Background: Endoscopic procedure for pineal region tumors and associated hydrocephalus has been getting more standard. We applied high-definition flexible neuroendoscopic system to the initial management of primary pineal malignant B-cell lymphoma. Efficacy of this new technology as an initial treatment of pineal region tumors is discussed.
Case description: A 31-year-old man presented with progressive left abducens nerve palsy with headache and nausea. Magnetic resonance imaging showed multiple enhanced lesions in several cranial nerves and obstructive hydrocephalus due to a pineal cystic lesion with nodular enhancement on its roof. Diagnostic endoscopic biopsy of the pineal region tumor and ETV were performed using new flexible endoscopic system, in which a small CCD camera is implanted at the tip of the flexible scope, without complications. The thin cyst membrane was perforated and then opened with endoscopic forceps. A biopsy of the solid nodule on the cyst wall was carefully performed without injuring the surrounding venous system. We found a lot of small wartlike lesions along the third ventricular wall and fish egg-like abnormal lesions adhered to the colloid plexus around the pineal region, which were considered to be associated with dissemination. These lesions were not apparent in initial MRI. Histopathologic diagnosis of the pineal region tumor was malignant B-cell lymphoma.
Conclusion: Endoscopic biopsy and ETV for pineal region tumors can be safely achieved using a high-definition flexible neuroendoscopic system. Moreover, this system allowed us to observe disseminated lesions that are not revealed by preoperative neuroradiologic studies, which might enable us to make staging diagnosis of the disease.