gms | German Medical Science

Objective: Frame-based stereotaxy has been the gold standard for biopsy of deep-seated intracranial pathologies for many years. However, direct visual control of the biopsy area is not possible. A direct endoscopic visualization of the biopsy site might harbor distinct advantages. Here, the authors present a series of endoscopic, neuronavigated fine-needle biopsies of paraventricular intraparenchymal tumors.

Methods: Endoscopic fine-needle sedan-probe biopsy of paraventricular pathologies was performed in 5 male and 3 female patients between 03/2013 and 09/2016. The patient age ranged from 18 to 82 years. All patients underwent a pure endoscopic procedure over a burr hole trepanation. The surgery was performed in supine position with fixed heads. As an addition to the direct visual control by using the endoscope camera system, the paraventricular position of the biopsy needle could be controlled by a passive neuronavigation tracking system that was fixed at the sedan-probe.

Results: Histological diagnoses were established in all biopsies. In all cases, a direct control of the biopsy area was feasible and hemostasis could be obtained. In 5 cases, endoscopic third ventriculostomy (ETV) was performed due to obstructive hydrocephalus. In case of ETV, the stoma was created prior to biopsy. In 7 cases, the postoperative course was uneventful. One patient with a large tumor of the left thalamus and tumor growth into the third ventricle suffered from persistent hydrocephalus and had to be treated with external ventricular drainage.

Conclusion: Endoscopically conducted biopsies with the aid of neuronavigated 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.