The role of neuroendoscopy in the management of solid or solid-cystic intra- and periventricular tumours

Objects The purpose of this study was to describe the surgical strategies of neuroendoscopic treatment in patients with solid or solid-cystic peri- and intraventricular tumours. Analysis of the postoperative histopathology and complication of neuroendoscopic interventions was also performed. Background A number of intracranial tumours do not ultimately require aggressive surgical intervention. Either definite or palliative treatment for the intra- and periventricular lesions could be accomplished using various neuroendoscopic techniques, depending on the histopathological diagnosis and aim of therapeutic intervention. Materials and methods Between 1994 and 2004, 46 patients with newly diagnosed solid or solid-cystic peri- and intraventricular tumours underwent neuroendoscopic procedures Twenty patients had associated hydrocephalus requiring the cerebrospinal fluid diversion procedures. Since 1997, neuronavigation has been applied to selected cases. Results Obstructive hydrocephalus was treated sufficiently by endoscopic third ventriculostomy or endoscopic stent placement. Partial or total extirpation of solid tumour was achieved in four cases. The majority of pathological examinations revealed astrocytoma (23), craniopharygioma (7) and metastasis (2). Subsequent mode of treatment such as chemotherapy, radiation therapy or microscopic surgery was determined according to the pathological findings. There were three transient morbidities and one permanent deficit, but no operative mortality. Conclusion Transventricular endoscopic approach is an effective and reliable alternative treatment of newly diagnosed peri- and intraventricular lesions. Neuroendocopic procedures offer the opportunity to combine tumour biopsy and treatment of hydrocephalus. In selected patients, partial or total tumour removal could be performed. Presented at the Third World Conference of the International Study Group on Neuroendoscopy (ISGNE), Marburg, Germany, 15–18 June 2005.