A patient with a synchronous pineal and suprasellar germinoma and symptomatic hydrocephalus
underwent a minimally invasive endoscopic biopsy and third ventriculostomy. We performed
multiple biopsies of both tumors and fenestration of the floor of the third ventricle
with a flexible fiberoptic endoscope through a single burr hole. Postoperative quantitative
cine-mode magnetic resonance imaging (MRI) confirmed the patency of the fenestration.
Selected pineal/posterior third ventricle region tumors, especially radiosensitive
germinomas, could be treated with this approach thereby obviating the need for either
stereotactic or craniotomy/open biopsy and the subsequent placement of a permanent
cerebrospinal fluid (CSF) shunt. The endoscopic approach to tumors in the pineal/posterior
third ventricle region provides an accurate straightforward, and safe method of obtaining
a diagnosis and treating the associated increased intracranial pressure.
Endoscopy - Germinoma - Pineal region - Hydrocephalus - Cine-mode - Magnetic resonance
imaging
