A restricted neuroendoscopic approach for pathological diagnosis of intraventricular and paraventricular tumours

There is increasing interest in the use of neuroendoscopic techniques in neuro-oncology. We report our experience of endoscopic biopsy in patients harbouring intraventricular and paraventricular brain tumours in order to define criteria for the use of this technique. We identified 23 patients (aged 7-78 years) who underwent endoscopic biopsy for intraventricular or paraventricular lesions considered not suitable for surgical removal and too risky for a stereotactical approach. All of the biopsies were obtained with a flexible endoscope using a free-hand technique. In 16 patients specimens were adequate and led to a diagnosis; in three patients they were informative but not completely diagnostic; a pathological diagnosis was unavailable in four patients. In 13 patients with a lesion causing an obstruction of the aqueduct, a third ventriculostomy was performed during the same procedure; in one patient with a lesion occluding the Monro foramen, a septostomy was done, while in another case multiple cystostomies were required. No specific complications were observed, either clinically or radiologically, in particular no major bleeding occurred. In our experience, endoscopic biopsy could provide a pathological diagnosis in 19 of 23 patients. Endoscopic biopsy sampling sufficient tissue should be considered as the first choice in selected lesions that are otherwise difficult to approach.