title: Neuroendoscopic biopsy of ventricular tumors: a multicentric experience.
abstract: OBJECTIVE
  Although neuroendoscopic biopsy is routinely performed, the safety and validity of this procedure has been studied only in small numbers of patients in single-center reports. The Section of Neuroendoscopy of the Italian Neurosurgical Society invited some of its members to review their own experience, gathering a sufficient number of cases for a wide analysis.
  
  
  METHODS
  Retrospective data were collected by 7 centers routinely performing neuroendoscopic biopsies over a period of 10 years. Sixty patients with newly diagnosed intraventricular and paraventricular tumors were included. No patient harboring a colloid cyst was included. Data regarding clinical presentation, neuroimaging findings, operative techniques, pathological diagnosis, postoperative complications, and subsequent therapy were analyzed.
  
  
  RESULTS
  In all patients, a neuroendoscopic tumor biopsy was performed. In 38 patients (64%), obstructive hydrocephalus was present. In addition to the tumor biopsy, 32 patients (53%) underwent endoscopic third ventriculostomy (ETV), and 7 (12%) underwent septum pellucidotomy. Only 2 patients required a ventriculoperitoneal shunt shortly after the endoscopy procedure because ETV was not feasible. The major complication due to the endoscopy procedure was ventricular hemorrhage noted on the postoperative images in 8 cases (13%). Only 2 patients were symptomatic and required medical therapy. Infection occurred in only 1 case, and the other complications were all reversible. In no case did clinically significant sequelae affect the patient's outcome. Tumor types ranged across the spectrum and included glioma (low- and high-grade [27%]), pure germinoma (15%), pineal parenchymal tumor (12%), primary neuroectodermal tumor (4%), lymphoma (9%), metastasis (4%), craniopharyngioma (6%), and other tumor types (13%). In 10% of patients, the pathological findings were inconclusive. According to diagnosis, specific therapy was performed in 35% of patients: 17% underwent microsurgical removal, and 18% underwent chemotherapy or radiotherapy.
  
  
  CONCLUSIONS
  This is one of the largest series confirming the safety and validity of the neuroendoscopic biopsy procedure. Complications were relatively low (about 13%), and they were all reversible. Neuroendoscopic biopsy provided meaningful pathological data in 90% of patients, making subsequent tumor therapy feasible. Cerebrospinal fluid pathways can be restored by ETV or septum pellucidotomy (65%) to control intracranial hypertension. In light of the results obtained, a neuroendoscopic biopsy should be considered a possible alternative to the stereotactic biopsy in the diagnosis and treatment of ventricular or paraventricular tumors. Furthermore, it could be the only surgical procedure necessary for the treatment of selected tumors.
authors: Department of Neurosurgery, National Cancer Institute IFO-Regina Elena, Roma, Italy. oppido@ifo.it
authors: Piero Andrea
authors: PA
authors: Oppido
authors: Alessandro
authors: A
authors: Fiorindi
authors: Lucia
authors: L
authors: Benvenuti
authors: Fabio
authors: F
authors: Cattani
authors: Saverio
authors: S
authors: Cipri
authors: Michelangelo
authors: M
authors: Gangemi
authors: Umberto
authors: U
authors: Godano
authors: Pierluigi
authors: P
authors: Longatti
authors: Carmelo
authors: C
authors: Mascari
authors: Enzo
authors: E
authors: Morace
authors: Luigino
authors: L
authors: Tosatto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods*; D002551:Cerebral Ventricle Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007558:Italy; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000473:pathology / Q000503:physiopathology; D012189:Retrospective Studies; D020542:Third Ventricle / Q000601:surgery; D055815:Young Adult