Endoscopic management of a pineal and suprasellar germinoma with associated hydrocephalus: technical case report.
A patient with a synchronous pineal and suprasellar germinoma and symptomatic hydrocephalus underwent a minimally invasive endoscopic biopsy and third ventriculostomy. We performed multiple biopsies of both tumors and fenestration of the floor of the third ventricle with a flexible fiberoptic endoscope through a single burr hole. Postoperative quantitative cine-mode magnetic resonance imaging (MRI) confirmed the patency of the fenestration. Selected pineal/posterior third ventricle region tumors, especially radiosensitive germinomas, could be treated with this approach thereby obviating the need for either stereotactic or craniotomy/open biopsy and the subsequent placement of a permanent cerebrospinal fluid (CSF) shunt. The endoscopic approach to tumors in the pineal/posterior third ventricle region provides an accurate straightforward, and safe method of obtaining a diagnosis and treating the associated increased intracranial pressure.
Ellenbogen
R G
RG
Division of Neurosurgery, Walter Reed Army Medical Center Washington, D.C.
Moores
L E
LE
D000328:Adult; D001706:Biopsy / Q000379:methods; D002552:Cerebral Ventricles / Q000601:surgery*; D003397:Craniopharyngioma / Q000150:complications / Q000175:diagnosis* / Q000532:radiotherapy; D004564:Electrocoagulation / Q000009:adverse effects; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D018237:Germinoma / Q000175:diagnosis* / Q000532:radiotherapy; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery*; D007431:Intraoperative Complications; D008279:Magnetic Resonance Imaging; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010871:Pinealoma / Q000150:complications / Q000175:diagnosis* / Q000532:radiotherapy; D014696:Ventriculostomy / Q000009:adverse effects / Q000379:methods*