title: Combined rigid and flexible endoscopy for tumors in the posterior third ventricle.
abstract: OBJECTIVE
  Tumors leading to occlusion of the sylvian aqueduct include those of pineal, thalamic, and tectal origins. These tumors cause obstructive hydrocephalus and thus necessitate a CSF diversion procedure such as an endoscopic third ventriculostomy (ETV), often coupled with an endoscopic biopsy (EBX). Lesions located posterior to the massa intermedia pose a technical challenge, as the use of a rigid endoscope for performing both an ETV and EBX is limited. The authors describe their experience using a combined rigid and flexible endoscopic procedure through a single bur hole for both procedures in patients with posterior third ventricular tumors.
  
  
  METHODS
  Since January 2012, patients with posterior third ventricular tumors causing hydrocephalus underwent dual ETV and EBX procedures using the combined rigid-flexible endoscopic technique. Following institutional review board approval, data from clinical, radiological, surgical, and pathological records were retrospectively collected.
  
  
  RESULTS
  Six patients 3.5-53 years of age were included. Lesion locations included pineal (n = 3), fourth ventricle (n = 1), aqueduct (n = 1), and tectum (n = 1). The ETV and EBX were successful in all cases. Pathologies included pilocytic astrocytoma, pineoblastoma, ependymoma Grade II, germinoma, low-grade glioneural tumor, and atypical choroid plexus papilloma. One patient experienced an immediate postoperative intraventricular hemorrhage necessitating evacuation of the clots and resection of the tumor, eventually leading to the patient's death.
  
  
  CONCLUSIONS
  The authors recommend using a combined rigid-flexible endoscope for endoscopic third ventriculostomy and biopsy to approach posterior third ventricular tumors (behind the massa intermedia). This technique overcomes the limitations of using a rigid endoscope by reaching 2 distant regions.
authors: Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors: Jonathan
authors: J
authors: Roth
authors: Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors: Shlomi
authors: S
authors: Constantini
mesh_terms: D000328:Adult; D002535:Cerebral Aqueduct / Q000473:pathology; D002551:Cerebral Ventricle Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D002675:Child, Preschool; D005260:Female; D005910:Glioma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D020542:Third Ventricle / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000379:methods*
keywords: EBX = endoscopic biopsy; ETV = endoscopic third ventriculostomy; IVH = intraventricular hemorrhage; biopsy; endoscopy; flexible; hydrocephalus; rigid; tumor; ventriculostomy