gms | German Medical Science

Objective: Tumors adjacent to the third ventricle in the pediatric population are challenging both for diagnosis and treatment or may cause occlusive hydrocephalus. Such tumors are often not accessible for open surgery, however, a histopathological diagnosis is warranted. Here we present our surgical technique combining endoscopic electromagnetic (EM)-guided third ventriculostomy and tumor biopsy using a single burr hole.

Methods: Over a 10-year period a total of 236 pediatric patients with brain tumors underwent surgery. In 10 patients (4.2 %) with occlusive hydrocephalus due to a tumor adjacent to the third ventricle a combined approach for ventriculostomy and tumor biopsy with EM-guidance was used.

Results: There were 7 male and 3 female patients. Age at surgery was at a mean of 9.8 years (range, 1.6 – 16.6 years). Both ventriculostomy and tumor biopsy was achieved in 9 cases without complications. In one instance, biopsy could not be performed because the cystic tumor was completely covered by normal tissue and did not reach the surface. Biopsy samples allowed a histopathological diagnosis in 8 cases: pilocytic astrocytoma (5 cases), PNET (one case), ganglioglioma (one case) and astrocytoma grade II (one case). In one case histolopathological diagnosis could not be carried out due to calcification and older bleeding signs of the specimen. Two patients needed CSF shunt surgery within months after the combined approach.

Conclusion: Endoscopic third ventriculostomy combined with biopsy of tumors adjacent to the third ventricle using EM-guidance via a single burr hole is safe and efficacious in the pediatric population.