The role of neuroendoscopy in the management of brain tumours

Abstract

Neuroendoscopy is increasingly used in the management of brain tumours and tumour related hydrocephalus and this study reviews the efficacy of neuroendoscopic interventions in this unit in patients with brain tumours. A series of 87 neuroendoscopic operations carried out in 77 patients with brain tumours over a 6-year period is reported. The age range of the patients was from 5 months to 70 years (median 13 years). In 56 cases (64%) presentation was with a newly-diagnosed tumour and hydrocephalus. The majority of the remaining patients had varying degrees of worsening hydrocephalus on the background of a previously diagnosed tumour. Neuroendoscopic third ventriculostomy (NTV) was successful in relieving hydrocephalus in the short term in 63/66 cases (95%) and in the longer term in 55/66 cases (83%). Neuroendoscopic tumour biopsies were successful in providing a tissue diagnosis in 17/28 cases (61%) and four extensive and three partial resections of tumour were carried out. There were two deaths within 30 days of the procedure with only one of these, secondary to intraventricular haemorrhage, directly related to neuroendoscopy. Few significant complications were noted otherwise. For selected intraventricular and paraventricular tumours neuroendoscopy offers the opportunity to combine relief of hydrocephalus with tumour biopsy and sampling of CSF in a single procedure.

Endoscopic management of pediatric brain tumors

“…This result represents a significant improvement from most other large studies with a diagnostic yield ranging from 52 to 63%. 6,13,14 In their series of 34 patients with pineal region tumors, Pople, et al, 17 also achieved a better than 90% diagnostic yield by using an endoscopic technique for tumor biopsy. The single failed biopsy procedure in the current series occurred early in my experience and was due to poor visualization of a posterior third ventricle tumor while using a fiberoptic scope and no navigational guidance.…”

“…2,6,7,9,13,15,17,18,22 Many factors, including the surgical technique, the tumor type, and the experience of the pathologist can influence the success of a diagnostic tumor biopsy procedure. In the current series of patients who underwent endoscopic surgery for intraventricular tumors, 24 of the 26 procedures were performed for tissue sampling.…”

“…Solid tumor removal, however, is somewhat limited due to the inadequacy of compatible instrumentation and the small caliber of current endoscopic portals. 2,7,13 The use of piecemeal removal with cupped biopsy forceps entails prolonged operative times even for relatively small tumors. Instead, the resection of solid tumor is principally achieved through the use of aspiration with a variable suction catheter.…”

“…The utility of endoscopic surgery is well established for the treatment of noncommunicating hydrocephalus, compartmentalized hydrocephalus, and arachnoid cysts. 3,8,13,16,21,23 Endoscopic neurosurgery for intraventricular brain tumors is a natural evolution of the technology, given that these lesions are positioned within a CSF interface and are amenable to detailed endoscopic inspection. Further contributing to the appeal of primary endoscopic management of intraventricular lesions is the fact that a number of tumors in children will not ultimately require aggressive surgical removal and that conventional craniotomy procedures can be demanding, with an inherently higher rate of surgical morbidity.…”

Ventricular endoscopy in the pediatric population: review of indications

“…In experienced hands, neuroendoscopic biopsy and resection of pediatric brain tumors appears to be an increasingly safe and effective procedure [51,55,[129][130][131][132]. The risks of clinically significant intraoperative hemorrhage necessitating abandonment of the procedure and postoperative bleeds are reported to be 2.3 and 3.5 %, respectively [133].…”