Abstract
Neuroendoscopy is now considered to be a minimally invasive surgical approach for expanding lesions bulging into the ventricle, and it is also considered to be a relevant tool for performing biopsy procedures, fenestration of cystic walls, or for performing tumor removal in selected cases. Furthermore, the use of neuroimaging and the accurate follow-up of brain tumor patients have allowed the documentation of tumoral and pseudotumoral cystic areas that cause the obstruction of cerebrospinal fluid (CSF) pathways. Neuroendoscopic procedures enable the fenestration of cystic lesions, in addition to enabling third ventriculostomy or septostomy to restore CSF pathways. We analyze our experience regarding 77 patients affected by brain tumors arising from the wall of the third or lateral ventricle. In all cases hydrocephalus or obstruction of CSF flow was present. With an endoscopic technique, septostomy, cystostomy, endoscopic third ventriculostomy (ETV), and tumor resection were performed to control intracranial hypertension.
ETV was performed in 53 patients with noncommunicating hydrocephalus. In 4 patients with low-grade astrocytoma ETV was definitely the only surgical treatment. In 12 cystic tumors, cystostomy and marsupialization into the ventricle solved a relevant mass effect with clinical intracranial hypertension syndrome. In 10 patients, neuroendoscopic relief of CSF pathways was possible by performing septostomy with the implantation of an Ommaya reservoir or one-catheter shunt. In 5 colloid cysts and 2 cystic craniopharyngiomas, removal was possible by restoring CSF flow without other procedures. After intracranial hypertension control, in 13 malignant gliomas and 5 leptomeningeal metastases, the patients’ quality of life improved sufficiently to provide for tumor adjuvant therapy.
In this series, endoscopy, due to its minimally invasive characteristics and reduced complications, was found to be safe and effective, without any relevant postoperative morbidity, gained by avoiding major surgical approaches.
Based on these results and on the increasing number of series described in the literature, we believe that endoscopic techniques should be considered a selected approach for treating CSF obstructions caused by para-intraventricular tumors. The result of using neuroendoscopy is the reconstruction of CSF pathways that bypass the tumor occlusion. This surgical procedure is not only limited to the relief of noncommunicating hydrocephalus, but it is also useful for tumor removal or biopsies and the evacuation of cystic lesions. In patients affected by malignant tumors, neuroendoscopy can be performed to control intracranial hypertension before the patients start adjuvant chemotherapy or radiotherapy.
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References
Bouras T et al (2013) Complications of endoscopic third ventriculostomy. World Neurosurg 79(2):S22.e9–S22.e12
Cappabianca P, Cinalli G, Gangemi M (2008) Application of neuroendoscopy to intraventricular lesions. Neurosurgery 62(suppl 2):SHC575–SHC598
Ferreri AJM, Dell’Oro S, Foppoli M (2006) MATILDE regimen followed by radiotherapy is an active strategy against primary CNS lymphomas. Neurology 66:1435–1438
Fiorindi A, Longatti P (2008) A restricted neuroendoscopic approach for pathological diagnosis of intraventricular and paraventricular tumours. Acta Neurochir (Wien) 150(12):1235–1239
Gangemi M, Mascari C, Maiuri F (2007) Long-term outcome of endoscopic third ventriculostomy in obstructive hydrocephalus. Minim Invasive Neurosurg 50:265–269
Hellwig D, Grotenhuis JA, Tirakoroi W et al (2005) Endoscopic third ventriculostomy for obstructive hydrocephalus. Neurosurg Rev 28:1–38
Johnson RR, Baehring J, Piepmeier J (2003) Surgery for third ventricular tumors. Neurosurg Quart 13:207–225
Koeller KK, Sandberg GD (2002) Cerebral intraventricular neoplasms: radiologic-pathologic correlation. RG 22:1473–1505
Longatti P, Godano U, Gangemi M, Delitala A, Morace E, Genitori L, Alafaci C, Benvenuti L, Brunori A, Cereda C, Cipri S, Fiorindi A, Giordano F, Mascari C, Oppido PA, Perin A, Tripodi M, Italian neuroendoscopy group (2006) Cooperative study by the Italian neuroendoscopy group on the treatment of 61 colloid cysts. Childs Nerv Syst 22(10):1263–1267, Epub 2006 Apr 29. Erratum in: Childs Nerv Syst. 2006 22(10):1375
Liu W, Fang Y, Cai B, Xu J, You C, Zhang H (2012) Intracystic bleomycin for cystic craniopharyngiomas in children (Abriged Republication of Cochrane Systematic Review). Neurosurgery 71(5):909–915. doi:10.1227/NEU.0b013e31826d5c31
Ludwig HC, Kruschat T, Knobloch T, Teichmann HO, Rostasy K, Rohde V (2007) First experience with a 2.0 micron near infrared laser system for neuroendoscopy. Neurosurg Rev 30:195–201
Najjar MW, Azzam NI, Baghdadi TS, Turkmani AH, Skaf G (2010) Endoscopy in the management of intra-ventricular lesions: preliminary experience in the Middle East. Clin Neurol Neurosurg 112(1):17–22
O’Brien DF, Hayhurst C, Pizer B et al (2006) Outcomes in patients undergoing single trajectory endoscopic third ventriculostomy and endoscopic biopsy for midline tumors presenting with obstructive hydrocephalus. J Neurosurg 105(Suppl Pediatrics):219–226
Oppido PA, Fiorindi A, Benvenuti L, Cattani F, Cipri S, Gangemi M, Godano U, Longatti P, Mascari C, Morace E, Tosatto L (2011) Neuroendoscopic biopsy of ventricular tumors: a multicentric experience. Neurosurg Focus 30(4):E2. doi:10.3171/2011.1.FOCUS10326
Passacantilli E, Antonelli M, D’Amico A, Delfinis CP, Anichini G, Lenzi J et al (2012) Neurosurgical applicationsof the 2 μm thulium laser: histological evaluation of meningiomas in comparison to bipolar forceps and ultrasonic aspirator. Photomed Laser Surg 30(5):286–292
Shono T, Natori Y, Morioka T et al (2007) Results of a long-term follow-up after neuroendoscopic biopsy procedure and third ventriculostomy in patients with intracranial germinomas. J Neurosurg 107(3 Suppl Pediatrics):193–198
Souweidane MM, Luther N (2006) Endoscopic resection of solid intraventricular brain tumors. J Neurosurg 105:271–278
Tirakotai W, Hellwig D, Bertalanffy H et al (2007) The role of neuroendoscopy in the management of solid-cystic intra and periventricular tumours. Childs Nerv Syst 23:653–658
Waldron JS, Tihan T (2003) Epidemiology and pathology of intraventricular tumors. Neurosurg Clin N Am 14:469–482
Yamini B, Refai D, Rubin CM (2004) Initial endoscopic management of pineal region tumors and associated hydrocephalus: clinical series and literature review. J Neurosurg 100(Suppl Pediatrics):437–441
Yasargil MG, Abdulrauf SI (2008) Surgery of intraventricular tumors. Neurosurgery 62(6 SHC Suppl 3):SHC 1029–SHC 1041
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Oppido, P.A. (2017). Endoscopic Reconstruction of CSF Pathways in Ventricular Tumors. In: Visocchi, M., Mehdorn, H.M., Katayama, Y., von Wild, K.R.H. (eds) Trends in Reconstructive Neurosurgery. Acta Neurochirurgica Supplement, vol 124. Springer, Cham. https://doi.org/10.1007/978-3-319-39546-3_14
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DOI: https://doi.org/10.1007/978-3-319-39546-3_14
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