Name: Yazar Spotlight: Üçüncü Ventrikülostomi ve Pineal Biyopsi için Tek Giriş Noktalı Endoskopik İntraventriküler Yaklaşım
Uploaded: 2024-06-28T14:00:00
Description: Pineal neoplasms have a significant impact on children although they are relatively uncommon. They account for approximately 3-11% of all childhood brain ...

Bu çalışma herhangi bir fon almadı.

İstanbul Tıp Fakültesi Kurumsal İnceleme Kurulu çalışma protokolünü onayladı. Çalışmaya başlamadan önce, hastadan verilerinin kullanım ve yayınlanma amacını özetleyen bilgilendirilmiş bir onam formu imzalaması istendi.
1. Ameliyat öncesi prosedürler
<ol><li>Ameliyatları genel anestezi altında gerçekleştirin. Ameliyathanede endoskopik ve optik ekipman hazırlayın.</li>
	<li>Prosedüre başlamadan önce aletleri kontrol edin (?...

Kocher'den endoskopi

<ol>
	<li>Favero, G., Bonomini, F., Rezzani, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pineal+gland+tumors:+A+review.">Pineal gland tumors: A review.</a> Cancers (Basel). 13 (7), 1547 (2021).</li><li>Nagasawa, D. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pineal+germ+cell+tumors:+Two+cases+with+review+of+histopathologies+and+biomarkers.">Pineal germ cell tumors: Two cases with review of histopathologies and biomarkers.</a> J Clin Neurosci. 38, 23-31 (2017).</li><li>Tamrazi, B., Nelson, M., Bl&#252;ml, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pineal+region+masses+in+pediatric+patients.">Pineal region masses in pediatric patients.</a> Neuroimaging Clin N Am. 27 (1), 85-97 (2017).</li><li>Carr, C., O'Neill, B. E., Hochhalter, C. B., Strong, M. J., Ware, M. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Biomarkers+of+pineal+region+tumors:+A+review.">Biomarkers of pineal region tumors: A review.</a> Ochsner J. 19 (1), 26-31 (2019).</li><li>Iorio-Morin, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Histology-stratified+tumor+control+and+patient+survival+after+stereotactic+radiosurgery+for+pineal+region+tumors:+A+report+from+the+international+gamma+knife+research+foundation.">Histology-stratified tumor control and patient survival after stereotactic radiosurgery for pineal region tumors: A report from the international gamma knife research foundation.</a> World Neurosurg. 107, 974-982 (2017).</li><li>Liu, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simultaneous+single-trajectory+endoscopic+biopsy+and+third+ventriculostomy+in+pediatric+pineal+region+tumors.">Simultaneous single-trajectory endoscopic biopsy and third ventriculostomy in pediatric pineal region tumors.</a> Acta Neurol Belg. 121 (6), 1535-1542 (2021).</li><li>Attri, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+third+ventriculostomy+and+simultaneous+tumor+biopsy+in+pineal+region+tumors+using+the+&amp;#34;single+burr+hole&amp;#34;+technique:+An+analysis+of+34+cases.">Endoscopic third ventriculostomy and simultaneous tumor biopsy in pineal region tumors using the &amp;#34;single burr hole&amp;#34; technique: An analysis of 34 cases.</a> Asian J Neurosurg. 15 (4), 976-982 (2020).</li><li>Abbassy, M., Aref, K., Farhoud, A., Hekal, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Outcome+of+single-trajectory+rigid+endoscopic+third+ventriculostomy+and+biopsy+in+the+management+algorithm+of+pineal+region+tumors:+A+case+series+and+review+of+the+literature.">Outcome of single-trajectory rigid endoscopic third ventriculostomy and biopsy in the management algorithm of pineal region tumors: A case series and review of the literature.</a> Childs Nerv Syst. 34 (7), 1335-1344 (2018).</li><li>Fukushima, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+biopsy+of+intraventricular+tumors+with+the+use+of+a+ventriculofiberscope.">Endoscopic biopsy of intraventricular tumors with the use of a ventriculofiberscope.</a> Neurosurgery. 2 (2), 110-113 (1978).</li><li>Kawsar, K. A., Haque, M. R., Chowdhury, F. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Avoidance+and+management+of+perioperative+complications+of+endoscopic+third+ventriculostomy:+The+Dhaka+experience.">Avoidance and management of perioperative complications of endoscopic third ventriculostomy: The Dhaka experience.</a> J Neurosurg. 123 (6), 1414-1419 (2015).</li><li>Yang, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+third+ventriculostomy+and+biopsy+of+a+tectal+lesion+using+flexible+neuroendoscopy+and+urological+cup+forceps:+Illustrative+case.">Endoscopic third ventriculostomy and biopsy of a tectal lesion using flexible neuroendoscopy and urological cup forceps: Illustrative case.</a> J Neurosurg Case Lessons. 5 (16), CASE22517 (2023).</li><li>Revuelta Barbero, J. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combined+microsurgical-endoscopic+paramedian+supracerebellar-infratentorial+approach+for+resection+of+a+pineal+low-grade+glioma.">Combined microsurgical-endoscopic paramedian supracerebellar-infratentorial approach for resection of a pineal low-grade glioma.</a> Neurosurg Focus Video. 5 (1), V9 (2021).</li><li>Al-Saiari, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simultaneous+biportal+endoscopic+management+of+pineal+region+tumors+in+patients+with+obstructive+hydrocephalus:+Technical+notes.">Simultaneous biportal endoscopic management of pineal region tumors in patients with obstructive hydrocephalus: Technical notes.</a> Chin Neurosurg J. 9 (1), 1 (2023).</li><li>Birski, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+versus+stereotactic+biopsies+of+intracranial+lesions+involving+the+ventricles.">Endoscopic versus stereotactic biopsies of intracranial lesions involving the ventricles.</a> Neurosurg Rev. 44 (3), 1721-1727 (2021).</li><li>Gurusamy, S. M., Yaakub, A., Wan Hitam, W. H., Ahmad Maulana, S. A., Wan Ibrahim, W. Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pineal+gland+tumour+with+drop+metastases:+A+case+report.">Pineal gland tumour with drop metastases: A case report.</a> Cureus. 14 (10), e29855 (2022).</li><li>Panyaping, T., Tritanon, O., Wisetsathon, P., Chansakul, T., Pongpitcha, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accuracy+of+apparent+diffusion+coefficient+values+for+distinguishing+between+pineal+germ+cell+tumour+and+pineoblastoma.">Accuracy of apparent diffusion coefficient values for distinguishing between pineal germ cell tumour and pineoblastoma.</a> Clin Radiol. 78 (7), e494-e501 (2023).</li><li>Leone, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Concomitant,+single+burr+hole+endoscopic+third+ventriculostomy+and+tumor+biopsy+for+pineal+lesions:+Feasibility,+safety,+and+benefits.">Concomitant, single burr hole endoscopic third ventriculostomy and tumor biopsy for pineal lesions: Feasibility, safety, and benefits.</a> World Neurosurg. 173, 5-11 (2023).</li><li>Morgenstern, P. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pineal+region+tumors:+An+optimal+approach+for+simultaneous+endoscopic+third+ventriculostomy+and+biopsy.">Pineal region tumors: An optimal approach for simultaneous endoscopic third ventriculostomy and biopsy.</a> Neurosurg Focus. 30 (4), E3 (2011).</li><li>Zhang, Z., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+hydrocephalus+secondary+to+pineal+region+tumors.">Management of hydrocephalus secondary to pineal region tumors.</a> Clin Neurol Neurosurg. 115 (9), 1809-1813 (2013).</li><li>Xin, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic-assisted+surgery+versus+microsurgery+for+pineal+region+tumors:+A+single-center+retrospective+study.">Endoscopic-assisted surgery versus microsurgery for pineal region tumors: A single-center retrospective study.</a> Neurosurg Rev. 44 (2), 1017-1022 (2021).</li><li>Choque-Velasquez, J., Resendiz-Nieves, J., Colasanti, R., Hernesniemi, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+obstructive+hydrocephalus+associated+with+pineal+region+cysts+and+tumors+and+its+implication+in+long-term+outcome.">Management of obstructive hydrocephalus associated with pineal region cysts and tumors and its implication in long-term outcome.</a> World Neurosurg. 149, e913-e923 (2021).</li><li>Chibbaro, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neuroendoscopic+management+of+posterior+third+ventricle+and+pineal+region+tumors:+Technique,+limitation,+and+possible+complication+avoidance.">Neuroendoscopic management of posterior third ventricle and pineal region tumors: Technique, limitation, and possible complication avoidance.</a> Neurosurg Rev. 35 (3), 338-340 (2012).</li><li>Ahmed, A. I., Zaben, M. J., Mathad, N. V., Sparrow, O. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+biopsy+and+third+ventriculostomy+for+the+management+of+pineal+region+tumors.">Endoscopic biopsy and third ventriculostomy for the management of pineal region tumors.</a> World Neurosurg. 83 (4), 543-547 (2015).</li></ol>

Pineal tümörler için ETV ve biyopsi tanımı ilk olarak 1970'lerde tanımlanmıştır. Tarihsel olarak, kontrolsüz kanama korkusu her zaman var olmuştur. Ancak endoskopik cerrahi tekniklerindeki ilerlemeler sayesinde kanama kontrolü günümüzde deneyimli cerrahlar için önemli bir komplikasyondeğildir9,10. Literatürdeki birçok olguya göre, hidrosefali ile prezente olan pineal bölge tümörlerinde endoskopik tedavinin başlangıç basamağı olarak et...

Epifiz bezi, omurgalılarda biyolojik ritimleri düzenlemekten sorumlu olan epitalamusta bulunan bir nöroendokrin bezdir. Anatomik sınırları, bezin tabanını oluşturan üçüncü ventrikül duvarının arka yüzeyini, korpus kallozumun spleniumunu ve her iki tarafı çevreleyen talamusu içerir. Çam kozalağı şeklindedir ve dörtlü sarnıçtaarkaya ve aşağıya doğru uzanır 1,2.
Pineal neoplazmlar nispeten nadir görülen tümörlerdir ve ağırlıklı olarak çocukluk çağı maligniteleridir ve yetişkin beyin tümörlerinin %<1'i ile karşılaştırıldığında tüm çocukluk çağı beyin tümörlerinin %3-11'ini oluşturur 1,3,4. Yaş, cinsiyet ve etnik köken, pineal neoplazmların göreceli insidansını değiştirebilir5. Pineal tümörler germ hücreli tümörler, pineal parankimal tümörler ve komşu anatomik bölgelerden kaynaklanan tümörler olmak üzere üç tipte sınıflandırılır. Germinomlar en sık görülen epifiz tümörleridir ve Avrupa'daki pineal tümörlerin %50'sini oluşturur 1,3.
Pineal bez tümörleri patolojik olarak çeşitlidir ve optimal tedavileri tartışmalıdır6. Nöroendoskopideki gelişmeler, epifiz bölgesi tümörlerinin tedavisine önemli ölçüde katkıda bulunmuştur. Nöroendoskopik teknikler bu tümörlerin tedavisinde minimal invaziv, etkili ve güvenlidir. Bu teknikle hidrosefaliyi tedavi etmek ve aynı anda biyopsi almak mümkündür7. Çoğu olguda, histopatolojik alt tiplerin çoğunda radyoterapi ve kemoterapinin etkinliği nedeniyle epifiz bölgesi tümörlerinde eş zamanlı endoskopik üçüncü ventrikülostomi (ETV) ve tümör biyopsisi ilk tercih edilen cerrahi prosedürdür. Eşzamanlı ETV ve biyopsi için çeşitli teknikler tanımlanmıştır ve şu anda bu prosedürü gerçekleştirmek için standart bir teknik yoktur8.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Adson periosteal elevator</td>
			<td>Ruggles-Redmond</td>
			<td>RO263</td>
			<td>Semi-sharp, 5 mm, curved 6-3/8, length 164 mm</td>
		</tr>
		<tr>
			<td>Automatic skin retractors&#160;</td>
			<td>Integra</td>
			<td>3,72,245</td>
			<td>Heiss Automatic Skin Retractor Length - Overall (mm): 102 
			Length 1 - Tip/Jaw (mm): 8</td>
		</tr>
		<tr>
			<td>Balloon catheter&#160;</td>
			<td>Edwards Fogarty</td>
			<td>120804FP</td>
			<td>Length (cm): 80, Catheter size (F): 4,&#160; Inflated balloon diameter (mm): 9</td>
		</tr>
		<tr>
			<td>Biopsy Forceps</td>
			<td>Karl Storz LOTTA CLICKLINE Grasping Forceps</td>
			<td>28164 LE</td>
			<td>Rotating, dismantling, single action jaws, diameter 2.7 mm, working length 30 cm</td>
		</tr>
		<tr>
			<td>Bipolar coagulation electrode</td>
			<td>Karl Storz LOTTA</td>
			<td>28161 SF</td>
			<td>Diameter 1.3 mm, working length 30 cm</td>
		</tr>
		<tr>
			<td>Bisture</td>
			<td>Beybi</td>
			<td>24,02,502</td>
			<td>Beybi Bisture Tip. No: 20 and No: 11</td>
		</tr>
		<tr>
			<td>High-speed drill</td>
			<td>Medtronic Midas Rex MR8</td>
			<td>MR8&#8482; Electric Plus EM850</td>
			<td>Perforator tip used</td>
		</tr>
		<tr>
			<td>Obturator</td>
			<td>Karl Storz LOTTA</td>
			<td>28164 LLO</td>
			<td>Use with Operating Sheaths for ventricular puncture</td>
		</tr>
		<tr>
			<td>Operating sheath</td>
			<td>Karl Storz LOTTA</td>
			<td>28164 LSB</td>
			<td>Graduated, rotating, outer diameter 6.8 mm, working length 13 cm</td>
		</tr>
		<tr>
			<td>Ventriculoscope</td>
			<td>Karl Storz LOTTA Ventriculoscope with HOPKINS</td>
			<td>28164 LAB</td>
			<td>Wide angle telescope 30&#176;, angled eyepiece, outer diameter 6.1 mm, length 18 cm, working channel diameter 2.9 mm, irrigation/suction channel diameter 1.6 mm</td>
		</tr>
	</tbody>
</table>

endoscopic third ventriculostomy and pineal biopsy from a single entry point

Pineal neoplazmlar, nispeten nadir olmalarına rağmen çocuklar üzerinde önemli bir etkiye sahiptir. Tüm çocukluk çağı beyin tümörlerinin yaklaşık %3-11'ini oluştururlar ve bu, yetişkin beyin tümörlerinde görülen %<1'den oldukça yüksektir. Bu tümörler germ hücreli tümörler, parankimal epifiz tümörleri ve ilgili anatomik yapılardan kaynaklanan tümörler olmak üzere üç ana kategoriye ayrılabilir. Pineal bez tümörü olan hastalar için en uygun tedavi rejimini seçmek için doğru ve minimal invaziv bir doku tanısı elde etmek çok önemlidir. Bunun nedeni, mevcut çeşitli tedavi seçenekleri ve tam rezeksiyon ile ilişkili potansiyel risklerdir. Hastaların epifiz bezi tümörünün neden olduğu akut obstrüktif hidrosefali ile başvurduğu durumlarda, hidrosefalinin acil tedavisi gereklidir. Aciliyet, artmış intrakraniyal basınç ve nörolojik defisitler dahil olmak üzere hidrosefalinin potansiyel komplikasyonlarından kaynaklanmaktadır. Bu zorlukların üstesinden gelmek için minimal invaziv endoskopik yaklaşım değerli bir fırsat sunar. Bu teknik, klinisyenlerin hidrosefaliyi derhal rahatlatmasına ve aynı anda histolojik bir tanı almasına olanak tanır. Bu ikili fayda, tümörün daha kapsamlı bir şekilde anlaşılmasını sağlar ve hasta için en etkili tedavi stratejisinin belirlenmesine yardımcı olur.

The pineal gland is a neuroendocrine gland located in the epithalamus that is responsible for regulating biological rhythms in vertebrates. Its anatomical boundaries include the posterior surface of the wall of the third ventricle, which forms the base of the gland, the splenium of the corpus callosum superiorly, and the thalamus surrounding both sides. It has a pinecone shape and extends posteriorly and inferiorly in the quadrigeminal cistern1,2. 
Pineal neoplasms are relatively rare tumors and are predominantly childhood malignancies, accounting for 3-11% of all childhood brain tumors compared with &lt;1% of adult brain tumors1,3,4. Age, sex, and ethnicity can modify the relative incidence of pineal neoplasms5. Pineal tumors are classified into three types: germ cell tumors, pineal parenchymal tumors, and tumors arising from neighboring anatomical regions. Germinomas are the most frequent pineal tumors, accounting for up to 50% of pineal tumors in Europe1,3.
Tumors of the pineal gland are pathologically diverse and their optimal management remains controversial6. Advances in neuroendoscopy have significantly contributed to treating pineal region tumors. Neuroendoscopic techniques are minimally invasive, effective, and safe in treating these tumors. With this technique, it is possible to treat hydrocephalus and obtain a biopsy simultaneously7. In most cases, simultaneous endoscopic third ventriculostomy (ETV) and tumor biopsy is the first-choice surgical procedure for pineal region tumors due to the effectiveness of radiotherapy and chemotherapy in most histopathological subtypes. Various techniques for simultaneous ETV and biopsy have been described, and there is currently no standard technique for performing this procedure8.

Yazar Spotlight: Üçüncü Ventrikülostomi ve Pineal Biyopsi için Tek Giriş Noktalı Endoskopik İntraventriküler Yaklaşım

Tek Giriş Noktasından Endoskopik Üçüncü Ventrikülostomi ve Pineal Biyopsi

Endoscopic intraventricular approach are widely used in neurosurgery. Here we describe the full endoscopic technique for third ventriculostomy and pineal biopsy from a single entry point in patient that had obstructive hydrocephalus due to pineal lesions. So endoscopic systems contains one channel and one irrigation channel.Bipolar coagulation, nerve balloon, and micro forceps are sufficient for the procedure. The advantage of advanced technology has enabled the acquisition of high definition HDI 4K quality images during endoscopic surgeries. Angled and flexible endoscope facilitate more effective work in smaller areas, enhancing the precision and efficiency of surgical procedures.

Preoperatif manyetik rezonans görüntülemede (MRG) pineal tümör ve triventriküler hidrosefali saptandı. Ameliyat öncesi endoskop setimizin, 4F Fogarty balon kateterimizin (bkz. Şekil 1) ve gerekli tüm materyallerin (bkz. Tablo 1) kontrol edildiğinden emin olduk. Pineal tümörün boyutu başlangıçta 30 mm x 15 mm x 20 mm olarak ölçüldü. Bununla birlikte, ameliyat sonrası MRG taramalarında, tümörün boyutunun 35 mm x 52 mm x 45 mm'ye yüks...

Pineal neoplazmlar sıklıkla obstrüktif hidrosefaliye neden olur ve tedavi rejimine karar vermek için histopatolojik tanı gerektirir. Patolojik tanıya göre cerrahi rezeksiyon veya kemoradyoterapi ile tedavi edilebilirler. Minimal invaziv bir başlangıç tedavisi olarak, Kocher'in bakış açısından endoskopik bir yaklaşımla hem üçüncü ventrikülostomi hem de biyopsi yapılabilir.

Pineal neoplasms have a significant impact on children although they are relatively uncommon. They account for approximately 3-11% of all childhood brain ...

endoscopic-third-ventriculostomy-pineal-biopsy-from-single-entry

Research

JoVE Journal

Medicine

Endoscopic Third Ventriculostomy and Pineal Biopsy from a Single Entry Point

Pineal neoplasms have a significant impact on children although they are relatively uncommon. They account for approximately 3-11% of all childhood brain tumors, which is considerably higher than the &lt;1% seen in adult brain tumors. These tumors can be divided into three main categories: germ cell tumors, parenchymal pineal tumors, and tumors arising from related anatomical structures. Obtaining an accurate and minimally invasive tissue diagnosis is crucial for selecting the most appropriate treatment regimen for patients with pineal gland tumors. This is due to the diverse treatment options available and the potential risks associated with complete resection. In cases where patients present with acute obstructive hydrocephalus caused by a pineal gland tumor, immediate treatment of the hydrocephalus is necessary. The urgency stems from the potential complications of hydrocephalus, including increased intracranial pressure and neurological deficits. To address these challenges, a minimally invasive endoscopic approach provides a valuable opportunity. This technique allows clinicians to promptly relieve hydrocephalus and obtain a histological diagnosis simultaneously. This dual benefit enables a more comprehensive understanding of the tumor and assists in determining the most effective treatment strategy for the patient.

Pineal neoplasms frequently cause obstructive hydrocephalus and require histopathological diagnosis to decide the treatment regimen. They might be treated by surgical resection or chemoradiotherapy according to the pathological diagnosis. As a minimally invasive initial treatment, an endoscopic approach from Kocher's point enables both third ventriculostomy and biopsy.

Tıp

Endoscopic Surgery for Concurrent Third Ventriculostomy and Pineal Biopsy

To begin, insert the 6.1 millimeter wide endoscope into the endoscope sheath, which is already inserted into the lateral ventricular cavity. Identify the septal and thalamostriate veins. Identify and follow the choroid plexus anteriorly, up to the third ventricle through the foramen of Monroe, or FOM.Pass the ventricular scope through the FOM to access the third ventricle. To find the floor of the third ventricle, which is usually thin due to hydrocephalus, identify the mammary bodies and infundibular recess in the third ventricle. Ensure that the hole at the base of the third ventricle is located at the most translucent point between the in infundibular recess and the mammillary bodies.Use the tip of the four French Fogarty catheter to puncture the base of the third ventricle. Then repeatedly inflate and deflate the balloon of the catheter to widen the opening. See the jet flow of CSF when the catheter balloon is deflated.Move the endoscope to the posterior region of the third ventricle, where the pineal gland tumor is located. Identify the massa intermedia to allow better visualization of the posterior third ventricle. Perform dissection and identify the tumor to examine its growth pattern before carefully coagulating the surface of the tumor using bipolar cautery.After complete coagulation of the tumor surface, take a biopsy using biopsy forceps. Resect the tumor according to the histopathological diagnosis. Control local hemorrhage with irrigation and bipolar cautery.Remove the endoscopic system before closing the wound with sutures without a drain.