ENDOSCOPIC MANAGEMENT OF A PINEAL AND SUPRASELLAR GERMINOMA WITH ASSOCIATED HYDROCEPHALUS - TECHNICAL CASE-REPORT

A patient with a synchronous pineal and suprasellar germinoma and symp tomatic hydrocephalus underwent a minimally invasive endoscopic biopsy and third ventriculostomy. We performed multiple biopsies of both tum ors and fenestration of the floor of the third ventricle with a flexib le fiberoptic endoscope through a single burr hole. Postoperative quan titative cine-mode magnetic resonance imaging (MRI) confirmed the pate ncy of the fenestration. Selected pineal/posterior third ventricle reg ion tumors, especially radiosensitive germinomas, could be treated wit h this approach thereby obviating the need for either stereotactic or craniotomy/open biopsy and the subsequent placement of a permanent cer ebrospinal fluid (CSF) shunt. The endoscopic approach to tumors in the pineal/posterior third ventricle region provides an accurate straight forward, and safe method of obtaining a diagnosis and treating the ass ociated increased intracranial pressure.