Endoscopic third ventriculocisternostomy for brainstem tumors

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Object

The authors retrospectively reviewed the charts of all patients harboring brainstem tumors treated at their institution, excluding those with tectal gliomas, who underwent an endoscopic third ventriculocisternostomy.

Methods

Endoscopic third ventriculocisternostomy was performed in 13 patients with tumors involving the brainstem: nine patients with diffuse pontine gliomas, two with posterior fossa ependymomas, one with a cervicomedullary tumor, and one with a pontine primitive neuroectodermal tumor. No technical difficulties attributable to the location of the tumors or surgery-related complications were encountered. Immediate symptomatic relief of hydrocephalus was achieved in all patients, and there was an associated decrease in steroid and analgesic agent requirements. Only one patient eventually required a shunt.

Conclusions

Endoscopic third ventriculocisternostomy can be used in the terminal treatment of patients with brainstem tumors, yielding good results without significant surgical morbidity.

Abbreviations used in this paper:BA = basilar artery; CSF = cerebrospinal fluid; DPG = diffuse pontine glioma; ETVC = endoscopic third ventriculocisternostomy; ICP = intracranial pressure; MR = magnetic resonance; VP = ventriculoperitoneal.

Article Information

Address reprint requests to: Liliana C. Goumnerova, M.D., Department of Neurosurgery, Bader–3, Children’s Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115. email: Liliana.Goumnerova@tch.harvard.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Sagittal(left) and axial(right) T2-weighted MR images showing a diffuse, infiltrative astrocytoma within the pons, reducing the subarachnoid space adjacent to the BA and clivus. Note how the tumor is engulfing the BA.

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