Combined endoscopic third ventriculostomy and tumor biopsy in the management of pineal region tumors, safety considerations

Abstract

BackgroundPineal region tumor is considered an ideal indication for endoscopic third ventriculostomy (ETV), with success rate up to 92%. The ultimate advantage is the ability to obtain tumor biopsy for histopathological diagnosis and for further treatment strategy plan design.ObjectivesTo investigate the safety considerations to minimize tumor biopsy-related bleeding, increase diagnostic accuracy, and establish a successful ETV procedure.MethodsRetrospective study including 25 patients of pineal region tumor with concomitant triventricular hydrocephalus. Preoperative planning to perform ETV and obtain tumor biopsy was achieved either through single more anteriorly located precoronal burr-hole (17 patients) or two separate burr-holes (eight patients). The patients’ age ranged from 9 months to 65 years with a mean age of 26.5 years. Preoperative MRI brain with coronal T2- and sagittal T1-weighted images was used to design trajectory.ResultsNo significant intraventricular bleeding reported. A diagnostic tumor biopsy yield was successful in 22 patients. Ventriculoperitoneal shunt insertion was required in 1 patient failed to improve.ConclusionEndoscopic tumor biopsy is relatively safe with high diagnostic yield that helps in management protocol plus shunt independent control of associated hydrocephalus.