Endoscopic third ventriculostomy for obstructive hydrocephalus combined with biopsy for tumors located in the tectum/posterior third ventricle using a single burr hole technique guided by electromagnetic navigation in pediatric neurosurgery.

BACKGROUND

Tumors located in the tectum/posterior third ventricle are challenging both for open and endoscopic surgery. Such tumors may cause obstructive hydrocephalus. Here, we investigate the use of a single burr hole approach combining endoscopic electromagnetic (EM)-guided third ventriculostomy and tumor biopsy in a pediatric setting.

METHODS

According to the inclusion and exclusion criteria, 10 patients were identified for the present study. Trajectories were planned on a workstation. Endoscopic third ventriculostomy was performed first followed by tumor biopsy.

RESULTS

There were 7 male and 3 female patients. Mean age at surgery was 9.8 years (range, 1.6 - 16.6 years). Endoscopic third ventriculostomy was achieved without intraoperative complications in all 10 patients. Two patients needed CSF shunt surgery 2 months and 4 months after surgery. Biopsy was achieved in 9 cases without complications. In one instance, no biopsy was performed because the cystic tumor was covered by normal neural tissue. Histopathological examinations revealed a tumor in 8/9 cases: low grade gliomas in 7 instances, and PNET grade 4 in one patient. One patient had open surgery later followed by radiation therapy and chemotherapy, two patients had chemotherapy only, one patient proton radiation therapy, and 6 patients underwent prolonged observation. Follow-up ranged between 1 - 9 years (mean, 6.1 years). All patients were alive and well at the last follow-up.

CONCLUSIONS

Endoscopic third ventriculostomy combined with biopsy of tumors located in the tectum/posterior third ventricle using EM-guidance via a single burr hole appears to be safe and feasible in selected pediatric patients.