Article
Endoscopic options in intra- and paraventricular low-grade gliomas
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Authors
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J. Oertel
- Neurochirurgische Universitätsklinik, Universitätsklinikum Mainz
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M.R. Gaab
- Klinik für Neurochirurgie, Nordstadtkrankenhaus Hannover
| Published: | May 20, 2009 |
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Outline
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Objective: Intra- and paraventricular low grade gliomas particularly when associated with CSF circulation obstruction might represent ideal candidates for neuroendoscopic approaches. The authors present their data from procedures performed from February 1993 until October 2008.
Methods: Out of 245 endoscopic procedures for CSF restoration in tumours (113) or direct endosocpic tumour biopsy and / or resection (132) performed between February 1993 and October 2008, only 28 were performed in low-grade gliomas. The endoscopic procedure performed and the surgical outcome was prospectively evaluated.
Results: There was no emergency stopping of any endoscopic procedure. An endoscopic third ventriculostomy was performed in 20 cases for restoration of CSF circulation because of CSF circulation obstruction in 20 cases of low-grade gliomas of the midbrain and the pons. The ETV was initially clinically and radiologically successful in 18 (90%). However, 6 out of 18 patients required shunting during the follow-up period within a mean interval of 2 years. There was no endoscopic procedure related complication. In eight cases, endoscopic tumour resection (3 cases) or tumour biopsy (5 cases) was done. While the tumour biopsy was done without any complications and revealed a definite diagnosis in all cases, the tumour resection of two out of three subependymomas was too time consuming and a switch to microsurgical resection was performed.
Conclusions: In all, the endoscopic technique represents a safe and effective therapeutic option in intra- and paraventricular low-grade gliomas. For CSF restoration, the endoscopic third ventriculostomy in midbrain and pontine low-grade gliomas is a valuable therapeutic option although shunting might be required subsequently during further progression of the disease. For tumour procedures, the technique is of particular value in biopsy procedures while the attempt of endoscopic low-grade glioma resection should be limited to tumours of the size of 1.5 to 2cm maximum diameter.
