ENDOSCOPIC SURGERY FOR INTRAVENTRICULAR BRAIN TUMORS IN PATIENTS WITHOUT HYDROCEPHALUS

OBJECTIVE: Endoscopy usually is avoided in patients without hydrocephalus because of presumed difficulties with ventricular cannulation and intraventricular navigation. The feasibility of endoscopic tumor management in patients without hydrocephalus was assessed on the basis of achieving the surgical objective and assessing procedure-related morbidity. METHODS: Eighty patients who underwent endoscopic management for an intraventricular brain tumor were identified from a prospective database. Of these patients, 15 had an intraventricular tumor without concomitant hydrocephalus and underwent primary endoscopic surgery for biopsy or resection. The surgical technique, the success rate, and patient outcome were assessed and then compared with 65 hydrocephalic patients who underwent similar procedures. RESULTS: Tumors were located in the third ventricle in 11 patients and the lateral ventricle in 4 patients. The ventricular compartment was cannulated successfully and the intended goal was accomplished in all patients (100%); 12 had successful diagnostic sampling and 3 had complete colloid cyst resection. There were no operative complications related to the endoscopic procedure, and no patient required subsequent intervention for hydrocephalus. The results in this group of patients did not differ with the success and morbidity after endoscopic tumor surgery in patients with hydrocephalus. CONCLUSION: Endoscopic biopsy or resection of intraventricular brain tumors in patients without hydrocephalus is feasible. The described procedure uniformly satisfied the intended surgical goal. The absence of ventriculomegaly in patients with an intraventricular brain tumor should not serve as a contraindication to endoscopic tumor biopsy or resection.