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Neuroendoscopy in the management of pineal region tumours in children

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Abstract

Introduction

Pineal region tumours (PRTs) are more common in children and represent a wide variety of lesions. The practise of a radiation test dose is obsolete and a biochemical/histological diagnosis is recommended before further therapy. Many patients present with hydrocephalus. Advances in neuroendoscopic techniques have allowed safe and effective management of this obstructive hydrocephalus with an opportunity to sample cerebrospinal fluid (CSF) and obtain tissue for histopathology. Definitive surgery is required in less than a third. Endoscopic visualisation and assistance is increasingly used for radical resection, where indicated.

Methodology

Our experience of endoscopic surgery for paediatric PRTs from 2002 to 2021 is presented. All patients underwent MRI with contrast. Serum tumour markers were checked. If negative, endoscopic biopsy and endoscopic third ventriculostomy (ETV) were performed; and CSF collected for tumour markers and abnormal cells. For radical surgery, endoscope-assisted microsurgery procedures were performed to minimise retraction, visualise the extent of resection and confirm haemostasis.

Results

M:F ratio was 2:1. The median age of presentation was 11 years. Raised ICP (88.88%) was the commonest mode of presentation. Nineteen patients had pineal tumours, one had a suprasellar and pineal tumour, one had disseminated disease, while six had tectal tumours. The ETB diagnosis rate was 95.45%, accuracy rate was 83.3% and ETV success rate was 86.96%.

Conclusion

Neuroendoscopy has revolutionised the management of paediatric PRTs. It is a safe and effective procedure with good diagnostic yield and allows successful concurrent CSF diversion, thereby avoiding major surgeries and shunt implantation. It is also helpful in radical resection of lesions, where indicated.

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Data availability

All the data analysed is in the manuscript and related files.

Abbreviations

PRT :

Pineal region tumour

ETB:

Endoscopic tumour biopsy

ETV :

Endoscopic third ventriculostomy

EAM:

Endoscope-assisted microsurgery

CSF :

Cerebrospinal fluid

GCT :

Germ cell tumour

ICP:

Intracranial pressure

MR:

Magnetic resonance

CT:

Computed tomography

VP :

Ventriculoperitoneal

AFP :

Alpha feto-protein

HCG:

Human chorionic gonadotropin

GCT :

Germ cell tumour

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Authors and Affiliations

  1. Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India, 400020

    Chandrashekhar Deopujari, Krishna Shroff, Vikram Karmarkar & Chandan Mohanty

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Contributions

CD reviewed and edited the manuscript and figures, and is the first and senior author. KS collected the data, formulated the results, reviewed the existing literature and wrote the manuscript primarily, and is the second author. VK and CM were part of the surgical team and reviewed the discussion, and share third authorship.

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Correspondence to Chandrashekhar Deopujari.

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Ethical approval was waived by the Institutional Ethics Committee in view of the retrospective nature of the study; and all procedures performed were part of routine care. The study was conducted in accordance with the declaration of Helsinki.

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Parents of the patients included in the study were informed that their patient’s clinical data and imaging photographs may be used for educational purposes such as presentation in conferences/journals, and consent was obtained. No personal identifying information has been submitted in this manuscript or in Figs. 1–5.

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No funding was received to assist with the preparation of this manuscript and the authors have no relevant financial or non-financial interests to disclose.

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Deopujari, C., Shroff, K., Karmarkar, V. et al. Neuroendoscopy in the management of pineal region tumours in children. Childs Nerv Syst 39, 2353–2365 (2023). https://doi.org/10.1007/s00381-022-05561-0

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