Article
The role of endoscopy in the management of intra- and periventricular tumors
Die Rolle der Endoskopie in der Behandlung intra- und periventrikulärer Tumore
Search Medline for
Authors
Published: | May 4, 2005 |
---|
Outline
Text
Objective
The operative therapy of ventricular tumors is still a challenge for the neurosurgeon. The transcallosal approach has a certain morbidity rate, which increases substantially in tumors of subependymal origin. Possibly, neuroendoscopy alone or in combination with adjuvant therapies offers the chance of treating some of these patients less invasively but still effectively. Therefore it was the purpose of this prospective clinical series to investigate the role of neuroendoscopy in the management of intra- and periventricular tumors.
Methods
In 36 patients with intra- or periventricular tumors (low-grade glioma n=16; craniopharnyngeoma n=8; high-grade glioma n=6; lymphoma n=2, germinoma, pituitary adenoma, granuloma, metastasis n=1 each) a biopsy was taken endoscopically. In 21 patients with tumor-associated hydrocephalus, a septostomy and/or third ventriculostomy were performed. Tumor cysts were opened to the ventricular system in 11 patients. In patients with non-benign tumors, radio- or chemotherapy were initiated after surgery. Patients with craniopharyngeomas underwent radiotherapy of the solid tumor remnant.
Results
There was no operative morbidity or mortality. Biopsy was conclusive in 35 of the 36 patients. Hydrocephalus was successfully controlled in 17 of the 21 patients. After initial clinical improvement after surgery in all cases, 3 patients deteriorated again during the hospital stay (cyst refilling, tumor growth, intratumoral bleeding n=1 each). Five of 6 patients with high-grade glioma survived 6-9 months, 1 patient more than 1.5 years. After a mean follow-up of 1.5 years, the clinical results of the remaining patients are stable.
Conclusions
In intra- and periventricular tumors, endoscopy with or without adjuvant therapy proved to be a very safe and nonetheless effective approach. Endoscopy should at least be taken into account when dealing with ventricular tumors.