Visual-Controlled Endoscopic Biopsy of Paraventricular Intraparenchymal Tumors

Abstract

Frame-based stereotaxy represents the gold standard for biopsy of deep-seated lesions. Visual control of possible bleeding in these lesions is not possible. Neuroendoscopic biopsy represents an alternative procedure for tissue sampling in deep-seated intraventricular lesions. The authors present a technique for transventricular-navigated endoscopic biopsy of lesions that are located in the paraventricular region. Biopsy of paraventricular pathologies was performed in 6 male and 6 female patients between March 2013 and September 2018. The patient age ranged from 18 to 82 years. All patients underwent a pure endoscopic procedure over a burr hole trepanation supported by frameless navigation of the sedan probe. Histologic diagnoses were established in all biopsies. In all patients, a direct control of the biopsy area was feasible, and hemostasis could be obtained. In 5 patients, endoscopic third ventriculostomy was performed first due to obstructive hydrocephalus. In 1 patient suffering from obstructive hydrocephalus, a pellucidotomy was performed. In 9 cases, the initial postoperative course was uneventful. Three patients suffered from persistent hydrocephalus and had to be treated with ventriculoperitoneal shunt insertion. Endoscopically conducted biopsies with the aid of navigated tracking of the probe represent a possible additional technique in selected paraventricular intraparenchymal pathologies. The endoscopic approach enables the direct visualization of the intraventricular surface and its vessels. In contrast to standard stereotactic biopsy, direct visual control of hemostasis can be obtained even in paraventricular tumors.