3. Ventriculoscopy in OncologyVentriculoscopy in Oncology
• In ventricular and paraventricular tumor management
• In Endoscopic Third Ventriculostomy (ETV)
– In the same time of supratentorial procedure
– in management of hydrocephalus from posterior fossa tumor
5. • Image Guided surgery
– Choice of the best entry point and the best trajectory
– Endoscope tracking per operative
Advantages of the rigid scopeAdvantages of the rigid scope
6. • Image Guided surgery
• Endoscope stability
– Pneumatic arm
– microdriver
Advantages of the rigid scopeAdvantages of the rigid scope
7. • Image Guided surgery
• Endoscop stabilisation
• Higher quality
– optical resolution
– trocars: multiple channels
AdvantagesAdvantages of the rigid scope
8. Case
N°
Sex/age
(yrs)
location Histiological
diagnose
ETV Further therapy
1 M / 69 3rd
V. ant. Pineocytoma II Y No
2 F / 41 3rd
V. ant.. Arachnoid cyst Y No
3 F / 72 Occ. paraV. Glioblastoma N Radiation
4 M / 35 3rd
V. ant. Dermoid cyst N No
5 M / 21 3rd
V. post Germinoma N Radiation
Chemotherapy
6 F / 16 Thalamic Astrocytoma III Y Open surgery
Clinical data 2003/2005Clinical data 2003/2005
18. • Biopsy diagnosis: astrocytoma III
• Treatement: conventional surgery
astrocytoma III confirmed
Case N° 6Case N° 6
19. • Acute hydrocephalus needs treatement:
– External Ventricular drainage
– VP shunt
– ETV
• In pediatric series:
– Majority of the authors advocate ETV prior to
definitive surgery
– Some others do not justify routine preoperative ETV
• In adult patients: there is no specific data
Hydrocephalus from P-fossa tumorHydrocephalus from P-fossa tumor
20. Case
N°
s/age ICP
Symp
ETV diagnose Open surgery
1 M/46 Y pre Lung metastase Y , radiation
2 F/22 Y pre Medulloblastoma Y , chemo + radiation
3 M/45 Y pre Ependymome II Y
4 M/55 Y pre Gliome II Y
5 F/34 Y pre Melanocytoma Y
6 F/39 Y pre Neurinoma VIII Y
7 M/23 N post cavernoma Y
8 F/56 Y single Breast mets. (3) palliatif
Clinical data in adult populationClinical data in adult population
21. • GA, supine position
• ETV with neuroballon
• Insertion of a ventricular reservoir
• Monitoring ICP 24h-48h with butterfly needle
without ventricular drainage
Surgical procedureSurgical procedure
22. • Complication: 1 infection (case 8: palliative)
resolved with antiobiotherapy
• No shunt
• No CSF leak after posterior fossa surgery
Out comeOut come
23. • Ventriculoscopy is safe and efficient
in selected cases
• It is more easier with navigation endoscope guided
• It takes its place in multimodal approach
• The ETV makes easier the management in P-Fossa
tumors with acute hydrocephalus in adult patients
as well as in pediatric
ConclusionsConclusions