Pediatric pineal and tectal region tumors: the use of neuroendoscopy

Yıl 2024, , 325 - 335, 01.04.2024

Pelin Kuzucu , Alp Özgün Börcek

https://doi.org/10.31362/patd.1363850

Öz

Purpose: In this article, we aimed to contribute to the literature by describing our approach to pediatric pineal
and tectal masses treated with endoscopic interventions in our clinic.
Materials and methods: We retrospectively reviewed the records of 26 patients with lesions in the pineal and
tectal regions who underwent endoscopic procedures between 2012 and 2023 at Gazi University Department
of Pediatric Neurosurgery. Demographic data, blood tumor markers (alpha fetoprotein-BETA AFP, alpha
fetoprotein-β-hCG), pathological diagnoses, reasons for clinical presentation, presence of hydrocephalus and
additional interventions were analyzed.
Results: Of the 26 patients who underwent endoscopic procedure, 6 had lesions in the pineal region and 20
had lesions in the tectal region. The success rate for ETV was 75-80%. The success rate for ETV was 78.3%
for patients with tumors in the pineal region and 84% for tectal tumors.
Conclusion: Pineal or tectal region tumors are a rare group of tumors. In addition, these regions are among
the most heterogeneous regions in the central nervous system in terms of tumor type and histology. Endoscopic
intervention through a single burr hole using rigid endoscopy is a comfortable and safe minimally invasive
method for both pathologic sampling and management of hydrocephalus in indicated cases in the same session.

Anahtar Kelimeler

Pediatric tumors, pineal tumors, tectal tumors, neuroendoscopy

Destekleyen Kurum

Gazi UNIVERSITY

Proje Numarası

6e27d218-19d0-4594-a3a3-5b3f63ac37b3

Pediatrik pineal ve tektal bölge tümörleri: nöroendoskopi kullanımı

Öz

Amaç: Bu yazıda kliniğimizde endoskopik girişimlerle tedavi edilen pediatrik pineal ve tektal kitlelere
yaklaşımımızı anlatarak literatüre katkıda bulunmayı amaçladık.
Gereç ve yöntem: Gazi Üniversitesi Çocuk Nöroşirürji Bilim Dalı'nda 2012-2023 yılları arasında pineal ve
tektal bölgede lezyonu olan ve endoskopik girişim uygulanan 26 hastanın kayıtları retrospektif olarak incelendi.
Demografik veriler, kan tümör belirteçleri (alfa fetoprotein-BETA AFP, alfa fetoprotein-β-hCG), patolojik tanılar,
klinik başvuru nedenleri, hidrosefali varlığı ve ek girişimler analiz edildi.
Bulgular: Endoskopik işlem uygulanan 26 hastanın 6'sında pineal bölgede, 20'sinde ise tektal bölgede lezyon
vardı. ETV için başarı oranı %75-80 idi. ETV için başarı oranı pineal bölgede tümörü olan hastalar için %78,3
ve tektal tümörler için %84 idi.
Sonuç: Pineal veya tektal bölge tümörleri nadir görülen bir tümör grubudur. Ayrıca bu bölgeler tümör tipi ve
histolojisi açısından santral sinir sistemindeki en heterojen bölgeler arasındadır. Rijit endoskopi kullanılarak tek
bir burr deliğinden endoskopik girişim, endikasyonu olan vakalarda aynı seansta hem patolojik örnekleme hem
de hidrosefali yönetimi için konforlu ve güvenli bir minimal invaziv yöntemdir.

Anahtar Kelimeler

Pediatrik tümörler, pineal tümörler, tektal tümörler, nöroendoskopi

Etik Beyan

6e27d218-19d0-4594-a3a3-5b3f63ac37b3

Destekleyen Kurum

GAZİ ÜNİVERSİTESİ

Proje Numarası

6e27d218-19d0-4594-a3a3-5b3f63ac37b3

Kaynakça

• 1. Bruce JN, Ogden AT. Surgical strategies for treating patients with pineal region tumors. J Neurooncol 2004;69:221-236. https://doi.org/10.1023/b:neon.0000041885.09226.2d
• 2. Ostrom QT, Gittleman H, Xu J, et al. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the united States in 2009-2013. Neuro Oncol 2016;18:1-75. https://doi.org/10.1093/neuonc/now207
• 3. Ezzat S, Kamal M, El Khateeb N, et al. Pediatric brain tumors in a low/middle income country: does it differ from that in developed world? J Neurooncol 2016;126:371-376. https://doi.org/10.1007/s11060-015-1979-7
• 4. Hu J, Western S, Kesari S. Brainstem Glioma in Adults. Front Oncol 2016;6:180(e1-7). https://doi.org/10.3389/fonc.2016.00180
• 5. Ahmed AI, Zaben MJ, Mathad NV, Sparrow OCE. Endoscopic biopsy and third ventriculostomy for the management of pineal region tumors World Neurosurg 2015;83:543-547. https://doi.org/10.1016/j.wneu.2014.11.013
• 6. O’Brien DF, Hayhurst C, Pizer B, Mallucci CL. Outcomes in patients undergoing single-trajectory endoscopic third ventriculostomy and endoscopic biopsy for midline tumors presenting with obstructive hydrocephalus. J Neurosurg 2006;105:219-226. https://doi.org/10.3171/ped.2006.105.3.219
• 7. Sahana D, Rathore L, Kumar S, Sahu RK. Endoscopic anatomy of lateral and third ventricles: a must know for performing endoscopic third ventriculostomy. Neurol India 2021;69:45-48. https://doi.org/10.4103/0028-3886.310075
• 8. Tien RD, Barkovich AJ, Edwards MS. MR imaging of pineal tumors. AJR Am J Roentgenol 1990;155:143-151. https://doi.org/10.2214/ajr.155.1.2162137
• 9. Fukushima T. Endoscopic biopsy of intraventricular tumors with the use of a ventriculofiberscope. Neurosurgery 1978;2:110-113. https://doi.org/10.1227/00006123-197803000-00006
• 10. Grant GA, Avellino AM, Loeser JD, Ellenbogen RG, Berger MS, Roberts TS. Management of intrinsic gliomas of the tectal plate in children: a ten-year review. Pediatr Neurosurg 1999;31:170-176. https://doi.org/10.1159/000028857
• 11. May PL, Blaser SI, Hoffman HJ, Humphreys RP, Harwood Nash DC. Benign intrinsic tectal “tumors” in children. J Neurosurg 1991;74:867-871. https://doi.org/10.3171/jns.1991.74.6.0867
• 12. Squires LA, Allen JC, Abbott R, Epstein FJ. Focal tectal tumors: management and prognosis. Neurology 1994;44:953-956. https://doi.org/10.1212/wnl.44.5.953
• 13. Pollack IF, Pang D, Albright AL. The long-term outcome in children with late-onset aqueductal stenosis resulting from benign intrinsic tectal tumors. J Neurosurg 1994;80:681-688. https://doi.org/10.3171/jns.1994.80.4.0681
• 14. Bowers DC, Georgiades C, Aronson LJ, et al. Tectal gliomas: natural history of an indolent lesion in pediatric patients. Pediatr Neurosurg 2000;32:24-29. https://doi.org/10.1159/000028893
• 15. Deopujari C, Shroff K, Karmarkar V, Mohanty C. Neuroendoscopy in the management of pineal region tumours in children. Childs Nerv Syst 2023;39:2353-2365. https://doi.org/10.1007/s00381-022-05561-0
• 16. Hirato J, Nakazato Y. Pathology of pineal region tumors. J Neurooncol 2001;54:239-249. https://doi.org/10.1023/a:1012721723387
• 17. Louis DN, Perry A, Reifenberger G, et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol 2016;131:803-820. https://doi.org/10.1007/s00401-016-1545-1
• 18. Song JH, Kong DS, Shin HJ. Feasibility of neuroendoscopic biopsy of pediatric brain tumors. Childs Nerv Syst 2010;26:1593-1598. https://doi.org/10.1007/s00381-010-1143-9
• 19. Chibbaro S, Di Rocco F, Makiese O, et al. Neuroendoscopic management of posterior third ventricle and pineal region tumors: technique, limitation, and possible complication avoidance. Neurosurg Rev 2012;35:331-340. https://doi.org/10.1007/s10143-011-0370-1
• 20. Kinoshita Y, Yamasaki F, Tominaga A, et al. Pitfalls of neuroendoscopic biopsy of ıntraventricular germ cell tumors. World Neurosurg 2017;106:430-434. https://doi.org/10.1016/j.wneu.2017.07.013
• 21. Morgenstern PF, Souweidane MM. Pineal region tumors: simultaneous endoscopic third ventriculostomy and tumor biopsy. World Neurosurg 2013;79:18(9-13). https://doi.org/10.1016/j.wneu.2012.02.020 22. ES, Goumnerova L. Endoscopic biopsy of brain tumors in children: diagnostic success and utility in guiding treatment strategies. J Neurosurg Pediatr 2010;5:255-262. https://doi.org/10.3171/2009.10.PEDS09172
• 23. Abhaya V, Kulkarni AV, Drake JM, et al. Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV Success Score. J Neurosurg Pediatr 2010;6:310-315. https://doi.org/10.3171/2010.8.PEDS103
• 24. Yamini B, Refai D, Rubin CM, Frim DM. Initial endoscopic management of pineal region tumors and associated hydrocephalus: clinical series and literature review. J Neurosurg 2004;100:437-441. https://doi.org/10.3171/ped.2004.100.5.0437
• 25. Mottolese C, Szathamari A, Beuriat PA, Grassiot B, Simon E. Neuroendoscopy and pineal tumors: a review of the literature and our considerations regarding its utility. Neurochirurgie 2015;61:155-159. https://doi.org/10.1016/j.neuchi.2013.12.008
• 26. Oka K, Kin Y, Go Y, et al. Neuroendoscopic approach to tectal tumors: a consecutive series. J Neurosurg 1999;91:964-970. https://doi.org/10.3171/jns.1999.91.6.0964
• 27. Cinalli G, Spennato P, Savarese L, et al. Endoscopic aqueductoplasty and placement of a stent in the cerebral aqueduct in the management of isolated fourth ventricle in children. J Neurosurg 2006;104:21-27. https://doi.org/10.3171/ped.2006.104.1.21
• 28. da Silva LRF, Cavalheiro S, Zymberg ST. Endoscopic aqueductoplasty in the treatment of aqueductal stenosis. Childs Nerv Syst 2007;23:1263-1268. https://doi.org/10.1007/s00381-007-0393-7
• 29. Erşahin Y. Endoscopic aqueductoplasty. Childs Nerv Syst 2007;23:143-150. https://doi.org/10.1007/s00381-006-0227-z
• 30. Sagan LM, Kojder I, Poncyljusz W. Endoscopic aqueductal stent placement for the treatment of a trapped fourth ventricle. J Neurosurg 2006;105:275-280. https://doi.org/10.3171/ped.2006.105.4.275
• 31. Schroeder HWS, Oertel J, Gaab MR. Endoscopic aqueductoplasty in the treatment of aqueductal stenosis. Childs Nerv Syst 2004;20:821-827. https://doi.org/10.1007/s00381-004-0937-z
• 32. Nishiyama K. Hydrocephalus in pineal and tectal tumors. Pediatric Hydrocephalus 2019;783-796. https://doi.org/10.1007/978-3-319-27250-4_56
• 33. Oka K, Kin Y, Go Y, et al. Neuroendoscopic approach to tectal tumors: a consecutive series. J Neurosurg 1999;91:964-970. https://doi.org/10.3171/jns.1999.91.6.0964