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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Figures

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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.

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    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.

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    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.

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

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