Endoscopic Treatment of Lesions of the Third Ventricle

Background The challenging deep location of third ventricular tumors and optimal CSF medium make endoscopy a good and safe alternative treatment option to microsurgery. Additionally endoscopic procedures treat, prevent and decrease CSF disruptive complications of intraventricular tumors. To date, the criteria for selecting the ideal pathologic substrate for intraventricular endoscopy remain non elusive. Objectives Our aim in this study is to assess the efficacy of use of the endoscope as a tool for access and excision/biopsy of 3rd ventricular tumors in a minimally invasive way and to determine the possible complications of endoscopic approach. Patients and Methods Prospective investigation of twenty nine patients with third ventricular lesions, who underwent thirty endoscopic procedures (Excision/biopsy with or without third ventriculostomy), was done at Ain Shams university hospitals (14/2/2012- 1/7/2014) and at Weill Cornell Medical College, New York Presbyterian hospital (9/7/2014- 30/6/2015), analyzing clinical information, procedural details, imaging and follow up data. Results Male to female ratio was 1: 1.64. Pattern of presentation was acute in seven patients (24.3%), subacute in eleven patients (37.9%) and chronic in six patients (20.7%). Diagnosis was accidental in five patients (17.2%). Biopsy was done in 5/30 (16.7%). Total endoscopic extirpation was done in 16/30 (53.3%). Cyst drainage and tissue biopsy was done in 4/30. Cyst drainage was done in only 3/30. No direct tumor management was done in 2/30. Total resolution of preoperative symptoms occurred in 18/24 (75%), partial improvement in 2/24 (8.3%), improvement and then recurrence in 4/24 (16.7%). Conclusion Stand-alone endoscopy can be definitive treatment for resection of some solid third ventricular tumors according to strict selection criteria. Endoscopy can provide also definitive treatment for cyst resection and fenestration of certain pathological entities i.e. colloid cysts and pineal cysts. More studies, preferably multi-center, can help set selection criteria for endoscopic targets and elucidate prognostic factors.