Ik. Pople et al., The role of endoscopic biopsy and third ventriculostomy in the management of pineal region tumours, BR J NEUROS, 15(4), 2001, pp. 305-311
The best surgical strategy for treating patients with pineal tumours presen
ting with acute hydrocephalus remains undermined. During the past 17 years
we have used transventricular endoscopic biopsy and third ventriculostomy a
s a onestep procedure in the initial management of these cases, and present
the largest consecutive case series illustrating the value of this techniq
ue. We have successfully managed 34 consecutive patients with pineal region
tumours, carrying out third ventriculostomy in 18 patients. Histological d
iagnosis was obtained in 32/34 (94%) of the cases. There were no deaths or
major complications and only one patient required a ventriculo-peritoneal s
hunt owing to ventriculostomy failure. According to current management prot
ocols and depending on histology, tumours were treated by a combination of
resection via craniotomy followed by radiotherapy or chemotherapy, or by th
e latter therapies alone. This one step procedure is minimally invasive and
safely achieves adequate biopsy with control of hydrocephalus, whilst defi
nitive histology and biochemical marker studies are obtained. Definitive tr
eatment for each tumour is designed according to diagnosis.