Endoscopic Management of Intra Ventricular Tumours

Objective: Neuroendoscopic removal of intraventricular tumors is difficult and time consuming because of the lack of an effective decompression system that can be used through the working channel of the endoscope. The authors report on the utilization of an endoscopic ultrasonic aspirator in the re...

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Autor principal:	Giuseppe Cinalli
Formato:	article
Lenguaje:	EN
Publicado:	Brazilian Society for Pediatric Neurosurgery 2021
Materias:	neuroendoscopy tumor intraventricular Pediatrics RJ1-570 Surgery RD1-811
Acceso en línea:	https://doaj.org/article/9e1e3174e9ce4511978cf201d16d2dd6
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spelling	oai:doaj.org-article:9e1e3174e9ce4511978cf201d16d2dd62021-11-23T21:46:36ZEndoscopic Management of Intra Ventricular Tumours2675-362610.46900/apn.v3i1(January-April).69https://doaj.org/article/9e1e3174e9ce4511978cf201d16d2dd62021-02-01T00:00:00Zhttps://www.archpedneurosurg.com.br/pkp/index.php/sbnped2019/article/view/69https://doaj.org/toc/2675-3626Objective: Neuroendoscopic removal of intraventricular tumors is difficult and time consuming because of the lack of an effective decompression system that can be used through the working channel of the endoscope. The authors report on the utilization of an endoscopic ultrasonic aspirator in the resection of intraventricular tumors. Methods: Seventeen pediatric patients (14 male, 3 female), ages 1-15 years old, underwent surgery via a purely endoscopic approach using a Gaab rigid endoscope and endoscopic ultrasonic aspirator. Ten patients presented with an intraventricular tumor, three with paraventricular, and 4 with suprasellar lesions. Histology analysis showed 6/17 glial tumors, 3/17 with subependymal giant cell astrocytomas (associated with tuberous sclerosis), two cases presented with intraventricular metastases from high-grade tumors (medulloblastoma, atypical teratoid rhabdoid tumor), 4/17 with suprasellar tumors (2 craniopharyngiomas and 2 optic pathway gliomas), and two with pineal region tumors (1 immature teratoma, 1 PNET). In all patients, the endoscopic trajectory and ventricular access were guided by electromagnetic neuronavigation. Fifteen patients underwent surgery via a precoronal bur hole while supine. In 1 case, surgery was performed through a frontal anterior bur hole and one patient underwent surgery via a posterior parietal approach to the trigone while in a lateral position. The endoscopic technique consisted of visualization of the tumor, ventricular washing to dilate the ventricles and to control bleeding, obtaining a tumor specimen with biopsy forceps, and ultrasonic aspiration of the tumor. Bleeding was controlled with irrigation, monopolar coagulation, and a thulium laser. Results/Discussion: In 9 cases, the resection was total or near total (more than 90% of lesion removed). In 8 cases, the resection was partial or biopsy. Histological evaluation of the collected material (withdrawn using biopsy forceps and aspirated with an ultrasonic aspirator) was diagnostic in all cases. The duration of surgery ranged from 30 to 120 minutes. One case was complicated by subdural hygroma requiring a subduro-peritoneal shunt implant. The dry field technique was used in cases with persistence of bleeding. Conclusion: Patients harboring intraventricular tumors are in most cases ideal candidates for endoscopy biopsy/resection. In this series, endoscopic ultrasonic aspiration proved to be a safe and reliable method for achieving extensive decompression or complete removal in the management of intra- and/or paraventricular lesions in pediatric patients.Giuseppe CinalliBrazilian Society for Pediatric NeurosurgeryarticleneuroendoscopytumorintraventricularPediatricsRJ1-570SurgeryRD1-811ENArchives of Pediatric Neurosurgery, Vol 3, Iss 1(January-April), Pp e692021-e692021 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	neuroendoscopy tumor intraventricular Pediatrics RJ1-570 Surgery RD1-811
spellingShingle	neuroendoscopy tumor intraventricular Pediatrics RJ1-570 Surgery RD1-811 Giuseppe Cinalli Endoscopic Management of Intra Ventricular Tumours
description	Objective: Neuroendoscopic removal of intraventricular tumors is difficult and time consuming because of the lack of an effective decompression system that can be used through the working channel of the endoscope. The authors report on the utilization of an endoscopic ultrasonic aspirator in the resection of intraventricular tumors. Methods: Seventeen pediatric patients (14 male, 3 female), ages 1-15 years old, underwent surgery via a purely endoscopic approach using a Gaab rigid endoscope and endoscopic ultrasonic aspirator. Ten patients presented with an intraventricular tumor, three with paraventricular, and 4 with suprasellar lesions. Histology analysis showed 6/17 glial tumors, 3/17 with subependymal giant cell astrocytomas (associated with tuberous sclerosis), two cases presented with intraventricular metastases from high-grade tumors (medulloblastoma, atypical teratoid rhabdoid tumor), 4/17 with suprasellar tumors (2 craniopharyngiomas and 2 optic pathway gliomas), and two with pineal region tumors (1 immature teratoma, 1 PNET). In all patients, the endoscopic trajectory and ventricular access were guided by electromagnetic neuronavigation. Fifteen patients underwent surgery via a precoronal bur hole while supine. In 1 case, surgery was performed through a frontal anterior bur hole and one patient underwent surgery via a posterior parietal approach to the trigone while in a lateral position. The endoscopic technique consisted of visualization of the tumor, ventricular washing to dilate the ventricles and to control bleeding, obtaining a tumor specimen with biopsy forceps, and ultrasonic aspiration of the tumor. Bleeding was controlled with irrigation, monopolar coagulation, and a thulium laser. Results/Discussion: In 9 cases, the resection was total or near total (more than 90% of lesion removed). In 8 cases, the resection was partial or biopsy. Histological evaluation of the collected material (withdrawn using biopsy forceps and aspirated with an ultrasonic aspirator) was diagnostic in all cases. The duration of surgery ranged from 30 to 120 minutes. One case was complicated by subdural hygroma requiring a subduro-peritoneal shunt implant. The dry field technique was used in cases with persistence of bleeding. Conclusion: Patients harboring intraventricular tumors are in most cases ideal candidates for endoscopy biopsy/resection. In this series, endoscopic ultrasonic aspiration proved to be a safe and reliable method for achieving extensive decompression or complete removal in the management of intra- and/or paraventricular lesions in pediatric patients.
format	article
author	Giuseppe Cinalli
author_facet	Giuseppe Cinalli
author_sort	Giuseppe Cinalli
title	Endoscopic Management of Intra Ventricular Tumours
title_short	Endoscopic Management of Intra Ventricular Tumours
title_full	Endoscopic Management of Intra Ventricular Tumours
title_fullStr	Endoscopic Management of Intra Ventricular Tumours
title_full_unstemmed	Endoscopic Management of Intra Ventricular Tumours
title_sort	endoscopic management of intra ventricular tumours
publisher	Brazilian Society for Pediatric Neurosurgery
publishDate	2021
url	https://doaj.org/article/9e1e3174e9ce4511978cf201d16d2dd6
work_keys_str_mv	AT giuseppecinalli endoscopicmanagementofintraventriculartumours
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Endoscopic Management of Intra Ventricular Tumours

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