Endoscopic management of pediatric brain tumors

ArticleinNeurosurgical FOCUS 18(6A):E1 · July 2005with2 Reads
DOI: 10.3171/foc.2005.18.6.2 · Source: PubMed
Abstract
Primary endoscopic procedures for children with intraventricular brain tumors include endoscopic tumor biopsy and endoscopic tumor removal. The simultaneous treatment of hydrocephalus with endoscopic third ventriculostomy (ETV) or endoscopic septostomy increases the appeal of a minimally invasive endoscopic approach. Eighty-five patients who underwent endoscopic management of an intraventricular brain tumor were identified from a prospective database. Of these patients, 26 were younger than 21 years of age at the time of diagnosis. The surgical technique, its success rate, and patient outcome were assessed. Illustrative cases are used in this study to detail the procedure of endoscopic tumor biopsy and resection. Endoscopic tumor procedures were successful in 96% of cases (23 of 24 endoscopic tumor biopsy samples and both endoscopic tumor removals). Fourteen simultaneous procedures were performed to treat hydrocephalus successfully. There was no recognized morbidity from the surgical procedures. Endoscopic surgery in children with intraventricular brain tumors is an effective and safe method for sampling of the lesion and, in select cases, its resection. This minimally invasive technique should be considered in situations in which the patient might thereby avoid a more conventional procedure, given the high rate of success and low morbidity associated with endoscopic management.
    • The risks of clinically significant intraoperative hemorrhage necessitating abandonment of the procedure and postoperative bleeds are reported to be 2.3 and 3.5 %, respectively [133]. The results of endoscopic biopsy in the setting of hydrocephalus are largely favorable, with recent studies citing success rates as high as 96.0 % [55]. In a recent multicenter study, Constantini et al. found that the technique provided meaningful pathological data for the majority of patients analyzed across a wide range of tumor types and locations with minimal morbidity and mortality.
    [Show abstract] [Hide abstract] ABSTRACT: Introduction Neuroendoscopy has greatly impacted pediatric neurosurgery over the past few decades. Improved optics and microsurgical tools have allowed neuroendoscopes to be used for a multitude of neurosurgical procedures. Discussion In this review article, we present the breadth of intraventricular neuroendoscopic procedures for the treatment of conditions ranging from hydrocephalus and brain tumors to congenital cysts and other pathologies. We critically discuss treatment indications and reported success rates for neuroendoscopic procedures. We also present novel approaches, technical nuances, and variations from recently published literature and as practiced in the authors’ institution.
    Full-text · Article · Aug 2014
    • Endoscopic tumor resections are also frequently said to result in inferior rates of gross total resection [25]. The resection rates demonstrated in our study (75.0%) and others (71–100%) [12, 32, 37, 65], however, appear comparable to those reported for microsurgical resection (80.4%–96%), particularly when endoscopic resection attempts are limited to tumors ≤2 cm in diameter (in which case resection rates in our analysis improve to 87.8%) [2, 67]. Some apprehension about the use of endoscopy for tumor resection arises from the perception that tumors resected endoscopically are more likely to recur [12, 21].
    [Show abstract] [Hide abstract] 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 (), the presence of a cystic tumor component (), and the use of navigation or stereotactic tools during the procedure () 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 (). 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.
    Full-text · Article · Sep 2013
    • Colloid cyst endoscopic surgery is described widely in the literature and is becoming a popular surgical technique in the management of these lesions (Grondin et al, 2007; Horn et al, 2007;). Navigation assisted endoscopy may be needed in some of these patients, especially when there is no accompanying hydrocephalus (Souweidane 2005). Navigation could be also of great value in colloid cyst surgery, especially in selecting the entry point necessary for the optimal working angle ().
    Full-text · Chapter · Nov 2011 · IEEE Transactions on Signal Processing
    • Endoscopic third ventriculostomy (ETV) has been widely applied in pediatric patients over the last several decades123456 with many centers reporting successful outcomes. Complications have also been reported, some quite serious789.
    [Show abstract] [Hide abstract] ABSTRACT: Uncertainty persists on the best treatment for patients with obstructive hydrocephalus: endoscopic third ventriculostomy (ETV) or shunt, particularly in the younger age groups. We performed decision analysis for quality of life (QOL) outcomes comparing these two procedures. Frequency of outcome events for ETV was obtained from the Canadian Pediatric Neurosurgery Study Group (368 patients) and for shunts from two prospective randomized trials, the Shunt Design Trial and the Endoscopic Shunt Insertion Trial (647 patients combined). Quality-adjusted life year (QALY) estimates for various outcomes were obtained from the literature. Decision analysis was performed at 1 year of follow-up for specific age groups, e.g., <1 month, 1-6 months, etc. Failure from cerebrospinal fluid (CSF) diversion from either procedure was a function of age with higher failures rates in younger patients. Expected QALY at 1 year were marginally higher for ETV for all age groups, but the outcomes were similar enough to be regarded as equivalent. The results, however, were highly sensitive to the assigned health utility value estimates for patients who are well with a functioning ETV or shunt and the severe complication rate from ETV. Age is a major determinant of outcome from CSF diversion with worse outcomes in young patients. QALY estimates for either ETV or shunt are similar at 1 year.
    Article · Apr 2009
  • [Show abstract] [Hide abstract] ABSTRACT: Low-rank estimators for higher order statistics are considered in this paper. The bias-variance tradeoff is analyzed for low-rank estimators of higher order statistics using a tensor product formulation for the moments and cumulants. In general, the low-rank estimators have a larger bias and smaller variance than the corresponding full-rank estimator, and the mean-squared error can be significantly smaller. This makes the low-rank estimators extremely useful for signal processing algorithms based on sample estimates of the higher order statistics. The low-rank estimators also offer considerable reductions in the computational complexity of such algorithms. The design of subspaces to optimize the tradeoffs between bias, variance, and computation is discussed, and a noisy input, noisy output system identification problem is used to illustrate the results
    Full-text · Article · Apr 1997
  • [Show abstract] [Hide abstract] ABSTRACT: Endoscopic fenestration has been recognized as an accepted treatment choice for patients with symptomatic arachnoid cysts. The success of this procedure, however, is greatly influenced by individual cyst anatomy and location as well as the endoscopic technique used. This review was conducted to assess what variables influence the treatment success for different categories of arachnoid cysts. Thirty-three consecutive patients who underwent endoscopic fenestration for treatment of an intracranial arachnoid cyst were identified from a prospective database. The surgical indications and techniques were reviewed, and surgical success rates and patient outcomes were assessed. Specific examples of each cyst category are included to illustrate the technical aspects of endoscopic cyst fenestration. Endoscopic fenestration of arachnoid cysts was successful when judged by cyst decompression, and symptom resolution was noted in 32 (97%) of 33 cases. The one patient with short-term treatment failure underwent a successful repetition of the operation. There were no surgery-related morbidities or deaths. Arachnoid cysts are a relatively benign pathological entity that can be managed by performing endoscopically guided cyst wall fenestrations into the ventricular system or cerebrospinal fluid-containing cisterns. Proper patient selection, preoperative planning of endoscope trajectory, use of frameless navigation, and advances in endoscope lens technology and light intensity combine to make this a safe procedure with excellent outcomes.
    Full-text · Article · Jan 2006
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