OBJECTIVE Neuroendoscopic removal of intraventricular
tumors is difficult and time consuming because of the lack of an effective
decompression system that can be used through the working channel of the
endoscope. The authors report on the utilization of an endoscopic ultrasonic aspirator in the resection of intraventricular
tumors. METHODS Twelve pediatric patients (10 male, 2 female), ages 1-15 years old, underwent surgery via a purely endoscopic approach using a Gaab rigid
endoscope and endoscopic ultrasonic aspirator. Two patients presented with intraventricular
metastases from high-grade
tumors (
medulloblastoma, atypical
teratoid rhabdoid tumor), 2 with subependymal giant cell
astrocytomas (associated with
tuberous sclerosis), 2 with low-grade intraparaventricular
tumors, 4 with suprasellar
tumors (2
craniopharyngiomas and 2 optic pathway
gliomas), and 2 with
pineal tumors (1
immature teratoma, 1 pineal anlage
tumor).
Hydrocephalus was present in 5 cases. In all patients, the endoscopic trajectory and ventricular access were guided by electromagnetic neuronavigation. Nine patients underwent surgery via a precoronal bur hole while supine. In 2 cases, surgery was performed through a frontal bur hole at the level of the hairline. One patient underwent surgery via a posterior parietal approach to the trigone while in a lateral position. The endoscopic technique consisted of visualization of the
tumor, ventricular washing to dilate the ventricles and to control
bleeding, obtaining a
tumor specimen with biopsy
forceps, and ultrasonic aspiration of the
tumor.
Bleeding was controlled with irrigation, monopolar coagulation, and a
thulium laser. RESULTS In 7 cases, the resection was total or near total (more than 90% of lesion removed). In 5 cases, the resection was partial. Histological evaluation of the collected material (withdrawn using biopsy
forceps and aspirated with an ultrasonic aspirator) was diagnostic in all cases. The duration of surgery ranged from 30 to 120 minutes. One case was complicated by
subdural hygroma requiring a subduro-peritoneal shunt implant. CONCLUSIONS In this preliminary series, endoscopic ultrasonic aspiration proved to be a safe and reliable method for achieving extensive
decompression or complete removal in the management of intra- and/or paraventricular lesions in pediatric patients.