Intraventricular tumors

Abstract

Objective: To describe the neuroendoscopic technique to deal with intraventricular tumors.

Methods: Details of the endoscopic approach to intraventricular tumors of the lateral, third, and fourth ventricle are presented.

Results: Intraventricular tumors are ideal indications for neuroendoscopic surgery. They often cause cerebrospinal fluid (CSF) pathway obstruction, resulting in ventricular dilation, which provides sufficient space for maneuvering with the endoscope. The general principle of the endoscopic removal of intraventricular tumors is interruption of the blood supply to the tumor and subsequent tumor debulking. In general, a piecemeal resection is performed; however, in some tumors, it is possible to detach the lesion from the surrounding brain tissue and remove it in toto. In unilateral hydrocephalus caused by obstruction of one foramen of Monro, the burr hole is placed more laterally to get good access to the foramen for biopsy and to the septum for septostomy. When the tumor arises in the anterior part of the third ventricle, the burr hole is made at the coronal suture. When the tumor is located in the posterior part, the entry point is selected more anteriorly in order to pass the foramen of Monro in a straight line. In pineal region tumors, which cause occlusive hydrocephalus due to aqueductal compression, third ventriculostomy as well as tumor biopsy are required.

Conclusion: Intraventricular tumors and related CSF pathway obstructions can be safely and effectively treated with endoscopic techniques. Small tumors may be totally removed via a ventriculoscope.