Abstract
Objective
A spectrum of both radiosensitive and radio-resistant lesions occurs in the region of the posterior third ventricle (PTV). Most of these are associated with hydrocephalus requiring a cerebrospinal fluid diversion procedure. The present study aims to assess the effectiveness of endoscopic biopsy and third ventriculostomy (ETV) in these patients.
Materials and methods
Twenty-four patients with PTV lesions with moderate to severe hydrocephalus were managed prospectively. All patients underwent ETV and biopsy of the lesion during the same procedure. The ETV could be performed in all patients, where as in 23, a successful biopsy could be obtained. The ETV was successful in 22 patients; it failed in 2 patients requiring shunt insertion. A positive biopsy was obtained in all the patients (pinealocytoma 4, pinealoblastoma 10, embryonal cell carcinoma 1, germinoma 2, oligodendroglioma 1, astrocytoma 2, tuberculoma 4). All patients were subsequently managed with further surgery, radiation, and chemotherapy either alone or in combination depending on the pathology. One patient with a tumor bed hematoma required clot evacuation. The follow-up period ranged from 12 to 36 months. Two patients died, one during hospital stay with a tumor bed hematoma and another at 6 months follow-up due to extensive leptomeningeal spread.
Conclusions
The high yield of endoscopic biopsy (100%) and success of ETV (91%) emphasizes its role in management of the diverse group of PTV lesions in arriving at the optimal definitive management.
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References
Barlas O, Bayindir C, Imer M, Ayan I, Darendeliler E (2000) Non-resectional management of pinealoblastoma. Minim Invasive Neurosurg 43:163–170
Berger M, Baumeister B, Geyer JR (1991) The risks of metastases from shunting in children with primary central nervous system tumors. J Neurosurg 74:872–877
Bruce JN (1993) Management of pineal region tumors. Neurosurg Q 3:103–119
Bruce JN, Ogdon AT (2004) Surgical strategies for treating patients with pineal region tumors. J Neuro Oncol 69:221–236
Bruce JN, Stein BM (1995) Surgical management of pineal region tumors. Acta Neurochir (Wien) 134:130–135
Buxton N, Vloeberghs M, Punt J (1998) Liliequist’s membrane in minimally invasive endoscopic neurosurgery. Clin Anat 11:187–190
Caemaert J, Abdullah J, Calloauw L (1994) A multipurpose cerebral endoscope and reflections on technique and instrumentation in endoscopic neurosurgery. Acta Neurochir (Wien) 61(Suppl):49–53
Calaminus G, Bamberg M, Baranzelli MC (1994) International germ cell tumors: a comprehensive update of the European data. Neuropediatrics 25:26–32
Chernov MF, Kamikawa S, Yamane F, Ishihara S, Kubo O, Hori T (2006) Neurofiberscopic biopsy of tumors of the pineal region and posterior third ventricle: indications, technique, complications and results. Neurosurgery 59:267–277
d’Andrea AD, Packer RJ, Rorke LB, Bilaniuk LT, Sutton LN, Bruce DA, Schut L (1987) Pineocytomas of childhood. A reappraisal of natural history and response to therapy. Cancer 59:1353–1357
Decampo MP, Davis MD (1991) The role of CT in diagnosis and management of childhood pineal region tumors. Australas Radiol 35:336–339
Diez B, Balamaceda C, Matsutami M, Weiner HL (1999) Germ cell tumors of the CNS in children: recent advances in therapy. Childs Nerv Syst 15:578–585
Domingo Z, Peter JC (1989) Intracranial tuberculomas. An assessment of a therapeutic drug trial in 35 children. Pediatr Neurosci 15:161–166
Edwards MS, Davis RL, Laurent JP (1995) Tumor markers and cytologic features of cerebrospinal fluid. Cancer 56:1773–1777
Ferrer E, Santamarta D, Garcia-Fructuoso G, Caral L, Rumia J (1997) Neuroendoscopic management of pineal region tumours. Acta Neurochir (Wien) 139:12–21
Gaab M (2006) Comments to the article by Chernov et al. Neurofiberscopic biopsy of the tumors of the pineal region and posterior third ventricle: indications, technique, complications and results. Neurosurgery 59:277
Gangemi M, Maiuri F, Colella G, Buonamassa S (2001) Endoscopic surgery for pineal region tumors. Minim Invasive Neurosurg 44:70–73
Hasegawa T, Kondziolka D, Hadjipanayis CG, Flickinger JC, Lunsford LD (2003) Stereotactic radiosurgery. Pediatr Neurosurg 38:329–333
Herrmann HD, Winkler D, Westphae M (1992) Treatment of tumors of the pineal region and posterior part of III ventricle. Acta Neurochir (Wien) 116:137–146
Hoffman HJ, Yoshida M, Becker LE, Hendrick EB, Humphrey RP (1994) Pineal region tumors in childhood. Experience at the hospital for sick children. Pediatr Neurosurg 21:91–104
Hyunnam D, Chu BK, Shin HJ, Ahn HS, Kim JJ, Wang KC (1999) Treatment of intracranial nongerminomatous malignant germ cell tumors in children: the role of each treatment modality. Childs Nerv Syst 15:185–191
Itoyama Y, Kochi M, Kuratsuy JI, Takamura S, Kitano I, Marubayashi T, Uemura S, Ushio Y (1995) Treatment of intracranial nongerminomatous malignant germ cell tumors producing α-fetoprotein. Neurosurgery 36:459–466
Jakachi R (1999) Pineal and nonpineal supratentorial primitive neuro ectodermal tumors. Childs Nerv Syst 15:586–591
Jenkin D, Berry M, Chan H (1990) Pineal region germinomas in childhood treatment considerations. Int J Radiat Oncol Biol Phys 18:541–545
Jennings MT, Gelman R, Hochberg F (1985) Intracranial germ cell tumors: natural history and pathogenesis. J Neurosurg 63:155–167
Knierim DS, Yamada S (2003) Pineal tumors and associated lesions: the effect of ethnicity on tumor type and treatment. Pediatr Neurosurg 38:307–323
Konovalov AN, Pitskhelavri DI (2003) Principles of treatment of pineal region tumors. Surg Neurol 59:250–268
Kreth FW, Schatz CR, Pagenstecher A, Faist M, Volk B, Ostergtag CB (1996) Stereotactic management of lesions of the pineal region. Neurosurgery 39:280–291
Macarthur DC, Buxton N, Punt J, Vloeberghs M, Robertson IJA (2002) The role of neuroendoscopy in the management of brain tumors. Br J Neurosurg 16:465–470
Macarthur DC, Buxton N, Vlorberghs M, Punt J (2001) The effectiveness of neuroendoscopic interventions in children with brain tumors. Childs Nerv Syst 17:589–594
Matsutani M, Sano K, Takakura K, Fujimaki T, Nakamura O, Funata N, Seto T (1997) Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg 86:446–455
Mohanty A, Santhosh V, Anandh B, Kolluri VR, Vasudev MK, Hegde T, Shankar SK (1999) Diagnostic efficacy of stereotactic biopsies in intracranial tuberculomas. Surg Neurol 52:252–257
Mohanty A, Vasudev MK, Sampath S, Radhesh S, Sastry Kolluri VR (2002) Failed endoscopic third ventriculostomy in children: management options. Pediatr Neurosurg 37:304–309
Neuwelt EA, Glasberg M, Frenkel E, Clark WK (1979) Malignant pineal region tumors: a clinical pathological study. J Neurosurg 51:597–607
Nicholson JC, Punt J, Hale J, Saran F, Calaminus G (2002) Neurosurgical management of paediatric germ cell tumours of the central nervous system—a multi disciplinary team approach for the new millennium. Br J Neurosurg 16:93–95
Oi S, Shibata M, Tominaga J, Honda Y, Shinoda M, Takei F, Tsugane R, Matsuzawa K, Sato O (2000) Efficacy of neuroendoscopic procedures in minimally invasive preferential management of pineal region tumors: a prospective study. J Neurosurg 93:245–253
Oka K, Kin Y, Go Y (1999) Neuroendoscopic approach to tectal tumors: a consecutive series. J Neurosurg 91:964–970
Packer RJ, Sutton LN, Rosenstock JG (1984) Pineal region tumors of childhood. Pediatrics 74:97–102
Patil AA, Good R, Bashir R, Etemadrezaie H (1995) Non-resective management of pineoblastoma: a case report. Surg Neurol 44:386–391
Pople IK, Athanasiou C, Sandeman R, Coakham HB (2001) The role of endoscopic biopsy and third ventriculostomy in the management of pineal region tumors. Br J Neurosurg 15:305–311
Rajshekhar V, Chandy MJ (1997) Tuberculomas presenting as isolated intrinsic brain stem masses. Br J Neurosurg 11:127–133
Reddy AT, Wellons JC 3rd, Allen JC, Fiveash JB, Abdullatif H, Braune KW, Grabb PA (2004) Refining the staging evaluation of pineal region germinoma using neuroendoscopy and the presence of preoperative diabetes insipidus. Neuro Oncol 6:127–133
Regis J, Bouillot P, Volat FR, Branger DF, Dufoer H, Peragut JC (1996) Pineal region tumors and the role of stereotactic biopsy: review of the mortality, morbidity and diagnostic rates in 370 cases. Neurosurgery 39:907–914
Reiger A, Rainov NG, Brucke M, Marx T, Holz C (2000) Endoscopic third ventriculostomy is the treatment of choice for obstructive hydrocephalus due to pediatric pineal tumors. Minim Invasive Neurosurg 43:83–86
Richard MW, Laws ER (1985) Shunting and irradiation of pineal tumors. Clin Neurosurg 32:384–396
Robinson S, Cohen AR (1997) The role of neuroendoscopy in the treatment of pineal region tumors. Surg Neurol 48:360–367
Sawamura Y, De Tribolet N, Ishii N, Abe H (1997) Management of primary intracranial germinomas: diagnostic biopsy or radical resection? J Neurosurg 87:262–266
Sawamura Y, DeTribolet N (2002) Neurosurgical management of pineal tumors. Adv Tech Stand Neurosurg 27:217–243
Selvapandian S, Rajashekar V, Chandy MJ, Idikula J (1994) Predictive value of computer tomography based diagnosis of intracranial tuberculomas. Neurosurgery 35:845–850
Smirniotopoulos JG, Rushing EJ, Mena H (1992) Pineal region masses, differential diagnosis. Radiographics 12:577–596
Steinbok P, Cochrane DD (2001) Pineal region and intracranial germ cell tumors. In: Mclone DG (ed) Pediatric neurosurgery: surgery of the developing nervous system. W.B. Saunders, Philadelphia, pp 711–724
Tandon PN, Bhargava S (1985) Effect of medical treatment on intracranial tuberculoma—a CT study. Tubercle 66:85–97
Teo C, Young R II (1999) Endoscopic management of hydrocephalus secondary to tumors of the posterior third ventricle. Neurosurg focus DOI 7: Article (2)
Vaquero J, Ramiro J, Martinez R, Bravo G (1992) Neurosurgical experience with tumors of pineal region at Clinica Puerta de Hierro. Acta Neurochir (Wien) 116:23–32
Vaquero J, Ramiro J, Martinez R, Coca S, Bravo G (1990) Clinicopathological experience with pineocytomas: report of five surgically treatment cases. Neurosurgery 27:612–619
Wara WM, Jenkin KDT, Evans A (1979) Tumors of the pineal and suprasellar region. Children’s cancer study group treatment results, 1960–1975. Cancer 43:698–701
Wong TT, Yen SH, Ho DM, Chang FC, Chang KP (2003) Pineal germinoma with intratumoral hemorrhage after neuroendoscopic tumor biopsy. Childs Nerv Syst 19:769–772
Yamini B, Refai D, Rubin CM, Frim DM (2004) Initial endoscopic management of pineal region tumors and associated hydrocephalus: clinical series and literature review. J Neurosurg 100(5 Suppl Pediatrics):437–441
Yurtseven T, Ersahin Y, Demirta E, Mutluer S (2003) Neuroendoscopic biopsy for intraventricular tumors. Minim Invasive Neurosurg 46:293–299
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Roopesh Kumar, S.V., Mohanty, A., Santosh, V. et al. Endoscopic options in management of posterior third ventricular tumors. Childs Nerv Syst 23, 1135–1145 (2007). https://doi.org/10.1007/s00381-007-0371-0
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DOI: https://doi.org/10.1007/s00381-007-0371-0