Endoscopic biopsy for intraventricular tumors in children

Abstract

Object: Endoscopy is a useful technique for obtaining biopsy samples of intraventricular tumors, and it offers the advantage of simultaneous treatment of obstructive hydrocephalus through endoscopic third ventriculostomy (ETV). Figures in the literature on the diagnostic yield of endoscopic biopsy, its complication rate, and the success rate of ETV in this context vary significantly. The authors performed a retrospective analysis of biopsy accuracy, complication rate, and success rate of ETV in a series of 31 endoscopic biopsy procedures.

Methods: All data regarding tissue and cerebrospinal fluid sampling, endoscopy-related complications, procedures performed for hydrocephalus treatment, tissue diagnosis, and further management were reviewed. The accuracy of the biopsy findings was graded on a four-level scale: Level I, fully diagnostic; Level II, diagnostic with some reservation; Level III, pathological categorization problematic; and Level IV, not interpretable. Failure of ETV was defined as the need for any further operation for the treatment of hydrocephalus. Tissue diagnosis was graded as Level I or II in 23 cases. One Level I diagnosis differed from the diagnosis made following craniotomy. During the study period one patient underwent endoscopy without biopsy because the tumor could not be visualized. Consequently, the percentage of successful biopsies was 69% (22 of 32 endoscopic procedures). Complications occurred in six cases (19%), of which two (6%) were significant. Three patients (10%) suffered hemorrhagic complications. When combined with biopsy, the ETV procedure was successful in nine (64%) of 14 patients.

Conclusions: Endoscopic biopsy of intraventricular tumors is a useful technique for establishing a tissue diagnosis and is associated with an acceptable complication rate. The biopsy does not affect the success rate of simultaneous ETV.