Transventricular Endoscopic Biopsy of Suprasellar Tumors: a Pediatric Case Series

Overview

Journal Childs Nerv Syst

Specialty Pediatrics

Date 2013 Apr 3

PMID 23545595

Citations 6

Authors

Kyunghwan Kim

Je Young Yeon

Ho Jun Seol

Hyung Jin Shin

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: The purpose of this study was to investigate the efficacy and safety of transventricular neuroendoscopic biopsies in pediatric patients with suprasellar tumors.

Methods: Twenty-three pediatric patients (12 males and 11 females) with suprasellar tumors underwent transventricular neuroendoscopic biopsy at our institute by a single surgeon from 2000 to 2011. Neuronavigation has been combined with endoscopic procedures since 2008. Neuroendoscopic biopsies were performed to verify the histopathological diagnosis of neoplasms and to plan appropriate treatment strategies.

Results: Neuroendoscopic biopsy specimens were appropriate for diagnosis in 22 of the 23 patients (95.7%) and revealed 14 germ cell tumors (12 germinomas, one choriocarcinoma, and one immature teratoma), seven astrocytomas, and one craniopharyngioma. Subsequent treatment modalities including chemotherapy, radiation therapy, or microscopic surgery were determined according to the pathological findings. Seventeen of the 23 patients (73.9%) showed ventriculomegaly. Among them, ventriculomegaly in 14 patients was resolved after an endoscopic procedure and/or adjuvant chemotherapy, but the remaining three patients (17.6%) required a ventriculoperitoneal shunt to relieve the ventriculomegaly. The pathologic diagnosis of these three patients was uniformly a large astrocytoma. Navigational tracking was helpful to enter small ventricles and the narrow foramen of Monro in patients without hydrocephalus. No mortalities were related to the procedures, but three transient diabetes insipidus (13.0%) cases occurred but fully recovered before the patients received adjuvant therapy.

Conclusion: Endoscopic biopsy is feasible and shows acceptable operation-related complications to obtain tissue from suprasellar tumors in pediatric patients. Navigation-assisted neuroendoscopic procedure improves the accuracy of the endoscopic approach. An associated endoscopic procedure can resolve hydrocephalus, but it has limitations with large ventricle-occupying tumors.

Citing Articles

So-called bifocal tumors with diabetes insipidus and negative tumor markers: are they all germinoma?.

Kanamori M, Takami H, Yamaguchi S, Sasayama T, Yoshimoto K, Tominaga T Neuro Oncol. 2020; 23(2):295-303.

PMID: 32818237 PMC: 7906060. DOI: 10.1093/neuonc/noaa199.

Neuroendoscopy via an Extremely Narrow Foramen of Monro: A Case Report.

Nagm A, Ogiwara T, Goto T, Chiba A, Hongo K NMC Case Rep J. 2017; 4(1):37-42.

PMID: 28664024 PMC: 5364906. DOI: 10.2176/nmccrj.cr.2016-0157.

Frontal burr hole approach for neuroendoscopic resection of craniopharyngioma with the NICO Myriad device: report of two cases.

Moore R, Scherer A, Fulkerson D Childs Nerv Syst. 2017; 33(4):659-664.

PMID: 28324187 DOI: 10.1007/s00381-017-3386-1.

Endoscopic biopsy of brain tumors: Does the technique matter?.

Azab W, Nasim K, Chelghoum A, Parwez A, Salaheddin W Surg Neurol Int. 2014; 5:159.

PMID: 25506504 PMC: 4253053. DOI: 10.4103/2152-7806.144597.

Ventricular endoscopy in the pediatric population: review of indications.

Choudhri O, Feroze A, Nathan J, Cheshier S, Guzman R Childs Nerv Syst. 2014; 30(10):1625-43.

PMID: 25081217 DOI: 10.1007/s00381-014-2502-8.

References

Bouras T, Sgouros S . Complications of endoscopic third ventriculostomy. J Neurosurg Pediatr. 2011; 7(6):643-9. DOI: 10.3171/2011.4.PEDS10503. View

Yurtseven T, Ersahin Y, Demirtas E, Mutluer S . Neuroendoscopic biopsy for intraventricular tumors. Minim Invasive Neurosurg. 2003; 46(5):293-9. DOI: 10.1055/s-2003-44450. View

Packer R . Brain tumors in children. Arch Neurol. 1999; 56(4):421-5. DOI: 10.1001/archneur.56.4.421. View

Astrup J . Natural history and clinical management of optic pathway glioma. Br J Neurosurg. 2003; 17(4):327-35. DOI: 10.1080/02688690310001601216. View

Song J, Kong D, Shin H . Feasibility of neuroendoscopic biopsy of pediatric brain tumors. Childs Nerv Syst. 2010; 26(11):1593-8. DOI: 10.1007/s00381-010-1143-9. View

Franzini A, Leocata F, Servello D, Cajola L, ALLEGRANZA A, Broggi G . Long-term follow-up of germinoma after stereotactic biopsy and brain radiotherapy: a cell kinetics study. J Neurol. 1998; 245(9):593-7. DOI: 10.1007/s004150050251. View

Tirakotai W, Hellwig D, Bertalanffy H, Riegel T . The role of neuroendoscopy in the management of solid or solid-cystic intra- and periventricular tumours. Childs Nerv Syst. 2007; 23(6):653-8. DOI: 10.1007/s00381-007-0328-3. View

Deopujari C, Kumar A, Karmarkar V, Biyani N, Mhatre M, Shah N . Pediatric suprasellar lesions. J Pediatr Neurosci. 2011; 6(Suppl 1):S46-55. PMC: 3208925. DOI: 10.4103/1817-1745.85710. View

Chernov M, Kamikawa S, Yamane F, Ishihara S, Kubo O, Hori T . Neurofiberscopic biopsy of tumors of the pineal region and posterior third ventricle: indications, technique, complications, and results. Neurosurgery. 2006; 59(2):267-77. DOI: 10.1227/01.NEU.0000223504.29243.0B. View

10.

Di Rocco C, Massimi L, Tamburrini G . Shunts vs endoscopic third ventriculostomy in infants: are there different types and/or rates of complications? A review. Childs Nerv Syst. 2006; 22(12):1573-89. DOI: 10.1007/s00381-006-0194-4. View

11.

Leibel S, SHELINE G . Radiation therapy for neoplasms of the brain. J Neurosurg. 1987; 66(1):1-22. DOI: 10.3171/jns.1987.66.1.0001. View

12.

Fukushima T, Ishijima B, Hirakawa K, Nakamura N, Sano K . Ventriculofiberscope: a new technique for endoscopic diagnosis and operation. Technical note. J Neurosurg. 1973; 38(2):251-6. DOI: 10.3171/jns.1973.38.2.0251. View

13.

Song J, Kong D, Seol H, Shin H . Transventricular Biopsy of Brain Tumor without Hydrocephalus Using Neuroendoscopy with Navigation. J Korean Neurosurg Soc. 2010; 47(6):415-9. PMC: 2899026. DOI: 10.3340/jkns.2010.47.6.415. View

14.

Souweidane M, Luther N . Endoscopic resection of solid intraventricular brain tumors. J Neurosurg. 2007; 105(2):271-8. DOI: 10.3171/jns.2006.105.2.271. View

15.

Drake J, Kulkarni A, Kestle J . Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in pediatric patients: a decision analysis. Childs Nerv Syst. 2009; 25(4):467-72. DOI: 10.1007/s00381-008-0761-y. View

16.

Matsutani M, Sano K, Takakura K, Fujimaki T, Nakamura O, Funata N . Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg. 1997; 86(3):446-55. DOI: 10.3171/jns.1997.86.3.0446. View

17.

Gaab M, Schroeder H . Neuroendoscopic approach to intraventricular lesions. J Neurosurg. 1998; 88(3):496-505. DOI: 10.3171/jns.1998.88.3.0496. View

18.

Yamini B, Refai D, Rubin C, Frim D . Initial endoscopic management of pineal region tumors and associated hydrocephalus: clinical series and literature review. J Neurosurg. 2004; 100(5 Suppl Pediatrics):437-41. DOI: 10.3171/ped.2004.100.5.0437. View

19.

Fiorindi A, Longatti P . A restricted neuroendoscopic approach for pathological diagnosis of intraventricular and paraventricular tumours. Acta Neurochir (Wien). 2008; 150(12):1235-9. DOI: 10.1007/s00701-008-0155-7. View

20.

Shono T, Natori Y, Morioka T, Torisu R, Mizoguchi M, Nagata S . Results of a long-term follow-up after neuroendoscopic biopsy procedure and third ventriculostomy in patients with intracranial germinomas. J Neurosurg. 2007; 107(3 Suppl):193-8. DOI: 10.3171/PED-07/09/193. View