title: Neuroendoscopic Intraventricular Biopsy in Children with Small Ventricles Using Frameless VarioGuide System.
abstract: Endoscopic biopsy for intraventricular tumors in pediatric patients with small ventricles is a challenging procedure because of the risk of morbidity during the intraventricular approach. We describe the use of the VarioGuide system for intraventricular endoscopic biopsy in 9 consecutive pediatric patients with intraventricular lesions and small ventricular size. All patients had lesions in the anterior part of the third ventricle with a median frontal and occipital horn ratio of 0.33. Patients presented with growth failure (n = 4), visual disturbances (n = 4), and seizures (n = 1). The VarioGuide system consists of an ergonomic arm with 3 joints for gross adjustment. The 3 rotational joints on the distal side of the system are adjusted according to the angles of the planned trajectory. The endoscope is adjusted to the distal side of the VarioGuide and inserted through the ring, previously set for the diameter of the endoscope and for the planned trajectory. The accuracy of the trajectory and correct ventricular cannulation are confirmed under endoscopic guidance. The biopsy is carried out according to the standard technique. In all cases, the biopsy sample provided the definitive diagnosis. Diagnoses included germinomas in 4 patients, hamartoma in 1 patient, hypothalamic astrocytoma in 2 patients, and craniopharyngioma in 2 patients. The use of the VarioGuide system for intraventricular endoscopic biopsy is highly recommended for pediatric patients with small ventricle size. This technique may help minimize the risk of unnecessary brain damage during the entrance to small ventricles.
authors.affiliation: Department of Neurosurgery, Hospital Universitario Clínico San Carlos, Madrid, Spain.
authors.forename: Josué M
authors.initials: JM
authors.lastname: Avecillas-Chasin
authors.affiliation: Department of Neurosurgery, Hospital Infantil Universitario Niño Jesus, Madrid, Spain. Electronic address: neurobudke@yahoo.es.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Budke
authors.affiliation: Department of Neurosurgery, Hospital Infantil Universitario Niño Jesus, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Villarejo
mesh_terms: D000293:Adolescent; D001706:Biopsy / Q000379:methods*; D002551:Cerebral Ventricle Neoplasms / Q000175:diagnosis / Q000473:pathology; D002552:Cerebral Ventricles / Q000033:anatomy & histology / Q000473:pathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000175:diagnosis / Q000473:pathology; D005260:Female; D018237:Germinoma / Q000175:diagnosis / Q000473:pathology; D006130:Growth Disorders / Q000175:diagnosis; D006222:Hamartoma / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D007029:Hypothalamic Neoplasms / Q000175:diagnosis / Q000473:pathology; D008297:Male; D044582:Neuroendoscopes; D044583:Neuroendoscopy / Q000379:methods*; D012189:Retrospective Studies; D014786:Vision Disorders / Q000175:diagnosis
keywords: Endoscopic biopsy; Intraventricular biopsy; Neuroendoscopy; Small ventricle size