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Child's Nervous System

, Volume 34, Issue 7, pp 1335–1344 | Cite as

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

  • Mahmoud Abbassy
  • Khaled Aref
  • Ahmed Farhoud
  • Anwar Hekal
Original Paper
  • 112 Downloads

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Pineal tumors Tectal gliomas Endoscopic third ventriculostomy Endoscopic biopsy 

Notes

Acknowledgements

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.

Ethical approval

For this type of study, formal consent is not required except for the illustrative cases.

References

  1. 1.
    Abtin K, Thompson BG, Walker ML (1998) Basilar artery perforation as a complication of endoscopic third ventriculostomy. Pediatr Neurosurg 28:35–41CrossRefPubMedGoogle Scholar
  2. 2.
    Ahn ES, Goumnerova L (2010) Endoscopic biopsy of brain tumors in children: diagnostic success and utility in guiding treatment strategies. J Neurosurg Pediatr 5:255–262.  https://doi.org/10.3171/2009.10.PEDS09172 CrossRefPubMedGoogle Scholar
  3. 3.
    Al-Tamimi YZ, Bhargava D, Surash S, Ramirez RE, Novegno F, Crimmins DW, Tyagi AK, Chumas PD (2008) Endoscopic biopsy during third ventriculostomy in paediatric pineal region tumours. Childs Nerv Syst 24:1323–1326.  https://doi.org/10.1007/s00381-008-0632-6 CrossRefPubMedGoogle Scholar
  4. 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
  5. 5.
    Balossier A, Blond S, Reyns N (2016) Endoscopic versus stereotactic procedure for pineal tumor biopsies: focus on overall efficacy rate. World Neurosurg 92:223–228.  https://doi.org/10.1016/j.wneu.2016.03.088 CrossRefPubMedGoogle Scholar
  6. 6.
    Bruce JN (2012) Management of pineal region tumors. In: Quinones-Hinjosa A (ed) Schimdek and sweet operative neurosurgical techniques: indications, methods and results, 6th edn. Elsevier, Philadelphia, pp 357–366CrossRefGoogle Scholar
  7. 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. 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
  9. 9.
    De Divitiis O (1998) Provision of a neuroendoscopy service. The Southampton experience. J Neurosurg Sci 42:137–143CrossRefPubMedGoogle Scholar
  10. 10.
    Decq P, Le Guerinel C, Sakka L, Roujeau T, Sol J, Palfi S, Nguyen J (2000) Endoscopic surgery of third ventricle lesions. Neurochirurgie 46:286–294PubMedGoogle Scholar
  11. 11.
    Depreitere B, Dasi N, Rutka J, Dirks P, Drake J (2007) Endoscopic biopsy for intraventricular tumors in children. J Neurosurg 106:340–346.  https://doi.org/10.3171/ped.2007.106.5.340 PubMedCrossRefGoogle Scholar
  12. 12.
    Durnford AJ, Kirkham FJ, Mathad N, Sparrow OC (2011) Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus: validation of a success score that predicts long-term outcome. J Neurosurg Pediatr 8:489–493.  https://doi.org/10.3171/2011.8.PEDS1166 CrossRefPubMedGoogle Scholar
  13. 13.
    Ellenbogen RG, Moores LE (1997) Endoscopic management of a pineal and suprasellar germinoma with associated hydrocephalus: technical case report. Minim Invasive Neurosurg 40:13–15; discussion 16.  https://doi.org/10.1055/s-2008-1053406 CrossRefPubMedGoogle Scholar
  14. 14.
    Ezzat S, Kamal M, El-Khateeb N, El-Beltagy M, Taha H, Refaat A, Awad M, Abouelnaga S, Zaghloul MS (2016) Pediatric brain tumors in a low/middle income country: does it differ from that in developed world? J Neuro-Oncol 126:371–376.  https://doi.org/10.1007/s11060-015-1979-7 CrossRefGoogle Scholar
  15. 15.
    Ferrer E, Santamarta D, Garcia-Fructuoso G, Caral L, Rumia J (1997) Neuroendoscopic management of pineal region tumours. Acta Neurochir 139:12–20 discussion 20-11CrossRefPubMedGoogle Scholar
  16. 16.
    Field M, Witham TF, Flickinger JC, Kondziolka D, Lunsford LD (2001) Comprehensive assessment of hemorrhage risks and outcomes after stereotactic brain biopsy. J Neurosurg 94:545–551.  https://doi.org/10.3171/jns.2001.94.4.0545 CrossRefPubMedGoogle Scholar
  17. 17.
    Fiorindi A, Longatti P (2008) A restricted neuroendoscopic approach for pathological diagnosis of intraventricular and paraventricular tumours. Acta Neurochir 150:1235–1239.  https://doi.org/10.1007/s00701-008-0155-7 CrossRefPubMedGoogle Scholar
  18. 18.
    Frappaz D, Conter CF, Szathmari A, Valsijevic A, Mottolese C (2015) The management of pineal tumors as a model for a multidisciplinary approach in neuro-oncology. Neurochirurgie 61:208–211.  https://doi.org/10.1016/j.neuchi.2014.03.003 CrossRefPubMedGoogle Scholar
  19. 19.
    Fukushima T (1978) Endoscopic biopsy of intraventricular tumors with the use of a ventriculofiberscope. Neurosurgery 2:110–113CrossRefPubMedGoogle Scholar
  20. 20.
    Gaab MR, Schroeder HW (1998) Neuroendoscopic approach to intraventricular lesions. J Neurosurg 88:496–505.  https://doi.org/10.3171/jns.1998.88.3.0496 CrossRefPubMedGoogle Scholar
  21. 21.
    Gallo P, Szathmari A, De Biasi S, Mottolese C (2010) Endoscopic third ventriculostomy in obstructive infantile hydrocephalus: remarks about the so-called 'unsuccessful cases. Pediatr Neurosurg 46:435–441.  https://doi.org/10.1159/000324913 CrossRefPubMedGoogle Scholar
  22. 22.
    Gangemi M, Maiuri F, Colella G, Buonamassa S (2001) Endoscopic surgery for pineal region tumors. Minim Invasive Neurosurg 44:70–73.  https://doi.org/10.1055/s-2001-16002 CrossRefPubMedGoogle Scholar
  23. 23.
    Gianaris TJ, Nazar R, Middlebrook E, Gonda DD, Jea A, Fulkerson DH (2017) Failure of ETV in patients with the highest ETV success scores. J Neurosurg Pediatr 20:225–231.  https://doi.org/10.3171/2016.7.PEDS1655 CrossRefPubMedGoogle Scholar
  24. 24.
    Haw C, Steinbok P (2001) Ventriculoscope tract recurrence after endoscopic biopsy of pineal germinoma. Pediatr Neurosurg 34:215–217.  https://doi.org/10.1159/000056022 CrossRefPubMedGoogle Scholar
  25. 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
  26. 26.
    Hirato J, Nakazato Y (2001) Pathology of pineal region tumors. J Neuro-Oncol 54:239–249CrossRefGoogle Scholar
  27. 27.
    Horowitz M, Albright AL, Jungreis C, Levy EI, Stevenson K (2001) Endovascular management of a basilar artery false aneurysm secondary to endoscopic third ventriculostomy: case report. Neurosurgery 49:1461–1464 discussion 1464-1465CrossRefPubMedGoogle Scholar
  28. 28.
    Kim IY, Jung S, Moon KS, Jung TY, Kang SS (2004) Neuronavigation-guided endoscopic surgery for pineal tumors with hydrocephalus. Minim Invasive Neurosurg 47:365–368.  https://doi.org/10.1055/s-2004-830150 CrossRefPubMedGoogle Scholar
  29. 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. 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. 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. 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. 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. 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
  35. 35.
    Macarthur DC, Buxton N, Punt J, Vloeberghs M, Robertson IJ (2002) The role of neuroendoscopy in the management of brain tumours. Br J Neurosurg 16:465–470CrossRefPubMedGoogle Scholar
  36. 36.
    McLaughlin MR, Wahlig JB, Kaufmann AM, Albright AL (1997) Traumatic basilar aneurysm after endoscopic third ventriculostomy: case report. Neurosurgery 41:1400–1403 discussion 1403-1404CrossRefPubMedGoogle Scholar
  37. 37.
    Morgenstern PF, Osbun N, Schwartz TH, Greenfield JP, Tsiouris AJ, Souweidane MM (2011) Pineal region tumors: an optimal approach for simultaneous endoscopic third ventriculostomy and biopsy. Neurosurg Focus 30:E3.  https://doi.org/10.3171/2011.2.FOCUS10301 CrossRefPubMedGoogle Scholar
  38. 38.
    Morgenstern PF, Souweidane MM (2013) Pineal region tumors: simultaneous endoscopic third ventriculostomy and tumor biopsy. World Neurosurg 79(S18):e19–e13.  https://doi.org/10.1016/j.wneu.2012.02.020 CrossRefGoogle Scholar
  39. 39.
    Mottolese C, Szathamari A, Beuriat PA, Grassiot B, Simon E (2015) Neuroendoscopy and pineal tumors: a review of the literature and our considerations regarding its utility. Neurochirurgie 61:155–159.  https://doi.org/10.1016/j.neuchi.2013.12.008 CrossRefPubMedGoogle Scholar
  40. 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. 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. 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
  43. 43.
    Pople IK, Athanasiou TC, Sandeman DR, Coakham HB (2001) The role of endoscopic biopsy and third ventriculostomy in the management of pineal region tumours. Br J Neurosurg 15:305–311CrossRefPubMedGoogle Scholar
  44. 44.
    Rezende MT, Spelle L, Piotin M, Mounayer C, Lucas Cde P, Abud DG, Moret J (2008) Selective endovascular treatment of a traumatic basilar aneurysm after endoscopic third ventriculostomy. Neuroradiology 50:443–446.  https://doi.org/10.1007/s00234-007-0357-3 CrossRefPubMedGoogle Scholar
  45. 45.
    Robinson S, Cohen AR (1997) The role of neuroendoscopy in the treatment of pineal region tumors. Surg Neurol 48:360–365 discussion 365-367CrossRefPubMedGoogle Scholar
  46. 46.
    Sacko O, Boetto S, Lauwers-Cances V, Dupuy M, Roux FE (2010) Endoscopic third ventriculostomy: outcome analysis in 368 procedures. J Neurosurg Pediatr 5:68–74.  https://doi.org/10.3171/2009.8.PEDS08108 CrossRefPubMedGoogle Scholar
  47. 47.
    Shim KW, Kim DS, Choi JU (2008) Simultaneous endoscopic third ventriculostomy and ventriculoperitoneal shunt for infantile hydrocephalus. Childs Nerv Syst 24:443–451.  https://doi.org/10.1007/s00381-007-0526-z CrossRefPubMedGoogle Scholar
  48. 48.
    Souweidane MM, Morgenstern PF, Kang S, Tsiouris AJ, Roth J (2010) Endoscopic third ventriculostomy in patients with a diminished prepontine interval. J Neurosurg Pediatr 5:250–254.  https://doi.org/10.3171/2009.10.PEDS09187 CrossRefPubMedGoogle Scholar
  49. 49.
    Vandertop PW (1998) Traumatic basilar aneurysm after endoscopic third ventriculostomy: case report. Neurosurgery 43:647–648CrossRefPubMedGoogle Scholar
  50. 50.
    Villano JL, Propp JM, Porter KR, Stewart AK, Valyi-Nagy T, Li X, Engelhard HH, McCarthy BJ (2008) Malignant pineal germ-cell tumors: an analysis of cases from three tumor registries. Neuro-Oncology 10:121–130.  https://doi.org/10.1215/15228517-2007-054 CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Warf BC, Mugamba J, Kulkarni AV (2010) Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus in Uganda: report of a scoring system that predicts success. J Neurosurg Pediatr 5:143–148.  https://doi.org/10.3171/2009.9.PEDS09196 CrossRefPubMedGoogle Scholar
  52. 52.
    Warf BC, Bhai S, Kulkarni AV, Mugamba J (2012) Shunt survival after failed endoscopic treatment of hydrocephalus. J Neurosurg Pediatr 10:463–470.  https://doi.org/10.3171/2012.9.PEDS1236 CrossRefPubMedGoogle Scholar
  53. 53.
    Wong TT, Ho DM, Chang KP, Yen SH, Guo WY, Chang FC, Liang ML, Pan HC, Chung WY (2005) Primary pediatric brain tumors: statistics of Taipei VGH, Taiwan (1975-2004). Cancer 104:2156–2167.  https://doi.org/10.1002/cncr.21430 CrossRefPubMedGoogle Scholar
  54. 54.
    Wong TT, Chen HH, Liang ML, Yen YS, Chang FC (2011) Neuroendoscopy in the management of pineal tumors. Childs Nerv Syst 27:949–959.  https://doi.org/10.1007/s00381-010-1325-5 CrossRefPubMedGoogle Scholar
  55. 55.
    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 100:437–441.  https://doi.org/10.3171/ped.2004.100.5.0437 PubMedCrossRefGoogle Scholar
  56. 56.
    Yurtseven T, Ersahin Y, Demirtas E, Mutluer S (2003) Neuroendoscopic biopsy for intraventricular tumors. Minim Invasive Neurosurg 46:293–299.  https://doi.org/10.1055/s-2003-44450 CrossRefPubMedGoogle Scholar
  57. 57.
    Zaazoue MA, Goumnerova LC (2016) Pineal region tumors: a simplified management scheme. Childs Nerv Syst 32:2041–2045.  https://doi.org/10.1007/s00381-016-3157-4 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Neurosurgery DepartmentAlexandria UniversityAlexandriaEgypt

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