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Neuroendoscopic biopsy for intraventricular tumors.

Neuroendoscopy has been shown to be an effective and minimally invasive method in the management of intraventricular tumors. Endoscopic tumor biopsy with or without additional endoscopic procedures such as third ventriculostomy and septostomy can be performed at the same session. Neuroendoscopic tumor biopsy was performed in 18 patients in our department. Their ages ranged from 2 to 65 years (median 12 years); only two of them were adult. Location of the tumors were as follows: pineal region in 7, hypothalamus and 3rd ventricle in 4, lateral ventricle in 4, thalamus in 2, and tectal in 1 patient. All procedures were performed under general anesthesia using rigid neuroendoscopes. Cerebrospinal fluid (CSF) was collected at the beginning of the procedure for cytological analysis and for pineal tumor markers. Biopsy forceps were used to obtain tissue from the lesion. The third ventriculostomy was performed in all patients with a pineal tumor, in addition to the tumor biopsy. The pathological examinations revealed a low-grade astrocytoma in 6 patients, anaplastic astrocytoma in 3, germinoma in 3, pineocytoma in 1, pineoblastoma in 2, glioblastoma multiforme in 1 and granulomatous lesion in 1. Subsequent mode of treatment such as radiation therapy, chemotherapy or radical surgery was determined on the basis of pathological diagnosis. Neuroendoscopic tumor biopsy is a less invasive method than open surgery and has some advantages such as treating the hydrocephalus at the same surgical session and the availability of CSF cytology. Neuroendoscopic techniques should be considered in selected patients.