Application of Endoscopy for a Midbrain Tumor

Zusammenfassung

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Abstract

Objective and Importance: It has been difficult to obtain a biopsy of a midbrain lesion. In addition, proper cerebrospinal fluid diversion should be secured because progressing tumor in the midbrain causes obstructive hydrocephalus. We report on the superiority of flexible neuroendoscopy to treat progressing midbrain tumor.

Clinical Presentation: A 64-year-old man presented with an occasional double vision. A magnetic resonance imaging scan disclosed an enhancing lesion in the midbrain.

Intervention: We performed a neuroendoscopic biopsy of the tumor and third ventriculostomy. Neuroendoscopy confirmed a bulging of the posterior commissure, which caused stenosis of the entrance of the aqueduct. Histological examination of the specimen obtained disclosed a diffuse astrocytoma. No permanent postoperative complications occurred although the patient felt slight double vision for 2 days after the operation. Conventional radiation therapy was supplemented.

Conclusion: Flexible neuroendoscopic biopsy with third ventriculostomy was a less-invasive and safer alternative for the progressing midbrain tumor bulging into the ventricles.

Key words

Endoscopy - hydrocephalus - biopsy

References

• 1 Coffey R J, Lunsford L D. Stereotactic surgery for mass lesions of the midbrain and pons.  Neurosurgery. 1985;  17 12-18
• 2 Fukuhara T, Vorster S J, Ruggieri P, Luciano M G. Third ventriculostomy patency: comparison of findings at cine phase-contrast MR imaging and at direct exploration.  AJNR Am J Neuroradiol. 1999;  20 1560-1566
• 3 Gaab M R, Schoeder H W. Neuroendoscopic approach to intraventricular lesions.  J Neurosurg. 1998;  88 496-505
• 4 Kang Y, Kawakami Y, Yoshida S, Hayase M, Imamura H, Kobayashi S, Matsumoto S, Sato S, Oda Y. Pitfalls of Third Ventriculostomy. 7^th World Congress of Endoscopic Surgery. Monduzzi Editore S.p.A 2000: 639-643
• 5 Lancon J A, Killough K R, Dhillon G, Parent A D. Interventional magnetic resonance imaging guided aspiration and biopsy of a cystic midbrain tumor.  Pediatr Neurosurg. 1999;  30 151-156
• 6 Mizoguchi M, Inamura T, Hikita T, Cheng C L, Ohgami S. Neuroendoscopic biopsy of tectal glioma: a case report.  Minim Invasive Neurosurg. 2000;  43 53-55
• 7 Oi S. [Clinical application and future prospect of neuroendoscopic surgery].  No To Hattatsu. 1999;  31 299-304
• 8 Oka K, Kin Y, Go Y, Ueno Y, Hirakawa K, Tomonaga M, Inoue T, Yoshioka S. Neuroendoscopic approach to tectal tumors: a consecutive series.  J Neurosurg. 1999;  91 964-970
• 9 Pople I K, Athanasiou T C, Sandeman D R, Coakham H B. The role of endoscopic biopsy and third ventriculostomy in the management of pineal region tumours.  Br J Neurosurg. 2001;  15 305-311
• 10 Siomin V, Weiner H, Wisoff J, Cinalli G, Pierre-Kahn A, Saint-Rose C, Abbott R, Elran H, Beni-Adani L, Ouaknine G, Constantini S. Repeat endoscopic third ventriculostomy: is it worth trying?.  Childs Nerv Syst. 2001;  17 551-555
• 11 Steck J, Friedman W A. Stereotactic biopsy of brainstem mass lesions. Surg Neurol 1995 43 563-567, discussion 567-568
• 12 Tuli S, Alshail E, Drake J. Third ventriculostomy versus cerebrospinal fluid shunt as a first procedure in pediatric hydrocephalus.  Pediatr Neurosurg. 1999;  30 11-15
• 13 Wang C, Zhang J, Liu A, Sun B, Zhao Y. Surgical treatment of primary midbrain gliomas.  Surg Neurol. 2000;  53 41-51