Biopsy of Brainstem Gliomas Using Flexible Endoscopes

Abstract

Objectives To describe our experience and the results obtained in performing transventricular brainstem biopsy with the use of flexible neuroendoscops.

Methods We identified patients who underwent a neuroendoscopic procedure with brainstem lesion biopsy to obtain histopathologic diagnosis and to treat obstructive hydrocephalus. All patients had follow-up examinations at months 1, 3, 6, and 12 postsurgery and then annually.

Results Seven patients had a transventricular biopsy of the brainstem performed. Of those, five were pediatric patients. The median age was 10 years (range: 3–26 years). Five of them were female and two male. Four patients presented with secondary obstructive hydrocephalus. The main clinical presentations were intracranial hypertension syndrome in four patients, motor neuron disease in four patients, two with decreased state of alertness, two with gait ataxia, and one with Parinaud syndrome. The types of tumors found in the histopathology and their location were one ventral (pons) and one aqueductal anaplastic astrocytoma, two ventral, one aqueductal, and one attached to the floor of the fourth ventricle pilocytic astrocytoma and one ventral low-grade astrocytoma. The route taken to approach the ventral tumors was made through premammillary fenestration. The tumors of the aqueduct and floor of the fourth ventricle were approached transaqueductally.

Conclusion The use of flexible endoscops for biopsy of ventral, dorsal (tectum lamina quadrigemina), and diffuse brainstem tumors is a useful, effective, and safe procedure that also allows to treat obstructive hydrocephalus secondary to the tumors.

Keywords

biopsy - brainstem glioma - hydrocephalus - neuroendoscopy

• References

• 1 Oppido PA, Fiorindi A, Benvenuti L , et al. Neuroendoscopic biopsy of ventricular tumors: a multicentric experience. Neurosurg Focus 2011; 30 (4) E2
• 2 Fischbein NJ, Prados MD, Wara W, Russo C, Edwards MS, Barkovich AJ. Radiologic classification of brain stem tumors: correlation of magnetic resonance imaging appearance with clinical outcome. Pediatr Neurosurg 1996; 24 (1) 9-23
• 3 Frazier JL, Lee J, Thomale UW, Noggle JC, Cohen KJ, Jallo GI. Treatment of diffuse intrinsic brainstem gliomas: failed approaches and future strategies. J Neurosurg Pediatr 2009; 3 (4) 259-269
• 4 Dellaretti M, Touzet G, Reyns N , et al. Correlation between magnetic resonance imaging findings and histological diagnosis of intrinsic brainstem lesions in adults. Neuro Oncol 2012; 14 (3) 381-385
• 5 Barkovich AJ, Krischer J, Kun LE , et al. Brain stem gliomas: a classification system based on magnetic resonance imaging. Pediatr Neurosurg 1990– 1991; 16 (2) 73-83
• 6 Guillamo JS, Monjour A, Taillandier L , et al; Association des Neuro-Oncologues d'Expression Française (ANOCEF). Brainstem gliomas in adults: prognostic factors and classification. Brain 2001; 124 (Pt 12) 2528-2539
• 7 Javadpour M, Mallucci C. The role of neuroendoscopy in the management of tectal gliomas. Childs Nerv Syst 2004; 20 (11–12) 852-857
• 8 Wang C, Zhang J, Liu A, Sun B, Zhao Y. Surgical treatment of primary midbrain gliomas. Surg Neurol 2000; 53 (1) 41-51
• 9 Oi S, Hidaka M, Honda Y , et al. Neuroendoscopic surgery for specific forms of hydrocephalus. Childs Nerv Syst 1999; 15 (1) 56-68
• 10 Miki T, Nakajima N, Akimoto J, Wada J, Haraoka J. Neuroendoscopic trans-third ventricle approach for lesions of the ventral brainstem surface. Minim Invasive Neurosurg 2008; 51 (6) 313-318
• 11 Reyes-Botero G, Mokhtari K, Martin-Duverneuil N, Delattre JY, Laigle-Donadey F. Adult brainstem gliomas. Oncologist 2012; 17 (3) 388-397
• 12 Pérez-Gómez JL, Rodríguez-Alvarez CA, Marhx-Bracho A, Rueda-Franco F. Stereotactic biopsy for brainstem tumors in pediatric patients. Childs Nerv Syst 2010; 26 (1) 29-34
• 13 Rajshekhar V, Moorthy RK. Status of stereotactic biopsy in children with brain stem masses: insights from a series of 106 patients. Stereotact Funct Neurosurg 2010; 88 (6) 360-366
• 14 Song JH, Kong DS, Shin HJ. Feasibility of neuroendoscopic biopsy of pediatric brain tumors. Childs Nerv Syst 2010; 26 (11) 1593-1598
• 15 Yurtseven T, Erşahin Y, Demirtaş E, Mutluer S. Neuroendoscopic biopsy for intraventricular tumors. Minim Invasive Neurosurg 2003; 46 (5) 293-299
• 16 Longatti P, Basaldella L, Feletti A, Fiorindi A, Billeci D. Endoscopic navigation of the fourth ventricle. Technical note and preliminary experience. Neurosurg Focus 2005; 19 (6) E12
• 17 Matula C, Reinprecht A, Roessler K, Tschabitscher M, Koos WT. Endoscopic exploration of the IVth ventricle. Minim Invasive Neurosurg 1996; 39 (3) 86-92
• 18 Nishikawa T, Kang Y, Lee T, Takehira N, Waga S. Application of endoscopy for a midbrain tumor. Minim Invasive Neurosurg 2003; 46 (3) 182-185
• 19 Torres-Corzo J, Rangel-Castilla L. Flexible neuroendoscopy: Part III—Basic endoscopic procedures and advantages of flexible neuroendoscopy. Contemp Neurosurg 2013; 35 (5) 1-5
• 20 Martin V, Moyal E, Delannes M , et al. Radiothérapie des tumeurs cérébrales: quelles marges? . Cancer Radiother 2013; 17 (5–6) 434-443
• 21 van den Bent MJ, Snijders TJ, Bromberg JE. Current treatment of low grade gliomas. Memo 2012; 5 (3) 223-227