Neuroendoscopic biopsy of ventricular tumors: A multicentric experience

Piero Andrea Oppido, Alessandro Fiorindi, Lucia Benvenuti, Fabio Cattani, Saverio Cipri, Michelangelo Gangemi, Umberto Godano, Pierluigi Longatti, Carmelo Mascari, Enzo Morace, Luigino Tosatto

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Object: Although neuroendoscopic biopsy is routinely performed, the safety and validity of this procedure has been studied only in small numbers of patients in single-center reports. The Section of Neuroendoscopy of the Italian Neurosurgical Society invited some of its members to review their own experience, gathering a sufficient number of cases for a wide analysis. Methods: Retrospective data were collected by 7 centers routinely performing neuroendoscopic biopsies over a period of 10 years. Sixty patients with newly diagnosed intraventricular and paraventricular tumors were included. No patient harboring a colloid cyst was included. Data regarding clinical presentation, neuroimaging findings, operative techniques, pathological diagnosis, postoperative complications, and subsequent therapy were analyzed. Results: In all patients, a neuroendoscopic tumor biopsy was performed. In 38 patients (64%), obstructive hydrocephalus was present. In addition to the tumor biopsy, 32 patients (53%) underwent endoscopic third ventriculos tomy (ETV), and 7 (12%) underwent septum pellucidotomy. Only 2 patients required a ventriculoperitoneal shunt shortly after the endoscopy procedure because ETV was not feasible. The major complication due to the endoscopy procedure was ventricular hemorrhage noted on the postoperative images in 8 cases (13%). Only 2 patients were symptomatic and required medical therapy. Infection occurred in only 1 case, and the other complications were all reversible. In no case did clinically significant sequelae affect the patient's outcome. Tumor types ranged across the spectrum and included glioma (low- and high-grade [27%]), pure germinoma (15%), pineal parenchymal tumor (12%), primary neuroectodermal tumor (4%), lymphoma (9%), metastasis (4%), craniopharyngioma (6%), and other tumor types (13%). In 10% of patients, the pathological fndings were inconclusive. According to diagnosis, specific therapy was performed in 35% of patients: 17% underwent microsurgical removal, and 18% underwent chemotherapy or radiotherapy. Conclusions: This is one of the largest series confirming the safety and validity of the neuroendoscopic biopsy procedure. Complications were relatively low (about 13%), and they were all reversible. Neuroendoscopic biopsy provided meaningful pathological data in 90% of patients, making subsequent tumor therapy feasible. Cerebrospinal fluid pathways can be restored by ETV or septum pellucidotomy (65%) to control intracranial hypertension. In light of the results obtained, a neuroendoscopic biopsy should be considered a possible alternative to the stereotactic biopsy in the diagnosis and treatment of ventricular or paraventricular tumors. Furthermore, it could be the only surgical procedure necessary for the treatment of selected tumors.

Original languageEnglish
Article numberE2
JournalNeurosurgical Focus
Volume30
Issue number4
DOIs
Publication statusPublished - Apr 2011

Fingerprint

Biopsy
Neoplasms
Endoscopy
Neuroendoscopy
Therapeutics
Colloid Cysts
Neuroectodermal Tumors
Germinoma
Pinealoma
Safety
Craniopharyngioma
Ventriculoperitoneal Shunt
Intracranial Hypertension
Hydrocephalus
Neuroimaging
Glioma
Cerebrospinal Fluid
Lymphoma
Radiotherapy
Hemorrhage

Keywords

  • Endoscopic biopsy
  • Endoscopic third ventriculostomy
  • Hydrocephalus
  • Intraventricular tumor

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Oppido, P. A., Fiorindi, A., Benvenuti, L., Cattani, F., Cipri, S., Gangemi, M., ... Tosatto, L. (2011). Neuroendoscopic biopsy of ventricular tumors: A multicentric experience. Neurosurgical Focus, 30(4), [E2]. https://doi.org/10.3171/2011.1.FOCUS10326

Neuroendoscopic biopsy of ventricular tumors : A multicentric experience. / Oppido, Piero Andrea; Fiorindi, Alessandro; Benvenuti, Lucia; Cattani, Fabio; Cipri, Saverio; Gangemi, Michelangelo; Godano, Umberto; Longatti, Pierluigi; Mascari, Carmelo; Morace, Enzo; Tosatto, Luigino.

In: Neurosurgical Focus, Vol. 30, No. 4, E2, 04.2011.

Research output: Contribution to journalArticle

Oppido, PA, Fiorindi, A, Benvenuti, L, Cattani, F, Cipri, S, Gangemi, M, Godano, U, Longatti, P, Mascari, C, Morace, E & Tosatto, L 2011, 'Neuroendoscopic biopsy of ventricular tumors: A multicentric experience', Neurosurgical Focus, vol. 30, no. 4, E2. https://doi.org/10.3171/2011.1.FOCUS10326
Oppido PA, Fiorindi A, Benvenuti L, Cattani F, Cipri S, Gangemi M et al. Neuroendoscopic biopsy of ventricular tumors: A multicentric experience. Neurosurgical Focus. 2011 Apr;30(4). E2. https://doi.org/10.3171/2011.1.FOCUS10326
Oppido, Piero Andrea ; Fiorindi, Alessandro ; Benvenuti, Lucia ; Cattani, Fabio ; Cipri, Saverio ; Gangemi, Michelangelo ; Godano, Umberto ; Longatti, Pierluigi ; Mascari, Carmelo ; Morace, Enzo ; Tosatto, Luigino. / Neuroendoscopic biopsy of ventricular tumors : A multicentric experience. In: Neurosurgical Focus. 2011 ; Vol. 30, No. 4.
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abstract = "Object: Although neuroendoscopic biopsy is routinely performed, the safety and validity of this procedure has been studied only in small numbers of patients in single-center reports. The Section of Neuroendoscopy of the Italian Neurosurgical Society invited some of its members to review their own experience, gathering a sufficient number of cases for a wide analysis. Methods: Retrospective data were collected by 7 centers routinely performing neuroendoscopic biopsies over a period of 10 years. Sixty patients with newly diagnosed intraventricular and paraventricular tumors were included. No patient harboring a colloid cyst was included. Data regarding clinical presentation, neuroimaging findings, operative techniques, pathological diagnosis, postoperative complications, and subsequent therapy were analyzed. Results: In all patients, a neuroendoscopic tumor biopsy was performed. In 38 patients (64{\%}), obstructive hydrocephalus was present. In addition to the tumor biopsy, 32 patients (53{\%}) underwent endoscopic third ventriculos tomy (ETV), and 7 (12{\%}) underwent septum pellucidotomy. Only 2 patients required a ventriculoperitoneal shunt shortly after the endoscopy procedure because ETV was not feasible. The major complication due to the endoscopy procedure was ventricular hemorrhage noted on the postoperative images in 8 cases (13{\%}). Only 2 patients were symptomatic and required medical therapy. Infection occurred in only 1 case, and the other complications were all reversible. In no case did clinically significant sequelae affect the patient's outcome. Tumor types ranged across the spectrum and included glioma (low- and high-grade [27{\%}]), pure germinoma (15{\%}), pineal parenchymal tumor (12{\%}), primary neuroectodermal tumor (4{\%}), lymphoma (9{\%}), metastasis (4{\%}), craniopharyngioma (6{\%}), and other tumor types (13{\%}). In 10{\%} of patients, the pathological fndings were inconclusive. According to diagnosis, specific therapy was performed in 35{\%} of patients: 17{\%} underwent microsurgical removal, and 18{\%} underwent chemotherapy or radiotherapy. Conclusions: This is one of the largest series confirming the safety and validity of the neuroendoscopic biopsy procedure. Complications were relatively low (about 13{\%}), and they were all reversible. Neuroendoscopic biopsy provided meaningful pathological data in 90{\%} of patients, making subsequent tumor therapy feasible. Cerebrospinal fluid pathways can be restored by ETV or septum pellucidotomy (65{\%}) to control intracranial hypertension. In light of the results obtained, a neuroendoscopic biopsy should be considered a possible alternative to the stereotactic biopsy in the diagnosis and treatment of ventricular or paraventricular tumors. Furthermore, it could be the only surgical procedure necessary for the treatment of selected tumors.",
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AU - Oppido, Piero Andrea

AU - Fiorindi, Alessandro

AU - Benvenuti, Lucia

AU - Cattani, Fabio

AU - Cipri, Saverio

AU - Gangemi, Michelangelo

AU - Godano, Umberto

AU - Longatti, Pierluigi

AU - Mascari, Carmelo

AU - Morace, Enzo

AU - Tosatto, Luigino

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N2 - Object: Although neuroendoscopic biopsy is routinely performed, the safety and validity of this procedure has been studied only in small numbers of patients in single-center reports. The Section of Neuroendoscopy of the Italian Neurosurgical Society invited some of its members to review their own experience, gathering a sufficient number of cases for a wide analysis. Methods: Retrospective data were collected by 7 centers routinely performing neuroendoscopic biopsies over a period of 10 years. Sixty patients with newly diagnosed intraventricular and paraventricular tumors were included. No patient harboring a colloid cyst was included. Data regarding clinical presentation, neuroimaging findings, operative techniques, pathological diagnosis, postoperative complications, and subsequent therapy were analyzed. Results: In all patients, a neuroendoscopic tumor biopsy was performed. In 38 patients (64%), obstructive hydrocephalus was present. In addition to the tumor biopsy, 32 patients (53%) underwent endoscopic third ventriculos tomy (ETV), and 7 (12%) underwent septum pellucidotomy. Only 2 patients required a ventriculoperitoneal shunt shortly after the endoscopy procedure because ETV was not feasible. The major complication due to the endoscopy procedure was ventricular hemorrhage noted on the postoperative images in 8 cases (13%). Only 2 patients were symptomatic and required medical therapy. Infection occurred in only 1 case, and the other complications were all reversible. In no case did clinically significant sequelae affect the patient's outcome. Tumor types ranged across the spectrum and included glioma (low- and high-grade [27%]), pure germinoma (15%), pineal parenchymal tumor (12%), primary neuroectodermal tumor (4%), lymphoma (9%), metastasis (4%), craniopharyngioma (6%), and other tumor types (13%). In 10% of patients, the pathological fndings were inconclusive. According to diagnosis, specific therapy was performed in 35% of patients: 17% underwent microsurgical removal, and 18% underwent chemotherapy or radiotherapy. Conclusions: This is one of the largest series confirming the safety and validity of the neuroendoscopic biopsy procedure. Complications were relatively low (about 13%), and they were all reversible. Neuroendoscopic biopsy provided meaningful pathological data in 90% of patients, making subsequent tumor therapy feasible. Cerebrospinal fluid pathways can be restored by ETV or septum pellucidotomy (65%) to control intracranial hypertension. In light of the results obtained, a neuroendoscopic biopsy should be considered a possible alternative to the stereotactic biopsy in the diagnosis and treatment of ventricular or paraventricular tumors. Furthermore, it could be the only surgical procedure necessary for the treatment of selected tumors.

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