Biopsia neuroendoscópica. Revisión de la literatura y experiencia en 31 pacientes

Abstract

Objective. To describe our experience with the endoscopic management of intraventricular tumors, analyzing biopsy effectiveness, and to compare our results with those obtained from an extensive literature review. Materials and methods. Between 2003 and 2010, 31 patients aged between 7 months and 77 years, diagnosed of solid and/or cystic intra and/or periventricular tumors, underwent neuroendoscopic biopsy. We analyze operative technique, pathological result, management of associated hydrocephalus, rate of complications and postoperative technique. Results. 32 endoscopic procedures were done and biopsy was successfully performed in 28 cases, with positive histological result in 25 of them (78% success rate per procedure and 89% success rate per biopsy). Most frequent pathological diagnosis was grade II astrocytoma. 30 patients had associated hydrocephalus that required endoscopic third ventriculostomy (19 cases, with 73.7% success rate) and/or septostomy (12 patients, 3 associated with ventriculostomy and 9 with ventriculo-peritoneal shunt). Frameless neuronavigation was used in three selected cases. During the surgery and the postoperative period the following complications appeared: intraventricular hemorrhage in four cases (two of them died), seizures in two patients, new neurological findings in three cases (Parinaud's sign, transient palsy of third cranial nerve and hemiparesis associated with palsy of third cranial nerve), and cerebrospinal fluid leak and infection in one case. 19 patients received subsequent treatment (microsurgical resection in 1, radiosurgery in 2, radiotherapy in 8, chemotherapy in 5 and chemo-radiotherapy in 3). Conclusions. Endoscopic management of intraventricular and/or periventricular brain tumors is effective, and allow diagnostic biopsy and simultaneous treatment of the associated ydrocephalus in many cases. So, it could be the treatment of choice in those tumors that are not suitable for microsurgical resection. Although this technique is not exempt of serious complications, morbimortality could be lower than conventional microsurgical approach.