Neuroendoscopic resection of intraventricular tumors: a systematic outcomes analysis

Sean M Barber, Leonardo Rangel-Castilla, David Baskin, Sean M Barber, Leonardo Rangel-Castilla, David Baskin

Abstract

Introduction. Though traditional microsurgical techniques are the gold standard for intraventricular tumor resection, the morbidity and invasiveness of microsurgical approaches to the ventricular system have galvanized interest in neuroendoscopic resection. We present a systematic review of the literature to provide a better understanding of the virtues and limitations of endoscopic tumor resection. Materials and Methods. 40 articles describing 668 endoscopic tumor resections were selected from the Pubmed database and reviewed. Results. Complete or near-complete resection was achieved in 75.0% of the patients. 9.9% of resected tumors recurred during the follow-up period, and procedure-related complications occurred in 20.8% of the procedures. Tumor size ≤ 2cm (P = 0.00146), the presence of a cystic tumor component (P < 0.0001), and the use of navigation or stereotactic tools during the procedure (P = 0.0003) were each independently associated with a greater likelihood of complete or near-complete tumor resection. Additionally, the complication rate was significantly higher for noncystic masses than for cystic ones (P < 0.0001). Discussion. Neuroendoscopic outcomes for intraventricular tumor resection are significantly better when performed on small, cystic tumors and when neural navigation or stereotaxy is used. Conclusion. Neuroendoscopic resection appears to be a safe and reliable treatment option for patients with intraventricular tumors of a particular morphology.

Figures

Figure 1
Figure 1
Column graphs displaying the variances in (a) resection success, (b) recurrence rate, and (c) complication rate seen with navigated endoscopic resection versus freehand, cystic tumors versus non-cystic, and large tumors (size > 2 cm) versus small (size ≤ 2 cm). *= statistically significant result.

References

    1. Gazi Yaşargil M, Abdulrauf SI. Surgery of intraventricular tumors. Neurosurgery. 2008;62(6):SHC1029–SHC1040.
    1. Grondin RT, Hader W, MacRae ME, Hamilton MG. Endoscopic versus microsurgical resection of third ventricle colloid cysts. Canadian Journal of Neurological Sciences. 2007;34(2):197–207.
    1. Abdou MS, Cohen AR. Endoscopic treatment of colloid cysts of the third ventricle. Journal of Neurosurgery. 1998;89(6):1062–1068.
    1. Goel A. Can the hype of, “Endoscope” become a reality for colloid cyst surgery? World Neurosurg. 2012;(12)
    1. Milligan BD, Meyer FB. Morbidity of transcallosal and transcortical approaches to lesions in and around the lateral and third ventricles: a single-institution experience. Neurosurgery. 2010;67(6):1483–1496.
    1. Jeffree RL, Besser M. Colloid cyst of the third ventricle: a clinical review of 39 cases. Journal of Clinical Neuroscience. 2001;8(4):328–331.
    1. Desai KI, Nadkarni TD, Muzumdar DP, Goel AH. Surgical management of colloid cyst of the third ventricle—a study of 105 cases. Surgical Neurology. 2002;57(5):295–302.
    1. Kehler U, Brunori A, Gliemroth J, et al. Twenty colloid cysts—comparison of endoscopic and microsurgical management. Minimally Invasive Neurosurgery. 2001;44(3):121–127.
    1. Lejeune J-P, Le Gars D, Haddad E. Tumors of the third ventricle: review of 262 cases. Neurochirurgie. 2000;46(3):211–238.
    1. Mathiesen T, Grane P, Lindgren L, Lindquist C. Third ventricle colloid cysts: a consecutive 12-year series. Journal of Neurosurgery. 1997;86(1):5–12.
    1. Lewis AI, Crone KR, Taha J, Van Loveren HR, Yeh H-S, Tew JM., Jr. Surgical resection of third ventricle colloid cysts. Preliminary results comparing transcallosal microsurgery with endoscopy. Journal of Neurosurgery. 1994;81(2):174–178.
    1. Gaab MR, Schroeder HWS. Neuroendoscopic approach to intraventricular lesions. Journal of Neurosurgery. 1998;88(3):496–505.
    1. Dandy W. Cerebral Ventriculoscopy. Vol. 33. Bull Johns Hopkins Hosp; 1922.
    1. Davis L. Neurological Surgery. Philadelphia, Pa, USA: Lea & Febiger; 1936.
    1. Enchev Y, Oi S. Historical trends of neuroendoscopic surgical techniques in the treatment of hydrocephalus. Neurosurgical Review. 2008;31(3):249–261.
    1. Ahmad F, Sandberg DI. Endoscopic management of intraventricular brain tumors in pediatric patients: a review of indications, techniques, and outcomes. Journal of Child Neurology. 2010;25(3):359–367.
    1. Kunwar S. Endoscopic adjuncts to intraventricular surgery. Neurosurgery Clinics of North America. 2003;14(4):547–557.
    1. Nulsen FE, Spitz EB. Treatment of hydrocephalus by direct shunt from ventricle to jugular vain. Surgical forum. 1951:399–403.
    1. Oertel JMK, Baldauf J, Schroeder HWS, Gaab MR. Endoscopic options in children: experience with 134 procedures: clinical article. Journal of Neurosurgery: Pediatrics. 2009;3(2):81–89.
    1. Husain M, Jha D, Vatsal DK, et al. Neuro-endoscopic surgery—experience and outcome analysis of 102 consecutive procedures in a busy neurosurgical centre of India. Acta Neurochirurgica. 2003;145(5):369–376.
    1. Abdullah J, Caemaert J. Endoscopic management of craniopharyngiomas: a review of 3 cases. Minimally Invasive Neurosurgery. 1995;38(2):79–84.
    1. Hellwig D, Bauer BL. Minimally invasive neurosurgery by means of ultrathin endoscopes. Acta Neurochirurgica. 1992;54:63–68.
    1. Cappabianca P, Cinalli G, Gangemi M, et al. Application of neuroendoscopy to intraventricular lesions. Neurosurgery. 2008;62(2):SHC575–SHC597.
    1. Teo C, Nakaji P. Neuro-oncologic applications of endoscopy. Neurosurgery Clinics of North America. 2004;15(1):89–103.
    1. Margetis K, Souweidane MM. Endoscopic Treatment of Intraventricular Cystic Tumors. World Neurosurg; 2012.
    1. Wilson DA, Fusco DJ, Wait SD, Nakaji P. Endoscopic Resection of Colloid Cysts: Use of A Dual-Instrument Technique and an Anterolateral Approach. World Neurosurg; 2012.
    1. Delitala A, Brunori A, Russo N. Supraorbital endoscopic approach to colloid cysts. Neurosurgery. 2011;69(2):176–182.
    1. Naftel RP, Shannon CN, Reed GT, et al. Small-ventricle neuroendoscopy for pediatric brain tumor management: clinical article. Journal of Neurosurgery. 2011;7(1):104–110.
    1. Boogaarts HD, Decq P, Grotenhuis JA, et al. Long-term results of the neuroendoscopic management of colloid cysts of the third ventricle: a series of 90 cases. Neurosurgery. 2011;68(1):179–187.
    1. El-Ghandour NMF. Endoscopic treatment of third ventricular colloid cysts: a review including ten personal cases. Neurosurgical Review. 2009;32(4):395–402.
    1. Greenlee JDW, Teo C, Ghahreman A, Kwok B. Purely endoscopic resection of colloid cysts. Neurosurgery. 2008;62(3):ONS51–ONS55.
    1. Souweidane MM, Luther N. Endoscopic resection of solid intraventricular brain tumors. Journal of Neurosurgery. 2006;105(2):271–278.
    1. Souweidane MM. Endoscopic surgery for intraventricular brain tumors in patients without hydrocephalus. Neurosurgery. 2005;57(4):S312–S317.
    1. Hellwig D, Bauer BL, Schulte M, et al. Neuroendoscopic treatment for colloid cysts of the third ventricle: the experience of a decade. Neurosurgery. 2003;52(3):525–533.
    1. Schroeder HWS, Gaab MR, Cohen AR. Endoscopic resection of colloid cysts. Neurosurgery. 2002;51(6):1441–1445.
    1. Rodziewicz GS, Smith MV, Hodge CJ., Jr. Endoscopic colloid cyst surgery. Neurosurgery. 2000;46(3):655–662.
    1. Souweidane MM. Endoscopic management of pediatric brain tumors. Neurosurgical Focus. 2005;18(6):p. E1.
    1. Stark AM, Hugo HH, Nabavi A, Mehdorn HM. Papillary ependymoma WHO grade II of the aqueduct treated by endoscopic tumor resection. Case Reports in Medicine. 2009;2009:5 pages.434905
    1. Mishra S, Chandra SPS, Suri A, Rajender K, Sharma BS, Mahapatra AK. Endoscopic management of third ventricular colloid cysts: eight years' institutional experience and description of a new technique. Neurology India. 2010;58(3):412–417.
    1. Horváth Z, Vetö F, Balás I, Dóczi T. Complete removal of colloid cyst via CT-guided stereotactic biportal neuroendoscopy. Acta Neurochirurgica. 2000;142(5):539–546.
    1. Sood S, Hoeprich M, Ham SD. Pure endoscopic removal of pineal region tumors. Child’s Nervous System. 2011;27(9):1489–1492.
    1. Selvanathan SK, Kumar R, Goodden J, Tyagi A, Chumas P. Evolving instrumentation for endoscopic tumour removal of CNS tumours. Acta Neurochirurgica. 2013;155(1):135–138.
    1. Longatti P, Godano U, Gangemi M, et al. Cooperative study by the Italian neuroendoscopy group on the treatment of 61 colloid cysts. Child’s Nervous System. 2006;22(10):1263–1267.
    1. Mohanty A, Thompson BJ, Patterson J. Initial experience with endoscopic side cutting aspiration system in pure neuroendoscopic excision of large intraventricular tumors. World Neurosurgery. 2012
    1. Dlouhy BJ, Dahdaleh NS, Greenlee JDW. Emerging technology in intracranial neuroendoscopy: application of the NICO Myriad Technical note. Neurosurgical Focus. 2011;30(4, article E6)
    1. Lekovic GP, Gonzalez LF, Feiz-Erfan I, Rekate HL. Endoscopic resection of hypothalamic hamartoma using a novel variable aspiration tissue resector. Neurosurgery. 2006;58(1):S166–S168.
    1. Luther N, Souweidane MM. Neuroendoscopic resection of posterior third ventricular ependymoma. Case report. Neurosurgical Focus. 2005;18(6 A):p. E3.
    1. Horn EM, Feiz-Erfan I, Bristol RE, et al. Treatment options for third ventricular colloid cysts: comparison of open microsurgical versus endoscopic resection. Neurosurgery. 2007;60(4):613–618.
    1. Najjar MW, Azzam NI, Baghdadi TS, Turkmani AH, Skaf G. Endoscopy in the management of intra-ventricular lesions: preliminary experience in the Middle East. Clinical Neurology and Neurosurgery. 2010;112(1):17–22.
    1. Romano A, Chibbaro S, Makiese O, Marsella M, Mainini P, Benericetti E. Endoscopic removal of a central neurocytoma from the posterior third ventricle. Journal of Clinical Neuroscience. 2009;16(2):312–316.
    1. King WA, Ullman JS, Frazee JG, Post KD, Bergsneider M. Endoscopic resection of colloid cysts: surgical considerations using the rigid endoscope. Neurosurgery. 1999;44(5):1103–1111.
    1. Schroeder HW. Intraventricular Tumors. World Neurosurg; 2013.
    1. Oka K, Yamamoto M, Nagasaka S, Tomonaga M. Endoneurosurgical treatment for hydrocephalus caused by intraventricular tumors. Child’s Nervous System. 1994;10(3):162–166.
    1. Zhang Y, Wang C, Liu P, Gao X. Clinical application of neuroendoscopic techniques. Stereotactic and Functional Neurosurgery. 2000;75(2-3):133–141.
    1. Decq P, Le Guerinel C, Sakka L, et al. Endoscopic surgery of third ventricle lesions. Neurochirurgie. 2000;46(3):286–294.
    1. Macarthur DC, Buxton N, Punt J, Vloeberghs M, Robertson IJ. The role of neuroendoscopy in the management of brain tumours. British Journal of Neurosurgery. 2002;16(5):465–470.
    1. Jho HD, Alfieri A. Endoscopic removal of third ventricular tumors: a technical note. Minim Invasive Neurosurg. 2002;45(2):114–119.
    1. Sgaramella E, Sotgiu S, Crotti FM. Neuroendoscopy: one year of experience—personal results, observations and limits. Minim Invasive Neurosurg. 2003;46(4):215–219.
    1. Jeon JH, Lee SW, Ko JK, et al. Neuroendoscopic removal of large choroid plexus cyst: a case report. Journal of Korean Medical Science. 2005;20(2):335–339.
    1. Harter DH, Omeis I, Forman S, Braun A. Endoscopic resection of an intraventricular dysembryoplastic neuroepithelial tumor of the septum pellucidum. Pediatric Neurosurgery. 2006;42(2):105–107.
    1. Levine NB, Miller MN, Crone KR. Endoscopic resection of colloid cysts: indications, technique, and results during a 13-year period. Minim Invasive Neurosurg. 2007;50(6):313–317.993215
    1. Drees C, Chapman K, Prenger E, et al. Seizure outcome and complications following hypothalamic hamartoma treatment in adults: endoscopic, open, and Gamma Knife procedures. Journal of Neurosurgery. 2012;117(2):255–261.112256
    1. Grunert P, Hopf N, Perneczky A. Frame-based and frameless endoscopic procedures in the third ventricle. Stereotactic and Functional Neurosurgery. 1997;68(1-4):80–89.
    1. Torrens MJ. Endoscopic neurosurgery. Neurosurgery Quarterly. 1995;5(1):18–33.
    1. Souweidane MM. Endoscopic surgery for intraventricular brain tumors in patients without hydrocephalus. Neurosurgery. 2008;62(6):SHC1042–SHC1047.
    1. Yamamoto M, Oka K, Takasugi S, Hachisuka S, Miyake E, Tomonaga M. Flexible neuroendoscopy for percutaneous treatment of intraventricular lesions in the absence of hydrocephalus. Minimally Invasive Neurosurgery. 1997;40(4):139–143.
    1. Hori T, Kawamata T, Amano K, Aihara Y, Ono M, Miki N. Anterior interhemispheric approach for 100 tumors in and around the anterior third ventricle. Neurosurgery. 2010;66(3):65–74.
    1. Kaur G, Kane AJ, Sughrue ME, et al. MIB-1 labeling index predicts recurrence in intraventricular central neurocytomas. Journal of Clinical Neuroscience. 2013;20(1):89–93.
    1. Nayar VV, DeMonte F, Yoshor D, Blacklock JB, Sawaya R. Surgical approaches to meningiomas of the lateral ventricles. Clinical Neurology and Neurosurgery. 2010;112(5):400–405.
    1. Nowak A, Marchel A. Surgical treatment of intraventricular ependymomas and subependymomas. Neurologia I Neurochirurgia Polska. 2012;46(4):333–343.
    1. Pan J, Qi S, Lu Y, et al. Intraventricular craniopharyngioma: morphological analysis and outcome evaluation of 17 cases. Acta Neurochirurgica. 2011;153(4):773–784.
    1. Qian H, Lin S, Zhang M, Cao Y. Surgical management of intraventricular central neurocytoma: 92 cases. Acta Neurochirurgica. 2012;154(11):1951–1960.
    1. Seçer HI, Düz B, Izci Y, Tehli Ö, Solmaz I, Gönüls E. Tumors of the lateral ventricle: the factors that affected the preference of the surgical approach in 46 patiens. Turkish Neurosurgery. 2008;18(4):345–355.
    1. Stachura K, Libionka W, Moskała M, Krupa M, Polak J. Colloid cysts of the third ventricle. Endoscopic and open microsurgical management. Neurologia I Neurochirurgia Polska. 2009;43(3):251–257.
    1. Vasiljevic A, François P, Loundou A, et al. Prognostic factors in central neurocytomas: a multicenter study of 71 cases. The American journal of surgical pathology. 2012;36(2):220–227.
    1. Rekate HL, Feiz-Erfan I, Ng Y-T, Gonzalez LF, Kerrigan JF. Endoscopic surgery for hypothalamic hamartomas causing medically refractory gelastic epilepsy. Child’s Nervous System. 2006;22(8):874–880.
    1. Decq P. Endoscopy or microsurgery: is the never-ending debate concerning the choice of surgical strategy for colloid cysts of the third ventricle still a topical issue or has it been resolved? World Neurosurg. 2012
    1. Schroeder HWS, Wagner W, Tschiltschke W, Gaab MR. Frameless neuronavigation in intracranial endoscopic neurosurgery. Journal of Neurosurgery. 2001;94(1):72–79.
    1. Rohde V, Behm T, Ludwig H, Wachter D. The role of neuronavigation in intracranial endoscopic procedures. Neurosurgical Review. 2012;35:351–358.
    1. Gökalp HZ, Yüceer N, Arasil E, et al. Tumours of the lateral ventricle. A retrospective review of 112 cases operated upon 1970–1997. Neurosurgical Review. 1998;21(2-3):126–137.
    1. Pendl G, Ozturk E, Haselsberger K. Surgery of tumours of the lateral ventricle. Acta Neurochirurgica. 1992;116(2–4):128–136.
    1. Pascual JM, González-Llanos F, Barrios L, Roda JM. Intraventricular craniopharyngiomas: topographical classification and surgical approach selection based on an extensive overview. Acta Neurochirurgica. 2004;146(8):785–800.
    1. Shapiro S, Rodgers R, Shah M, Fulkerson D, Campbell RL. Interhemispheric transcallosal subchoroidal fornix-sparing craniotomy for total resection of colloid cysts of the third ventricle: clinical article. Journal of Neurosurgery. 2009;110(1):112–115.
    1. Sampath R, Vannemreddy P, Nanda A. Microsurgical excision of colloid cyst with favorable cognitive outcomes and short operative time and hospital stay: operative techniques and analyses of outcomes with review of previous studies. Neurosurgery. 2010;66(2):368–374.
    1. Piepmeier J, Spencer DD, Sass KJ, George TM. Lateral ventricular masses. In: Apuzzo M, editor. Brain Surgery: Complication Avoidance and Management. New York, NY, USA: Churchhill Livingstone; 1993. pp. 581–599.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera