Artikel
Transventricular endoscopic approach to suprasellar tumorous lesions – a minimal invasive surgical technique with low morbidity
Transventrikulärer endoskopischer Zugang zu suprasellären Tumoren – eine minimal-invasive chirurgische Technik mit niedriger Morbidität
Suche in Medline nach
Autoren
Veröffentlicht: | 8. Mai 2019 |
---|
Gliederung
Text
Objective: Most suprasellar tumors directly involve the optical pathways and the hypothalamic-pituitary axis making complete removal without deleterious sequels impossible. In case of tumor extension into the 3rd ventricle, e.g. if cystic, a transventricular endoscopic approach may provide a safe option to significantly reduce tumor volume and in the meantime address occlusive hydrocephalus with avoidance of further morbidity.
Methods: All patients with suprasellar tumors treated in our department with transventricular endoscopic surgery have been retrospectively investigated by evaluating electronic patient data and images and videos.
Results: 8 patients aged 1 to 10 years (average 7.1 year), 2 girls and 6 boys, have been selected between 2013 and 2018. Histology: Craniopharyngeoma (5), pilocytic astrocytoma (2), bilocular germinoma (1). In all patient primary surgery was transventricular endoscopic, in 2 a 2nd and a 3rd endoscopic surgery and two additional open surgeries were performed. Partial removal has been obtained in 5, biopsy in 2 and total removal in one. Additional procedures were septostomy (1), ETV (1), reservoir implantation (5) and shunt (2). Pathological hormone status was found preoperatively in 3 patients without postoperative changes. No patient needed treatment for diabetes insipidus. 5 patients had initial ophthalmological signs, 3 resolved postoperatively (papilledema, Parinaud’s syndrome). 3 patients were suffering from obesity pre- and postoperatively. All patients had hydrocephalus at time of diagnosis. 6 patients received adjuvant radiotherapy (2 proton beam) and 3 chemotherapy. 6 patients are clinically stable without new postinterventional deficits (1 LOF).
Conclusion: Transventricular endoscopic surgery of suprasellar tumors with 3rd ventricle involvement provides an adequate approach to tumor reduction, even removal, or at least histology and offers additional hydrocephalus treatment options without creating new morbidity. It is mainly indicated in tumors that cannot be removed completely in order to minimize the preradiation tumor volume.