title: Flexible endoscopy for management of intraventricular brain tumors in patients with small ventricles.
abstract: OBJECTIVE
  Endoscopic surgery is generally withheld in patients with small ventricles due to difficulties in ventricular cannulation and intraventricular manipulation. The effectiveness of flexible endoscopy for management of intraventricular brain tumors in patients with small ventricles was evaluated.
  
  
  METHODS
  Forty-five patients who underwent endoscopic surgery with a flexible endoscope for intraventricular brain tumors were divided into small-ventricle and ventriculomegaly groups according to the frontal and occipital horn ratio (FOR). Retrospective review of these cases was performed and achievement of surgical goals and morbidity were assessed.
  
  
  RESULTS
  Among the 45 patients, there were 14 with small ventricles and 31 with ventriculomegaly. In the smallventricle group, targeted tumors were located in the suprasellar region in 12 patients and in the pineal region in 2. In the ventriculomegaly group, tumors were located in the pineal region in 15 patients, in the suprasellar region in 9, in the lateral ventricle in 4, in the midbrain in 2, and in the fourth ventricle in 1. In the small-ventricle group, ventricular cannulation was successful and the surgical goals were accomplished in all patients. In ventriculomegaly group, sampling of the tumor was not diagnostic due to intraoperative hemorrhage in 1 patient. There were no significant differences in the rate of achieving the surgical goals or the morbidity between the 2 groups.
  
  
  CONCLUSIONS
  Endoscopic surgery using a flexible endoscope is useful for management of intraventricular brain tumors in patients with small ventricles. A flexible endoscope allows excellent maneuverability in introducing the device into the lateral ventricle and manipulating through small ventricles.
authors.affiliation: Division of Neurosurgery, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ogiwara
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Morota
mesh_terms: D000293:Adolescent; D000328:Adult; D002551:Cerebral Ventricle Neoplasms / Q000473:pathology* / Q000601:surgery*; D002552:Cerebral Ventricles / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D020546:Fourth Ventricle; D006801:Humans; D020547:Lateral Ventricles; D008279:Magnetic Resonance Imaging; D008297:Male; D044582:Neuroendoscopes; D044583:Neuroendoscopy / Q000295:instrumentation*; D010870:Pineal Gland; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: EVD = external ventricular drain; FOR = frontal and occipital horn ratio; flexible endoscopy; intraventricular tumor; oncology; small ventricles