Considerations on surgical strategies and associated risk profiles for endoscopic tumor biopsies within the third ventricle and periaqueductal region

Fritz Teping; Joachim Oertel

doi:10.1007/s00381-023-06122-9

Considerations on surgical strategies and associated risk profiles for endoscopic tumor biopsies within the third ventricle and periaqueductal region

Childs Nerv Syst. 2023 Dec;39(12):3407-3414. doi: 10.1007/s00381-023-06122-9. Epub 2023 Sep 8.

Authors

Fritz Teping¹, Joachim Oertel²

Affiliations

¹ Department of Neurosurgery, Faculty of Medicine, Saarland University, Kirrbergerstraße, Building 90.5, D-66421, Homburg, Germany.
² Department of Neurosurgery, Faculty of Medicine, Saarland University, Kirrbergerstraße, Building 90.5, D-66421, Homburg, Germany. joachimoertel1970@gmail.com.

Abstract

Introduction: Neuroendoscopic techniques have proven to be a successful and minimally-invasive technique for tumor biopsies within the third ventricle in pediatric patients. However, a comprehensive assessment of associated surgical strategies, techniques, and morbidity is essential to optimize patient outcomes.

Methods: This retrospective study analyzed full endoscopic tumor biopsies in pediatric patients with tumors in the third ventricle and periaqueductal region. Data from 1995 to 2022 were collected from medical records, imaging, and intraoperative video documentation.

Results: In this study, 16 shear endoscopic tumor biopsies were performed using the transventricular transforaminal approach. Tumors were located in the anterior or mid part of the third ventricle (50%) or in the periaqueductal and pineal recess region (50%). Preoperative hydrocephalus was seen in 81.25%. Tumor biopsies were harvested successfully in all cases. Simultaneous ETV was performed in 12 (75%) cases and additional septostomy in 3 (18.75%). Significant intraoperative bleeding occurred in 3 cases (18.75%). All bleeding situations could be successfully managed with continuous irrigation. Histopathology revealed astrocytoma as the predominant diagnosis (75%). No new neurologic deficits were observed, except for one case of transient oculomotor nerve paralysis after ETV. Hydrocephalus persisted in 18.6% of all cases with the need of urgent ventriculoperitoneal shunting in two patients.

Conclusion: In conclusion, neuroendoscopy emerges as an effective technique for tumor biopsies within the third ventricle in pediatric patients, offering the added advantage of simultaneous treatment of obstructive hydrocephalus. However, it is essential to acknowledge the specific intra- and postoperative risks associated with various surgical strategies. The safe management and achievement of favorable clinical results demand extensive experience and expertise.

Keywords: Endoscopic tumor biopsy; Neuroendoscopy; Pediatric; Ventricular surgery.

MeSH terms

Astrocytoma* / surgery
Biopsy / methods
Child
Humans
Hydrocephalus* / diagnosis
Hydrocephalus* / etiology
Hydrocephalus* / surgery
Neuroendoscopy* / methods
Retrospective Studies
Third Ventricle* / pathology
Third Ventricle* / surgery
Treatment Outcome
Ventriculostomy / methods