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Simultaneous single-trajectory endoscopic biopsy and third ventriculostomy in pediatric pineal region tumors

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Abstract

Pineal region tumors have different pathological tumors and their optimal management remains controversial. Advancements in neuroendoscopy have led to the ability to simultaneously treat the hydrocephalus and obtain a tissue diagnosis. A retrospective review of 34 patients with pineal region tumors in Beijing Tiantan hospital from the year 2016 to 2018 was undertaken. A single bur hole for both procedures was used successfully in all patients. Once pathologic diagnosis is made, the subsequent management of different tumors is dependent on response to therapy, the tumor markers and original pathology. Follow-up period was 4–26 months. All 34 cases presented with hydrocephalus and increased intracranial pressure manifestations. Elevated blood tumor markers were found in seven cases. The neuroendoscopic biopsy was diagnostic in 32 samples (94.1%) and nondiagnostic (gliosis) in two patients. 21 cases were germinomas, five cases were tectal astrocytomas, two cases were pineoblastomas, two cases were non-germinomatous germ-cell tumours (NG-GCTs) and 1 case immature teratoma and glioblastoma respectively. During the follow-up period, all germinomas but one case with elevated blood α-fetoprotein received craniotomy with a final diagnosis of NG-GCT received radiotherapy and chemotherapy. Four tectal astocytomas, two pineoblastomas and two NG-GCTs received subsequent open surgery due to progressive development, the pathological data was concordant with the initial endoscopic biopsy sample. An additional VP shunt was inserted in one tectal astrocytoma who have hydrocephalus after craniotomy. Except for 18 cases of transient fever and a case with intratumoral hemorrhage, there was no other significant complications, cognitive disorder and no death. The simultaneous single-trajectory endoscopic technique permits not only to control hydrocephalus but also to obtain histological diagnosis with a low incidence of complication and higher safety. Providing meaningful pathological data, endoscopic biopsies could lead to an appropriate management decision. Especially, it is favored as an early step in the management of patients with marker-negative tumors.

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Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China

    Wei Liu, Yongji Tian, Jian Gong, Zhenyu Ma & Chunde Li

  2. NeuroIntervention Center, Beijing Tiantan Hospital Capital Medical University, Beijing, 100050, China

    Raynald

  3. Department of Neurosurgery, Gatot Subroto Central Army Hospital, Jakarta, 10410, Indonesia

    Lukman Ma’ruf

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  1. Wei Liu
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  2. Raynald
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  6. Lukman Ma’ruf
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  7. Chunde Li
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Correspondence to Chunde Li.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

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This study was approved by the Ethics Committee of Beijing Tiantan Hospital, Capital Medical University.

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Liu, W., Raynald, Tian, Y. et al. Simultaneous single-trajectory endoscopic biopsy and third ventriculostomy in pediatric pineal region tumors. Acta Neurol Belg 121, 1535–1542 (2021). https://doi.org/10.1007/s13760-020-01387-2

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  • DOI: https://doi.org/10.1007/s13760-020-01387-2

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