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Endoscopic resection of a low-grade ependymoma of the pineal region

BACKGROUND: Full endoscopic resection of solid brain tumors represents a challenge for neurosurgeons. This can be achieved with modern technology and advanced surgical tools. CASE DESCRIPTION: A 23-years-old male was referred to our unit with raised intracranial pressure. Head computed tomography an...

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Autores principales: Schonauer, Claudio, Jannelli, Gianpaolo, Tessitore, Enrico, May, Adrien Thomas, Guatta, Ramona, Bartoli, Andrea
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Scientific Scholar 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8248020/
https://www.ncbi.nlm.nih.gov/pubmed/34221610
http://dx.doi.org/10.25259/SNI_250_2021
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author Schonauer, Claudio
Jannelli, Gianpaolo
Tessitore, Enrico
May, Adrien Thomas
Guatta, Ramona
Bartoli, Andrea
author_facet Schonauer, Claudio
Jannelli, Gianpaolo
Tessitore, Enrico
May, Adrien Thomas
Guatta, Ramona
Bartoli, Andrea
author_sort Schonauer, Claudio
collection PubMed
description BACKGROUND: Full endoscopic resection of solid brain tumors represents a challenge for neurosurgeons. This can be achieved with modern technology and advanced surgical tools. CASE DESCRIPTION: A 23-years-old male was referred to our unit with raised intracranial pressure. Head computed tomography and magnetic resonance imaging (MRI) revealed obstructive hydrocephalus and a third ventricle lesion. Endoscopic third ventriculostomy and biopsy were performed, a left frontal external ventricular drain was left in place. A second-look surgery for endoscopic removal was planned. Decision to proceed with an endoscopic removal was supported by the following characteristics found during the first surgery: tumor exophytic, soft texture, scarce vascularity, and low-grade appearance. A rescue strategy for microscopic resection via transcallosal approach was decided. A straight trajectory to the tumor was planned with navigation. A further anterior left frontal burr-hole was performed, and the ventricular system was entered via the left frontal horn. Resection was carried out alternating laser for hemostasis and cutting, endoscopic ultrasonic aspirator, and endoscopic forceps for piecemeal resection. Laser hemostasis and cutting (1 Watt power at tip, continuous wave mode) were useful at the ventricular wall-tumor interface. Relevant landmarks guided the approach and the resection (foramen of Monro, mammillary bodies, aqueduct, pineal and suprapineal recess, and posterior commissure). The surgery was carried uneventfully. Histopathology confirmed a lowgrade ependymoma. Post-operative MRI showed residual tumor within the lower aqueduct. At 3 years follow-up, residual tumor is stable. CONCLUSION: In selected cases, endoscopic resection for third ventricular tumors is feasible and safe, and represents a valid alternative to microsurgical approaches.
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spelling pubmed-82480202021-07-02 Endoscopic resection of a low-grade ependymoma of the pineal region Schonauer, Claudio Jannelli, Gianpaolo Tessitore, Enrico May, Adrien Thomas Guatta, Ramona Bartoli, Andrea Surg Neurol Int Video Abstract BACKGROUND: Full endoscopic resection of solid brain tumors represents a challenge for neurosurgeons. This can be achieved with modern technology and advanced surgical tools. CASE DESCRIPTION: A 23-years-old male was referred to our unit with raised intracranial pressure. Head computed tomography and magnetic resonance imaging (MRI) revealed obstructive hydrocephalus and a third ventricle lesion. Endoscopic third ventriculostomy and biopsy were performed, a left frontal external ventricular drain was left in place. A second-look surgery for endoscopic removal was planned. Decision to proceed with an endoscopic removal was supported by the following characteristics found during the first surgery: tumor exophytic, soft texture, scarce vascularity, and low-grade appearance. A rescue strategy for microscopic resection via transcallosal approach was decided. A straight trajectory to the tumor was planned with navigation. A further anterior left frontal burr-hole was performed, and the ventricular system was entered via the left frontal horn. Resection was carried out alternating laser for hemostasis and cutting, endoscopic ultrasonic aspirator, and endoscopic forceps for piecemeal resection. Laser hemostasis and cutting (1 Watt power at tip, continuous wave mode) were useful at the ventricular wall-tumor interface. Relevant landmarks guided the approach and the resection (foramen of Monro, mammillary bodies, aqueduct, pineal and suprapineal recess, and posterior commissure). The surgery was carried uneventfully. Histopathology confirmed a lowgrade ependymoma. Post-operative MRI showed residual tumor within the lower aqueduct. At 3 years follow-up, residual tumor is stable. CONCLUSION: In selected cases, endoscopic resection for third ventricular tumors is feasible and safe, and represents a valid alternative to microsurgical approaches. Scientific Scholar 2021-06-14 /pmc/articles/PMC8248020/ /pubmed/34221610 http://dx.doi.org/10.25259/SNI_250_2021 Text en Copyright: © 2021 Surgical Neurology International https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Video Abstract
Schonauer, Claudio
Jannelli, Gianpaolo
Tessitore, Enrico
May, Adrien Thomas
Guatta, Ramona
Bartoli, Andrea
Endoscopic resection of a low-grade ependymoma of the pineal region
title Endoscopic resection of a low-grade ependymoma of the pineal region
title_full Endoscopic resection of a low-grade ependymoma of the pineal region
title_fullStr Endoscopic resection of a low-grade ependymoma of the pineal region
title_full_unstemmed Endoscopic resection of a low-grade ependymoma of the pineal region
title_short Endoscopic resection of a low-grade ependymoma of the pineal region
title_sort endoscopic resection of a low-grade ependymoma of the pineal region
topic Video Abstract
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8248020/
https://www.ncbi.nlm.nih.gov/pubmed/34221610
http://dx.doi.org/10.25259/SNI_250_2021
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