitted for second ETVs. In this series, no major permanent morbidity or mortality was observed. Conclusions: ETV is a safe procedure and an effective treatment for obstructive hydrocephalus even following the dysfunction of previous VPSs and in children younger than two years.

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“…15 The alternative for the treatment of hydrocephalus is VP shunting, a procedure that may play a role in dissemination of some tumors such as pinealoblastoma and germ cell tumors into the peritoneum. 24 For this reason, even today, microsurgical removal is considered the best therapeutic option in selected cases. However, due to the deep location of intra-and paraventricular tumors, it remains challenging and is fraught with potential complications, which may be functional and cognitive or even life-threatening.…”

Section: Discussionmentioning

confidence: 99%

Neuroendoscopic biopsy of ventricular tumors: a multicentric experience

Fiorindi

Benvenuti

et al. 2011

FOC

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Object Although neuroendoscopic biopsy is routinely performed, the safety and validity of this procedure has been studied only in small numbers of patients in single-center reports. The Section of Neuroendoscopy of the Italian Neurosurgical Society invited some of its members to review their own experience, gathering a sufficient number of cases for a wide analysis. Methods Retrospective data were collected by 7 centers routinely performing neuroendoscopic biopsies over a period of 10 years. Sixty patients with newly diagnosed intraventricular and paraventricular tumors were included. No patient harboring a colloid cyst was included. Data regarding clinical presentation, neuroimaging findings, operative techniques, pathological diagnosis, postoperative complications, and subsequent therapy were analyzed. Results In all patients, a neuroendoscopic tumor biopsy was performed. In 38 patients (64%), obstructive hydrocephalus was present. In addition to the tumor biopsy, 32 patients (53%) underwent endoscopic third ventriculostomy (ETV), and 7 (12%) underwent septum pellucidotomy. Only 2 patients required a ventriculoperitoneal shunt shortly after the endoscopy procedure because ETV was not feasible. The major complication due to the endoscopy procedure was ventricular hemorrhage noted on the postoperative images in 8 cases (13%). Only 2 patients were symptomatic and required medical therapy. Infection occurred in only 1 case, and the other complications were all reversible. In no case did clinically significant sequelae affect the patient's outcome. Tumor types ranged across the spectrum and included glioma (low- and high-grade [27%]), pure germinoma (15%), pineal parenchymal tumor (12%), primary neuroectodermal tumor (4%), lymphoma (9%), metastasis (4%), craniopharyngioma (6%), and other tumor types (13%). In 10% of patients, the pathological findings were inconclusive. According to diagnosis, specific therapy was performed in 35% of patients: 17% underwent microsurgical removal, and 18% underwent chemotherapy or radiotherapy. Conclusions This is one of the largest series confirming the safety and validity of the neuroendoscopic biopsy procedure. Complications were relatively low (about 13%), and they were all reversible. Neuroendoscopic biopsy provided meaningful pathological data in 90% of patients, making subsequent tumor therapy feasible. Cerebrospinal fluid pathways can be restored by ETV or septum pellucidotomy (65%) to control intracranial hypertension. In light of the results obtained, a neuroendoscopic biopsy should be considered a possible alternative to the stereotactic biopsy in the diagnosis and treatment of ventricular or paraventricular tumors. Furthermore, it could be the only surgical procedure necessary for the treatment of selected tumors.

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Initial endoscopic management of pineal region tumors and associated hydrocephalus: clinical series and literature review

Abstract: The authors conclude that the endoscopic management of patients with pineal region masses and hydrocephalus may be a preferred initial strategy.

Cited by 84 publications

References 17 publications

Intracranial teratomas in children: the role and timing of surgical removal

Intracranial teratomas in children: the role and timing of surgical removal

Endoscopic third ventriculostomy in the management of hydrocephalus: Outcome analysis of 168 consecutive procedures

Neuroendoscopic biopsy of ventricular tumors: a multicentric experience

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