Endoscopic needle biopsy of thalamic tumors: technical note
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TECHNICAL NOTES
Endoscopic needle biopsy of thalamic tumors: technical note Pietro Spennato 1 Giuseppe Cinalli 1
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Claudio Ruggiero 1 & Giuseppe Mirone 1 & Alessia Imperato 1 & Raffaele Stefano Parlato 1 &
Received: 26 April 2020 / Accepted: 11 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Neuroendoscopic biopsy represents the procedure of choice for pure intraventricular lesions. Instead, in case of deep-seated paraventricular tumors, with intact ependyma, the advantage of neuroendoscopy over stereotactic biopsy is not so evident, because the lesion is not under direct vision; the tissue sample may be limited to more superficial ependymal layer, and bleeding may obscurate vision. Also, stereotactic biopsy may reserve additional problems for these lesions: inaccuracy caused by leak of cerebrospinal fluid and increased risk of severe hemorrhage due to damage of the ependymal vessels. Case reports We report two cases of young children affected by thalamic tumors that were biopsied using a modification of a recently proposed technique: endoscopic visual control, neuronavigated needle biopsy. Conclusion This technique may combine the accuracy of a stereotactic needle biopsy with the advantage of visual control on site of ependymal puncture and possibility of immediate bleeding control. Keywords Brain tumors . Stereotactic biopsy . Hydrocephalus . Pediatric tumors . Neuroendoscopy
Introduction In the last decades, neuroendoscopy has become the procedure of choice to biopsy intraventricular tumors. For pure intraventricular tumors, neuroendoscopic biopsy offers advantages if compared with stereotactic “blind” needle biopsy, such as clear visibility, possibility to select a specific point for the biopsy, and opportunity to examine biopsy site and verify that there is no active bleeding [1, 2]. In case of deepseated paraventricular tumors, with intact ependyma, the advantage of neuroendoscopy over stereotactic biopsy is not so evident, because the lesion is not under direct vision; the tissue sample may be limited to more superficial ependymal layer; the grasping forceps used for biopsy may cause bleeding, with significant obscuration of the vision. However, also, stereotactic biopsy may reserve additional problems when Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00381-020-04676-6) contains supplementary material, which is available to authorized users. * Pietro Spennato [email protected] 1
Department of Neurosciences, Department of Pediatric Neurosurgery, Santobono-Pausilipon Children’s Hospital, Via Mario Fiore 6, 80121 Naples, Italy
ventricular system is crossed by the needle: trajectory may be inaccurate because of brain shift caused by leak of cerebrospinal fluid (CSF). Moreover, an increased risk of severe hemorrhage is expected due to the possibility of highly vascularized ependymal walls to be blindly crossed by the needle. Recently, Oertel et al. [3] described a technique that offers the advantages of both en
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