Department of Neurosurgery, National Cancer Institute IFO-Regina Elena, Roma, Italy.
Neurosurg Focus. 2011 Apr;30(4):E2. doi: 10.3171/2011.1.FOCUS10326.
Although neuroendoscopic biopsy is routinely performed, the safety and validity of this procedure has been studied only in small numbers of patients in single-center reports. The Section of Neuroendoscopy of the Italian Neurosurgical Society invited some of its members to review their own experience, gathering a sufficient number of cases for a wide analysis.
Retrospective data were collected by 7 centers routinely performing neuroendoscopic biopsies over a period of 10 years. Sixty patients with newly diagnosed intraventricular and paraventricular tumors were included. No patient harboring a colloid cyst was included. Data regarding clinical presentation, neuroimaging findings, operative techniques, pathological diagnosis, postoperative complications, and subsequent therapy were analyzed.
In all patients, a neuroendoscopic tumor biopsy was performed. In 38 patients (64%), obstructive hydrocephalus was present. In addition to the tumor biopsy, 32 patients (53%) underwent endoscopic third ventriculostomy (ETV), and 7 (12%) underwent septum pellucidotomy. Only 2 patients required a ventriculoperitoneal shunt shortly after the endoscopy procedure because ETV was not feasible. The major complication due to the endoscopy procedure was ventricular hemorrhage noted on the postoperative images in 8 cases (13%). Only 2 patients were symptomatic and required medical therapy. Infection occurred in only 1 case, and the other complications were all reversible. In no case did clinically significant sequelae affect the patient's outcome. Tumor types ranged across the spectrum and included glioma (low- and high-grade [27%]), pure germinoma (15%), pineal parenchymal tumor (12%), primary neuroectodermal tumor (4%), lymphoma (9%), metastasis (4%), craniopharyngioma (6%), and other tumor types (13%). In 10% of patients, the pathological findings were inconclusive. According to diagnosis, specific therapy was performed in 35% of patients: 17% underwent microsurgical removal, and 18% underwent chemotherapy or radiotherapy.
This is one of the largest series confirming the safety and validity of the neuroendoscopic biopsy procedure. Complications were relatively low (about 13%), and they were all reversible. Neuroendoscopic biopsy provided meaningful pathological data in 90% of patients, making subsequent tumor therapy feasible. Cerebrospinal fluid pathways can be restored by ETV or septum pellucidotomy (65%) to control intracranial hypertension. In light of the results obtained, a neuroendoscopic biopsy should be considered a possible alternative to the stereotactic biopsy in the diagnosis and treatment of ventricular or paraventricular tumors. Furthermore, it could be the only surgical procedure necessary for the treatment of selected tumors.
神经内镜活检已常规开展，但该操作的安全性和有效性仅在单中心报告的少数患者中进行了研究。意大利神经外科学会神经内镜分会邀请部分成员回顾其经验，收集了足够数量的病例进行广泛分析。
7 家常规行神经内镜活检的中心回顾性收集了 10 年的数据。纳入 60 例新诊断的脑室和脑室旁肿瘤患者。未纳入存在胶样囊肿的患者。分析了患者的临床表现、神经影像学表现、手术技术、病理诊断、术后并发症和后续治疗。
所有患者均行神经内镜肿瘤活检。38 例（64%）患者存在梗阻性脑积水。除肿瘤活检外，32 例（53%）患者行内镜第三脑室造瘘术（ETV），7 例（12%）患者行透明隔切开术。仅 2 例患者因 ETV 不可行，内镜术后需立即行脑室-腹腔分流术。内镜术后，8 例（13%）患者术后影像学检查见脑室出血，为主要并发症。仅有 2 例患者出现症状，需要药物治疗。仅发生 1 例感染，其他并发症均为可逆性。无一例发生有临床意义的后遗症影响患者预后。肿瘤类型广泛，包括胶质瘤（低级别和高级别[27%]）、纯生殖细胞瘤（15%）、松果体实质肿瘤（12%）、原发性神经外胚层肿瘤（4%）、淋巴瘤（9%）、转移瘤（4%）、颅咽管瘤（6%）和其他肿瘤类型（13%）。10%的患者病理结果不明确。根据诊断，35%的患者进行了特定治疗：17%行显微镜下切除，18%行化疗或放疗。
这是确认神经内镜活检操作安全性和有效性的最大系列之一。并发症相对较低（约 13%），且均为可逆性。神经内镜活检为 90%的患者提供了有意义的病理数据，使后续肿瘤治疗成为可能。通过 ETV 或透明隔切开术（65%）恢复脑脊液通路，以控制颅内压增高。鉴于研究结果，神经内镜活检应考虑作为脑室或脑室旁肿瘤诊断和治疗的立体定向活检的一种可能替代方法。此外，对于某些特定肿瘤，它可能是唯一必要的手术。
