Endoscopic removal of an intraventricular primitive neuroectodermal tumor: retrieval of a free-floating fragment using a urological basket retriever

Case report

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The endoscopic resection of intraventricular tumors represents a unique challenge to the neurological surgeon. These neoplasms are invested deep within the brain parenchyma and are situated among neurologically vital structures. Additionally, the cerebrospinal fluid system presents a dynamic pathway for resected tumors to be mobilized and entrapped in other regions of the brain. In 2011, the authors treated a 3-year-old girl with a third ventricular mass identified on stereotactic brain biopsy as a WHO Grade IV CNS primitive neuroectodermal tumor. After successful neoadjuvant chemotherapy, endoscopic resection was performed. Despite successful resection of the tumor, the operation was complicated by mobilization of the resected tumor and entrapment in the atrial horn of the lateral ventricle. Using a urological stone basket retriever, the authors were able to retrieve the intact tumor without additional complications. The flexibility afforded by the nitinol urological stone basket was useful in the endoscopic removal of a free-floating intraventricular tumor. This device may prove to be useful for other practitioners performing these complicated intraventricular resections.

Article Information

Address correspondence to: Scott L. Zuckerman, M.D., 1500 21st Avenue South, Suite 4340, Nashville, Tennessee 37212. email: scott.zuckerman@vanderbilt.edu.

Please include this information when citing this paper: published online April 26, 2013; DOI: 10.3171/2013.3.PEDS12392.

© AANS, except where prohibited by US copyright law.



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    A and B: T1-weighted Gd-enhanced slices from an MRI study of the brain demonstrating a solid mass with subependymal spread along the floor of the third ventricle. C and D: The same tumor (arrows) after 3 cycles of chemotherapy demonstrates significant reduction in tumor burden with residual intraventricular neoplasm on the anterior floor of the third ventricle.

  • View in gallery

    Left: Endoscopic view of intraventricular lesion embedded in gliotic tissue. Right: The gliotic tissue was excised with tumor intact prior to resection from the adjacent brain parenchyma.

  • View in gallery

    A–C: T1-weighted Gd-enhanced cuts from an MRI study demonstrating entrapment of nodular lesion in the atrium of the right lateral ventricle. D: T2-weighted slice from a driven equilibrium MRI study demonstrating the nodular lesion abutting the choroid plexus of the right lateral ventricle.

  • View in gallery

    Photographs of the nitinol stone basket retriever with flexible design and collapsible operative head.



Abdou MSCohen AR: Endoscopic treatment of colloid cysts of the third ventricle. Technical note and review of the literature. J Neurosurg 89:106210681998


Auer LM: Intraoperative ultrasound as guide for neurosurgical endoscopic procedures. Acta Radiol Suppl 369:1641661986


Boogaarts HDDecq PGrotenhuis JALe Guérinel CNseir RJarraya B: Long-term results of the neuroendoscopic management of colloid cysts of the third ventricle: a series of 90 cases. Neurosurgery 68:1791872011


Brailovski VTrochu F: Review of shape memory alloys medical applications in Russia. Biomed Mater Eng 6:2912981996


Chibbaro SDi Rocco FMakiese OReiss APoczos PMirone G: Neuroendoscopic management of posterior third ventricle and pineal region tumors: technique, limitation, and possible complication avoidance. Neurosurg Rev 35:3313402012


Cremonesi ACastriota F: Efficacy of a nitinol filter device in the prevention of embolic events during carotid interventions. J Endovasc Ther 9:1551592002


Duffner PKHorowitz MEKrischer JPBurger PCCohen MESanford RA: The treatment of malignant brain tumors in infants and very young children: an update of the Pediatric Oncology Group experience. Neuro Oncol 1:1521611999


Gaab MRSchroeder HW: Neuroendoscopic approach to intraventricular lesions. Neurosurg Focus 6:4e51999


Grondin RTHader WMacRae MEHamilton MG: Endoscopic versus microsurgical resection of third ventricle colloid cysts. Can J Neurol Sci 34:1972072007


Harris AEHadjipanayis CGLunsford LDLunsford AKKassam AB: Microsurgical removal of intraventricular lesions using endoscopic visualization and stereotactic guidance. Neurosurgery 56:1 Suppl1251322005


Hellwig DBauer BLSchulte MGatscher SRiegel TBertalanffy H: Neuroendoscopic treatment for colloid cysts of the third ventricle: the experience of a decade. Neurosurgery 52:5255332003


Honey RJ: Assessment of a new tipless nitinol stone basket and comparison with an existing flat-wire basket. J Endourol 12:5295311998


Jho HDAlfieri A: Endoscopic removal of third ventricular tumors: a technical note. Minim Invasive Neurosurg 45:1141192002


Lafay-Cousin LStrother D: Current treatment approaches for infants with malignant central nervous system tumors. Oncologist 14:4334442009


Lejay AThaveau FGirsowicz EGeorg YHeim FDurand B: Stent evolution for peripheral arterial disease. J Cardiovasc Surg (Torino) 53:1 Suppl 11711792012


Oppido PAFiorindi ABenvenuti LCattani FCipri SGangemi M: Neuroendoscopic biopsy of ventricular tumors: a multicentric experience. Neurosurg Focus 30:4E22011


Qiao LSouweidane MM: Purely endoscopic removal of intraventricular brain tumors: a consensus opinion and update. Minim Invasive Neurosurg 54:1491542011


Schirmer CMHeilman CB: Complete endoscopic removal of colloid cyst using a nitinol basket retriever. Neurosurg Focus 30:4E82011


Senft CForster MTBink AMittelbronn MFranz KSeifert V: Optimizing the extent of resection in eloquently located gliomas by combining intraoperative MRI guidance with intraoperative neurophysiological monitoring. J Neurooncol 109:81902012


Senft CSeifert VHermann EFranz KGasser T: Usefulness of intraoperative ultra low-field magnetic resonance imaging in glioma surgery. Neurosurgery 63:4 Suppl 22572672008


Sood SHoeprich MHam SD: Pure endoscopic removal of pineal region tumors. Childs Nerv Syst 27:148914922011


Souweidane MMLuther N: Endoscopic resection of solid intraventricular brain tumors. J Neurosurg 105:2712782006


Strowitzki MKiefer MSteudel WI: A new method of ultrasonic guidance of neuroendoscopic procedures. Technical note. J Neurosurg 96:6286322002


Van Poppel MKlimo P JrDewire MSanford RABoop FBroniscer A: Resection of infantile brain tumors after neoadjuvant chemotherapy: the St. Jude experience Clinical article. J Neurosurg Pediatr 8:2512562011


Zada GLiu CApuzzo ML: “Through the looking glass”: optical physics, issues, and the evolution of neuroendoscopy. World Neurosurg 77:921022012


Zamorano LChavantes CDujovny MMalik GAusman J: Stereotactic endoscopic interventions in cystic and intraventricular brain lesions. Acta Neurochir Suppl (Wien) 54:69761992




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