Pineal Region Tumors: Simultaneous Endoscopic Third Ventriculostomy and Tumor Biopsy

OBJECTIVE: Advances in neuroendoscopy have accommodated the development of intraventricular techniques that enhance the management of multiple disease processes. Tumors of the pineal region are amenable to endoscopic management in that they are accessible through the third ventricle and commonly cause hydrocephalus that can be alleviated by endoscopic third ventriculostomy (ETV). We describe the indications for and procedure of simultaneous ETV and biopsy of pineal region tumors, as well as the clinical features favoring different approaches to this procedure. METHODS: The current literature on endoscopic management of pineal region tumors and the senior author's clinic experience with current techniques are reviewed. RESULTS: Simultaneous tumor biopsy with ETV following initial evaluation with tumor markers and imaging can be accomplished using a single or dual entry approach. The choice of approach is dependent on multiple clinical factors including massa intermedia size, goals of surgery, degree of hydrocephalus, and the relationship between the tumor and massa intermedia. CONCLUSIONS: Simultaneous ETV and tumor biopsy is a valuable technique that can be used to manage hydrocephalus and establish diagnosis in patients with newly diagnosed pineal region tumors, potentially avoiding traditional craniotomy and ventriculoperitoneal shunt placement. It is favored as an early step in the management of patients with marker-negative tumors.