Outcome of single-trajectory rigid endoscopic third ventriculostomy and biopsy in the management algorithm of pineal region tumors: a case series and review of the literature
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Tumors within the pineal region represent 1.5 to 8.5% of the pediatric brain tumors and 1.2% of all brain tumors. A management algorithm has been proposed in several publications. The algorithm includes endoscopic third ventriculostomy (ETV) and biopsy in cases presenting with hydrocephalus. In this series, we are presenting the efficacy of a single-trajectory approach for both ETV and biopsy.
Eleven cases were admitted to Alexandria main university hospital from 2013 to 2016 presenting with pineal region tumors and hydrocephalus. Mean age at diagnosis was 11 years (1–27 years). All cases had ETV and biopsy using rigid ventriculoscope through a single trajectory from a burr hole planned on preoperative imaging. Follow-up period was 7–48 months.
All 11 cases presented with hydrocephalus and increased intracranial pressure manifestations. Histopathological diagnosis was successful in 9 out of 11 cases (81.8%). Three cases were germ-cell tumors, two cases were pineoblastomas, two cases were pilocytic astrocytomas, and two cases were grade 2 tectal gliomas. Five of the ETV cases (45.5%) failed and required VPS later on. Other complications of ETV included one case of intraventricular hemorrhage and a case with tumor disseminated to the basal cisterns.
In our series, we were able to achieve ETV and biopsy through a single trajectory and a rigid endoscope with results comparable to other studies in the literature.
KeywordsPineal tumors Tectal gliomas Endoscopic third ventriculostomy Endoscopic biopsy
The authors would like to express their deepest gratitude to Professor Yosry El-Adawy, professor of Neurosurgery, Alexandria University, for sharing his results and his scientific guidance.
Compliance with ethical standards
Conflict of interest
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.
For this type of study, formal consent is not required except for the illustrative cases.
- 4.Balossier A, Blond S, Touzet G, Lefranc M, de Saint-Denis T, Maurage CA, Reyns N (2015) Endoscopic versus stereotactic procedure for pineal tumour biopsies: comparative review of the literature and learning from a 25-year experience. Neurochirurgie 61:146–154. https://doi.org/10.1016/j.neuchi.2014.06.002 CrossRefPubMedGoogle Scholar
- 7.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; discussion 267-277. https://doi.org/10.1227/01.NEU.0000223504.29243.0B CrossRefPubMedGoogle Scholar
- 8.Chibbaro S, Di Rocco F, Makiese O, Reiss A, Poczos P, Mirone G, Servadei F, George B, Crafa P, Polivka M, Romano A (2012) Neuroendoscopic management of posterior third ventricle and pineal region tumors: technique, limitation, and possible complication avoidance. Neurosurg Rev 35:331–338; discussion 338-340. doi: https://doi.org/10.1007/s10143-011-0370-1
- 25.Hayashi N, Murai H, Ishihara S, Kitamura T, Miki T, Miwa T, Miyajima M, Nishiyama K, Ohira T, Ono S, Suzuki T, Takano S, Date I, Saeki N, Endo S (2011) Nationwide investigation of the current status of therapeutic neuroendoscopy for ventricular and paraventricular tumors in Japan. J Neurosurg 115:1147–1157. https://doi.org/10.3171/2011.7.JNS101976 CrossRefPubMedGoogle Scholar
- 29.Kulkarni AV, Drake JM, Kestle JR, Mallucci CL, Sgouros S, Constantini S, Canadian Pediatric Neurosurgery Study G (2010) Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV success score. J Neurosurg Pediatr 6:310–315. https://doi.org/10.3171/2010.8.PEDS103 CrossRefPubMedGoogle Scholar
- 30.Kulkarni AV, Riva-Cambrin J, Browd SR (2011) Use of the ETV success score to explain the variation in reported endoscopic third ventriculostomy success rates among published case series of childhood hydrocephalus. J Neurosurg Pediatr 7:143–146. https://doi.org/10.3171/2010.11.PEDS10296 CrossRefPubMedGoogle Scholar
- 31.Kunz M, Schulte-Altedorneburg G, Uhl E, Schmid-Elsaesser R, Scholler K, Zausinger S (2008) Three-dimensional constructive interference in steady-state magnetic resonance imaging in obstructive hydrocephalus: relevance for endoscopic third ventriculostomy and clinical results. J Neurosurg 109:931–938. https://doi.org/10.3171/JNS/2008/109/11/0931 CrossRefPubMedGoogle Scholar
- 32.Labidi M, Lavoie P, Lapointe G, Obaid S, Weil AG, Bojanowski MW, Turmel A (2015) Predicting success of endoscopic third ventriculostomy: validation of the ETV success score in a mixed population of adult and pediatric patients. J Neurosurg 123:1447–1455. https://doi.org/10.3171/2014.12.JNS141240 CrossRefPubMedGoogle Scholar
- 33.Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, Ohgaki H, Wiestler OD, Kleihues P, Ellison DW (2016) The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol 131:803–820. https://doi.org/10.1007/s00401-016-1545-1 CrossRefPubMedGoogle Scholar
- 34.Luther N, Stetler WR, Jr., Dunkel IJ, Christos PJ, Wellons JC, 3rd, Souweidane MM (2010) Subarachnoid dissemination of intraventricular tumors following simultaneous endoscopic biopsy and third ventriculostomy. J Neurosurg Pediatr 5:61–67. doi: https://doi.org/10.3171/2009.7.PEDS0971
- 40.O'Brien DF, Hayhurst C, Pizer B, Mallucci CL (2006) Outcomes in patients undergoing single-trajectory endoscopic third ventriculostomy and endoscopic biopsy for midline tumors presenting with obstructive hydrocephalus. J Neurosurg 105:219–226. https://doi.org/10.3171/ped.2006.105.3.219 PubMedCrossRefGoogle Scholar
- 41.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. https://doi.org/10.3171/jns.2000.93.2.0245 CrossRefPubMedGoogle Scholar
- 42.Ostrom QT, Gittleman H, Xu J, Kromer C, Wolinsky Y, Kruchko C, Barnholtz-Sloan JS (2016) CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2009-2013. Neuro-Oncology 18:v1–v75. https://doi.org/10.1093/neuonc/now207 CrossRefPubMedGoogle Scholar