Endoscopic third ventriculostomy is the treatment of choice for obstructive hydrocephalus due to pediatric pineal tumors

Pineal lesions in the pediatric patient are often complicated by the develo pment of hydrocephalus due to obstruction of the aqueduct or the third vent ricle by tumor masses. In such cases, hydrocephalus treatment has the highe st priority and should be performed prior to any surgical treatment of the pineal tumor itself. The golden standard in obstructive hydrocephalus treat ment remains placement of a temporary or permanent cerebrospinal fluid shun t, although there are many long-term complications associated with a shunt system. To avoid these and to render the patients independent from a failur e-prone shunt system, we employed endoscopic third ventriculostomy for perm anent relief of elevated intracranial pressure prior to surgical removal of the pineal lesions. The present study summarizes the results of this appro ach in 7 pediatric patients with obstructive hydrocephalus. No complication s of the endoscopic procedure were encountered, and the ventriculostomy rem ained patent in all cases, as confirmed by motion sensitive MRI. The advant ages of endoscopic third ventriculostomy as compared with other techniques are discussed, and its increasing role in the management of children with s pace occupying lesions of the pineal region is defined.