Advertisement

Child's Nervous System

, Volume 30, Issue 6, pp 1055–1060 | Cite as

Neuroendoscopic biopsy of pediatric brain tumors with small ventricle

  • Min Ho Lee
  • Hong Rye Kim
  • Ho Jun Seol
  • Hyung Jin ShinEmail author
Original Paper

Abstract

Purpose

Intraventricular endoscopic procedures to resect or biopsy peri- or intraventricular tumors may have not been used in patients with small ventricles due to the presumed difficulties with ventricular cannulation and the perceived risk of morbidity. The purpose of this study is to review the feasibility and safety of neuroendoscopic procedures in the biopsy of pediatric brain tumors with a small ventricle.

Methods

Between January 2006 and January 2013, 72 children were identified with brain tumors confirmed by transventricular endoscopic biopsy. Patients were divided into non-hydrocephalus and hydrocephalus groups, and the ratio of the two groups was 20:52.

Results

In 20 pediatric brain tumors with small ventricle, the targeted lesion was successfully approached under the guidance of neuronavigation. Navigational tracking was especially helpful in entering small ventricles and in approaching the third ventricle through the narrow foramen of Monro. The histopathologic diagnosis was established in all 20 patients: nine germinomas, three mixed germ cell tumors, two pilomyxoid astrocytomas, and two pilocytic astrocytomas. The tumor biopsy sites were the suprasellar area (n = 10), pineal area (n = 4), lateral ventricular wall (n = 4), and mammillary body (n = 1). There were no major morbidities related to the endoscopic procedure.

Conclusion

Neuroendoscopic biopsy or resection of peri- or intraventricular tumors in pediatric patients without hydrocephalus is feasible. Navigation-guided neuroendoscopic procedures improved the accuracy of the neuroendoscopic approach and minimized brain trauma. The absence of ventriculomegaly in patients with brain tumor may not serve as a contraindication to neuroendoscopic tumor biopsy.

Keywords

Neuroendoscopic surgery Intraventricular tumor Neuronavigation Endoscope 

Notes

Conflict of interest

The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.

Supplementary material

Supplemental video 1

An eight year old female patient admitted with a supra-sellar mass with small ventricle. (FOR: 0.34) An endoscopic biopsy was planned. Entry point and trajectory were defined with a neuronavigation system. Passing through the foramen of Monro, the lesion was identified and biopsy was done with micro forcep. Focal bleeding was controlled with bipolar coagulator. The pathologic result was reported as germinoma (MPG 6574 kb)

References

  1. 1.
    Cappabianca P, Cinalli G, Gangemi M, Brunori A, Cavallo LM, de Divitiis E, Decq P, Delitala A, Di Rocco F, Frazee J, Godano U, Grotenhuis A, Longatti P, Mascari C, Nishihara T, Oi S, Rekate H, Schroeder HW, Souweidane MM, Spennato P, Tamburrini G, Teo C, Warf B, Zymberg ST (2008) Application of neuroendoscopy to intraventricular lesions. Neurosurgery 62(Suppl 2):575–597. doi: 10.1227/01.neu.0000316262.74843.dd, discussion 597–578PubMedGoogle Scholar
  2. 2.
    Chowdhry SA, Cohen AR (2013) Intraventricular neuroendoscopy: complication avoidance and management. World Neurosurg 79(S15):e1–10. doi: 10.1016/j.wneu.2012.02.030 PubMedGoogle Scholar
  3. 3.
    Constantini S, Mohanty A, Zymberg S, Cavalheiro S, Mallucci C, Hellwig D, Ersahin Y, Mori H, Mascari C, Val JA, Wagner W, Kulkarni AV, Sgouros S, Oi S (2013) Safety and diagnostic accuracy of neuroendoscopic biopsies: an international multicenter study. J Neurosurg Pediatr 11:704–709. doi: 10.3171/2013.3.PEDS12416 PubMedCrossRefGoogle Scholar
  4. 4.
    Enchev Y, Oi S (2008) Historical trends of neuroendoscopic surgical techniques in the treatment of hydrocephalus. Neurosurg Rev 31:249–262. doi: 10.1007/s10143-008-0131-y PubMedCrossRefGoogle Scholar
  5. 5.
    Fiorindi A, Longatti P (2008) A restricted neuroendoscopic approach for pathological diagnosis of intraventricular and paraventricular tumours. Acta Neurochir (Wien) 150:1235–1239. doi: 10.1007/s00701-008-0155-7 CrossRefGoogle Scholar
  6. 6.
    Fukushima T (1978) Endoscopic biopsy of intraventricular tumors with the use of a ventriculofiberscope. Neurosurgery 2:110–113PubMedCrossRefGoogle Scholar
  7. 7.
    Gaab MR, Schroeder HW (1998) Neuroendoscopic approach to intraventricular lesions. J Neurosurg 88:496–505. doi: 10.3171/jns.1998.88.3.0496 PubMedCrossRefGoogle Scholar
  8. 8.
    Grunert P, Hopf N, Perneczky A (1997) Frame-based and frameless endoscopic procedures in the third ventricle. Stereotact Funct Neurosurg 68:80–89PubMedCrossRefGoogle Scholar
  9. 9.
    Hall WA (1998) The safety and efficacy of stereotactic biopsy for intracranial lesions. Cancer 82:1749–1755PubMedCrossRefGoogle Scholar
  10. 10.
    Jho HD, Alfieri A (2002) Endoscopic removal of third ventricular tumors: a technical note. Minim Invasive Neurosurg 45:114–119. doi: 10.1055/s-2002-32487 PubMedCrossRefGoogle Scholar
  11. 11.
    Kim JE, Kim DG, Paek SH, Jung HW (2003) Stereotactic biopsy for intracranial lesions: reliability and its impact on the planning of treatment. Acta Neurochir (Wien) 145:547–554. doi: 10.1007/s00701-003-0048-8, discussion 554–555CrossRefGoogle Scholar
  12. 12.
    Kim K, Yeon JY, Seol HJ, Shin HJ (2013) Transventricular endoscopic biopsy of suprasellar tumors: a pediatric case series. Childs Nerv Syst 29:1285–1291. doi: 10.1007/s00381-013-2085-9 PubMedCrossRefGoogle Scholar
  13. 13.
    Naftel RP, Shannon CN, Reed GT, Martin R, Blount JP, Tubbs RS, Wellons JC 3rd (2011) Small-ventricle neuroendoscopy for pediatric brain tumor management. J Neurosurg Pediatr 7:104–110. doi: 10.3171/2010.10.PEDS10338 PubMedCrossRefGoogle Scholar
  14. 14.
    O’Hayon BB, Drake JM, Ossip MG, Tuli S, Clarke M (1998) Frontal and occipital horn ratio: a linear estimate of ventricular size for multiple imaging modalities in pediatric hydrocephalus. Pediatr Neurosurg 29:245–249PubMedCrossRefGoogle Scholar
  15. 15.
    Pettorini BL, Al-Mahfoud R, Jenkinson MD, Avula S, Pizer B, Mallucci C (2013) Surgical pathway and management of pineal region tumours in children. Childs Nerv Syst 29:433–439. doi: 10.1007/s00381-012-1954-y PubMedCrossRefGoogle Scholar
  16. 16.
    Song JH, Kong DS, Seol HJ, Shin HJ (2010) Transventricular biopsy of brain tumor without hydrocephalus using neuroendoscopy with navigation. J Korean Neurosurg Soc 47:415–419. doi: 10.3340/jkns.2010.47.6.415 PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Song JH, Kong DS, Shin HJ (2010) Feasibility of neuroendoscopic biopsy of pediatric brain tumors. Childs Nerv Syst 26:1593–1598. doi: 10.1007/s00381-010-1143-9 PubMedCrossRefGoogle Scholar
  18. 18.
    Souweidane MM, Sandberg DI, Bilsky MH, Gutin PH (2000) Endoscopic biopsy for tumors of the third ventricle. Pediatr Neurosurg 33:132–137PubMedCrossRefGoogle Scholar
  19. 19.
    Teo C, Nakaji P (2004) Neuro-oncologic applications of endoscopy. Neurosurg Clin N Am 15:89–103. doi: 10.1016/s1042-3680(03)00068-8 PubMedCrossRefGoogle Scholar
  20. 20.
    Woodworth GF, McGirt MJ, Samdani A, Garonzik I, Olivi A, Weingart JD (2006) Frameless image-guided stereotactic brain biopsy procedure: diagnostic yield, surgical morbidity, and comparison with the frame-based technique. J Neurosurg 104:233–237. doi: 10.3171/jns.2006.104.2.233 PubMedCrossRefGoogle Scholar
  21. 21.
    Yamamoto M, Oka K, Takasugi S, Hachisuka S, Miyake E, Tomonaga M (1997) Flexible neuroendoscopy for percutaneous treatment of intraventricular lesions in the absence of hydrocephalus. Minim Invasive Neurosurg 40:139–143. doi: 10.1055/s-2008-1053435 PubMedCrossRefGoogle Scholar
  22. 22.
    Yoo KH, Lee SH, Lee J, Sung KW, Jung HL, Koo HH, Lim DH, Kim JH, Shin HJ (2010) Improved outcome of central nervous system germ cell tumors: implications for the role of risk-adapted intensive chemotherapy. J Korean Med Sci 25:458–465PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Min Ho Lee
    • 1
  • Hong Rye Kim
    • 1
  • Ho Jun Seol
    • 1
  • Hyung Jin Shin
    • 1
    Email author
  1. 1.Department of Neurosurgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea

Personalised recommendations