Neurofiberscopic biopsy of tumors of the pineal region and posterior third ventricle: indications, technique, complications, and results.
OBJECTIVE
Evaluation of results of the neurofiberscopic biopsy of tumors of the pineal region and posterior third ventricle.


METHODS
From 2001 to 2004, 23 patients (mean age, 30.6 yr) with tumors located in the pineal region or posterior third ventricle underwent neurofiberscopic biopsy with simultaneous third ventriculostomy. The procedure was indicated for verification of the histological diagnosis of the neoplasm, which was planned to be treated by radiotherapy and/or chemotherapy without open surgery (eight patients), establishment of the pathological diagnosis for further choice of the most appropriate treatment strategy (11 patients), differentiation of the recurrent neoplasm and radiation necrosis (two patients), and decompression of the large tumor-associated cyst (two patients). In six previously shunted patients, substitution of the ventriculoperitoneal shunt on the third ventricle stoma was performed.


RESULTS
There was no postoperative mortality or permanent morbidity. In all cases, the obtained tissue sample was sufficient for pathological diagnosis. Transient postoperative complications included fever (15 patients), nausea and vomiting (three patients), and diplopia (one patient). On the long-term follow-up, delayed third ventricular stoma failure caused by tumor regrowth and scar formation was found in one patient, and dissemination of the malignant glioma through the subarachnoid space was found in another patient.


CONCLUSIONS
Neurofiberscopic biopsy represents a useful method for sampling of tumors of the pineal region and posterior third ventricle, which can be effectively used in both previously shunted and shunt-free patients.
Chernov
Mikhail F
MF
Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
Kamikawa
Shuji
S
Yamane
Fumitaka
F
Ishihara
Shoichiro
S
Kubo
Osami
O
Hori
Tomokatsu
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D005260:Female; D005334:Fever / Q000209:etiology / Q000503:physiopathology; D005336:Fiber Optic Technology / Q000295:instrumentation / Q000379:methods / Q000592:standards; D018237:Germinoma / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D005910:Glioma / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010870:Pineal Gland / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D010871:Pinealoma / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D011237:Predictive Value of Tests; D020542:Third Ventricle / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D017287:Ventriculoperitoneal Shunt; D014696:Ventriculostomy / Q000295:instrumentation / Q000379:methods