Transventricular endoscopic biopsy of suprasellar tumors: a pediatric case series

Background and purpose

The purpose of this study was to investigate the efficacy and safety of transventricular neuroendoscopic biopsies in pediatric patients with suprasellar tumors.

Methods

Twenty-three pediatric patients (12 males and 11 females) with suprasellar tumors underwent transventricular neuroendoscopic biopsy at our institute by a single surgeon from 2000 to 2011. Neuronavigation has been combined with endoscopic procedures since 2008. Neuroendoscopic biopsies were performed to verify the histopathological diagnosis of neoplasms and to plan appropriate treatment strategies.

Results

Neuroendoscopic biopsy specimens were appropriate for diagnosis in 22 of the 23 patients (95.7 %) and revealed 14 germ cell tumors (12 germinomas, one choriocarcinoma, and one immature teratoma), seven astrocytomas, and one craniopharyngioma. Subsequent treatment modalities including chemotherapy, radiation therapy, or microscopic surgery were determined according to the pathological findings. Seventeen of the 23 patients (73.9 %) showed ventriculomegaly. Among them, ventriculomegaly in 14 patients was resolved after an endoscopic procedure and/or adjuvant chemotherapy, but the remaining three patients (17.6 %) required a ventriculoperitoneal shunt to relieve the ventriculomegaly. The pathologic diagnosis of these three patients was uniformly a large astrocytoma. Navigational tracking was helpful to enter small ventricles and the narrow foramen of Monro in patients without hydrocephalus. No mortalities were related to the procedures, but three transient diabetes insipidus (13.0 %) cases occurred but fully recovered before the patients received adjuvant therapy.

Conclusion

Endoscopic biopsy is feasible and shows acceptable operation-related complications to obtain tissue from suprasellar tumors in pediatric patients. Navigation-assisted neuroendoscopic procedure improves the accuracy of the endoscopic approach. An associated endoscopic procedure can resolve hydrocephalus, but it has limitations with large ventricle-occupying tumors.