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

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>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 Histological evaluation of the collected material (withdrawn using biopsy forceps and aspirated with an ultrasonic aspirator) was diagnostic in all cases.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.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>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.</jats:p></jats:sec>

A review of common endoscopic intracranial approaches

“…The tumors ranged from medulloblastomas, atypical teratoid rhabdoid tumors, subependymal giant cell astrocytomas, craniopharyngiomas, optic pathway gliomas, and pineal tumors. [ 77 ] Ibáñez-Botella et al . received similar results in their series of nine patients who had lesions such as SEGAs, colloid cysts, pilocytic astrocytoma, epidermoid tumor, and central neurocytoma.…”

The endoscope and instruments for minimally invasive neurosurgery

“…Results of endoscopic ultrasonic aspirator use were first published in 2008 by Oertel et al [49] . Since then, it has been used for intraventricular [ Figure 10] and paraventricular lesions along with thulium LASER for hemostasis [50] . For endonasal surgeries, special thin and long tip ultrasonic aspirators can be used (Both ultastrasonic aspirators by Soering, Germany).…”

Pediatric Central Nervous System Tumors: State-of-the-Art and Debated Aspects

“…Pure endoscopic tumor resection is described for select cases, but is seldom performed in our practice, and is better described elsewhere ( 29 , 30 ). The dexterity of endoscopic instruments and techniques is improving; the advent of endoscopic lasers, and ultrasonic aspirators has expanded the capability of endoscopic tumor resection ( 31 ). Endoscopy can be combined in a multimodal approach for example alongside neuronavigation and ioMRI (Figure 3 ).…”