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Endoscopic ultrasonic aspiration as alternative to more invasive surgery in initial management of optic pathway gliomas in children

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Abstract

Introduction

Optic pathway gliomas (OPGs) presenting with acute hydrocephalus represent a true neurosurgical and neurooncological challenge. Two main strategies are currently used: microsurgical removal of the tumor, restoring CSF pathways, and endoscopic biopsy associated with ventriculo-peritoneal shunt implantation. Since the availability of an ultrasonic aspirator handpiece, that can be used inside the working channel of a neuroendoscope, a different less invasive surgical strategy can be used.

Methods

Four pediatric patients were treated by endoscopic ultrasonic aspiration, in order to remove the upper pole of the tumor, obtaining tissue for diagnosis and restoring CSF pathways as initial treatment of OPG invading the third ventricle and causing hydrocephalus due to simultaneous blockage of both Monro foramina and of the Sylvian aqueduct. Surgical technique is described. Pre-operative and post-operative volumes were calculated on magnetic resonance imaging.

Results

In all cases, the surgical procedure was uneventful, the biopsy was diagnostic, and CSF pathways were restored. The amount of tumor removed ranged between 31 and 76%. All patients underwent oncological treatment of their tumors. One patient received V-P shunt only 1 year after endoscopic decompression due to tumor progression.

Conclusion

Our preliminary results show that the use of endoscopic cavitron aspirator is safe and effective to obtain CSF flow restoration and tumor biopsy (for histological and molecular purposes), avoiding CSF shunt implant in the acute phase and offering the chance to obtain a consistent tumor debulking in a minimally invasive fashion. Neuroendoscopic approach together with modern target therapy offers the opportunity to avoid or delay major surgery.

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Authors and Affiliations

  1. Department of Neurosciences, Unit of Pediatric Neurosurgery, Santobono-Pausilipon Children’s Hospital, Via Mario Fiore 6, 80121, Naples, Italy

    Pietro Spennato, Andrea De Rosa, Giulia Meccariello, Alessia Imperato, Maria Rosaria Scala & Giuseppe Cinalli

  2. Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli Federico II, Naples, Italy

    Andrea De Rosa & Maria Rosaria Scala

  3. Università Degli Studi Di Milano, Milan, Italy

    Giulia Meccariello

  4. Department of Onco-Hematology, Santobono-Pausilipon Children’s Hospital, Unit of Neuro-oncology, Naples, Italy

    Lucia Quaglietta

  5. Department of Neurosciences, Unit of Pediatric Neuroradiology, Santobono-Pausilipon Children’s Hospital, Naples, Italy

    Carmela Russo

Authors
  1. Pietro Spennato
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  2. Andrea De Rosa
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  3. Giulia Meccariello
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  4. Lucia Quaglietta
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  5. Alessia Imperato
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  6. Maria Rosaria Scala
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  7. Carmela Russo
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  8. Giuseppe Cinalli
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Corresponding author

Correspondence to Pietro Spennato.

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All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standard.

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Spennato, P., De Rosa, A., Meccariello, G. et al. Endoscopic ultrasonic aspiration as alternative to more invasive surgery in initial management of optic pathway gliomas in children. Childs Nerv Syst 38, 1281–1287 (2022). https://doi.org/10.1007/s00381-022-05515-6

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  • DOI: https://doi.org/10.1007/s00381-022-05515-6

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