Neuroendoscopy can play a role in the management of ventricular and paraventricular tumors. It allows for biopsy of lesions as well as endoscopic third ventriculostomy (ETV) to treat hydrocephalus. ETV is a less invasive alternative to shunt placement and can be performed at the same time as other supratentorial procedures or for hydrocephalus caused by posterior fossa tumors. Case studies demonstrate the use of neuroendoscopy for biopsy and drainage in patients with tumors such as pineocytoma, arachnoid cyst, glioblastoma, and germinoma. Neuroendoscopy is shown to be safe and effective, especially when image-guided, for selecting entry points and trajectories.

1. The role of NeuroEndoscopy
in NeuroOncology
M. Triffaux
V. Marneffe
A. Tyberghien
I. Origer
7th EANO Congress, Vienna 16/09/06

2. NeuroEndoscopyNeuroEndoscopy
Ventriculoscopy Pituitary Key hole surgery

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

4. • Rigid
• Flexible
VentriculoscopeVentriculoscope

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

9. • 21 yrs , recent diplopia
• CT MR imaging: pineal tumor whithout hydrocephalus
• Pet methionine: +
• Blood α fetoproteine , βHCG: nl < 1 mUI/ml
• CSF α fetoproteine: nl, βHCG:  3 mUI/ml
Case N° 5Case N° 5

10. Case N° 5Case N° 5

12. • Biopsy diagnosis: germinoma
• Treatment: chemotherapy & radiotherapy
2 cycles carbo/ etoposide / Ifosfamide
40 Gy radiotherapy
Case N° 5Case N° 5

13. Case N° 5Case N° 5
Initial MR Post multimodal therapy

14. Case N° 6Case N° 6
• 16 yrs , Parinaud’s syndrome
• CT MR imaging: left thalamic mass
hydrocephalus
• Pet FDG: – Pet methionine: +

15. Case N° 6Case N° 6
CT Pet FDG MR Pet met.

16. Case N° 6Case N° 6

17. J10 post biopsy & ETVPre operative
Case N° 6Case N° 6

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