[The use of neuroendoscopy in the treatment of intraventricular and paraventricular brain tumors].
OBJECTIVE
Because of their deep location, intra- and para- ventricular brain tumors pose an important therapeutic issue. Technical difficulties during the operation often result from the alteration of anatomy produced by the tumor, which brings about the risk of injury to functionally important structures. The authors assess clinical usefulness of neuroendoscopy in the treatment of discussed tumors.


METHODS
Medical records of 16 adult patients treated between 2000 and 2003 were analyzed. The diagnosis was based on CT with 3D reconstruction and MRI. In 7 cases the tumor was located in the third ventricle, in 4--in lateral ventricles, in 5--paraventricularly. Surgery was performed using a rigid neuroendoscope and/or neurofiberscope equipped with the basic set of endoscopic instruments. The efficacy of the procedure was evaluated by clinical, CT and MRI follow-up examinations. The intended and achieved aim of the operation as well as the remote outcome were analyzed.


RESULTS
The planned aim of the procedure was achieved in 12 (75%) patients. In 3 cases the tumor was removed totally, in 5--tumor mass was reduced restoring the cerebro-spinal fluid passage, in 4--tumor biopsy was performed. In 4 patients different obstacles made it impossible to achieve the intended aim of the procedure. 1 patient died in the direct postoperative course. In the long-term postoperative follow-up ranging from 8 to 44 months (median: 23 months), the clinical condition improved or was stable in 10 patients, 2 patients were reoperated, 2 became dependent and 1 was lost for follow-up.


CONCLUSIONS
Neuroendoscopy offers new options in the treatment of intraventricular and paraventricular brain tumors allowing for their removal, reduction, histopathological verification and restoration of the cerebrospinal fluid passage. The outcome is good with a low complication rate.
Stachura
Krzysztof
K
Klinika Neurochirurgii, Collegium Medicum, Uniwersytet Jagielloński w Krakowie. kkstach@poczta.onet.pl
Libionka
Witold
W
Czepko
Ryszard
R
D000328:Adult; D002551:Cerebral Ventricle Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome