NSRG-22. ENDOSCOPIC APPROACH TO PINEAL REGION LESIONS WITH SPLITTING OF THE CHOROID FISSURE AND MASSA INTERMEDIA

Abstract

INTRODUCTION: In patients presenting with obstructive hydrocephalus secondary to pineal region lesions, a combined endoscopic third ventriculostomy (ETV) and tumour biopsy is an increasingly common procedure. Performing it through a monoportal approach with a rigid scope is especially challenging given the anatomy of the third ventricle. Here we report our experience of the monoportal endoscopic combined approach made possible by splitting the choroid fissure (CF) and massa intermedia (MI). METHODS: A 13-year-old male was referred to our unit having presented with a 2-day history of headache, blurred vision, diplopia and vomiting. An MRI revealed a pineal region lesion causing obstructive hydrocephalus. RESULTS: An ETV was performed. Access to the pineal region was then gained by splitting of the CF and subsequent division of a small MI. A biopsy was taken and limited debulking performed (tumour was large and hard making complete resection difficult). Histopathology confirmed an immature teratoma. Post-operatively the patient made an excellent recovery. CONCLUSION: The endoscopic transchoroidal approach with splitting of the MI allows management of hydrocephalus and access to pineal tumours for biopsy/debulking via a single burr hole and using a solid scope. In the future complete resection of pineal lesions via this approach may become commonplace with improved instrumentation and equipment.