gms | German Medical Science

Objective: Although Neuro-Endoscopic biopsies (NEB) are routinely performed, the safety and validity of NEB has been studied only in a small number of patients in single centre reports. The aim of this study is to collect data on large numbers of NEB patients retrospectively at several Italian centres known to perform neuro-endoscopic procedures on a regular basis.

Methods: Retrospective data-collection from 7 centres routinely performing NEB over a period of 11 years. The essential patient data focused on all biopsy attempts. Feedback from the neuropathologist on the study form was essential.

Results: We received 60 patient data forms from 7 medical centres in Italy. Patients' age ranged from 5 to 78 years (median 43,1). Tumor location was pineal (38%), thalamic (20%), mesencephalon (18%) and other locations (24%). Tumor size was <10mm (11%), 10-20mm (36%), and 20mm (49%). In addition to the NEB, 54% had endoscopic third ventriculostomy (ETV) and 12% septum pellucidotomy. The major complication was haemorrage (14%). Bleeding occurred during the procedure in 33%: in 20% it was mild,in 10% moderate, and in 3% severe. Infection occurred in 1 case (1,7%), while other complications, mostly reversible, were found in 10%. Tumor types included 27% glioma (low-grade and high-grade), 15% germinoma, 12% pineal tumor, 4% PNET, 9% lymphoma, 4% metastasis, 6% craniopharyngioma, 2 cases of non-neoplastic lesions and 13% other tumour types. 10% had non-conclusive pathology. Depending on the diagnosis, specific therapy of the patients was performed in 35%: microsurgical removal in15%, chemotherapy in9% and radiotherapy in 7%.

Conclusions: This is one of the largest series confirming the safety and validity of NEB. NEB had a relatively low, and mostly reversible, complication rate of below 14%. Neuroendoscopic biopsy provided meaningful pathological data for 90% of the patients, thereby allowing complementary therapy. By implementing ETV or septum pellucidotomy (66%) to control intracranial hypertension, the CSF pathways can be restored. Based on these results, NEB should be considered a safe and efficient procedure for the diagnosis and therapy of periventricular or ventricular tumours.