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Bart Depreitere, Neermala Dasi, James Rutka, Peter Dirks, and James Drake

interface. Endoscopic biopsy as a first procedure is even more appealing to treat intraventricular tumors causing obstructive hydrocephalus, which in some cases can be treated by simultaneous ETV and/or septostomy. Moreover, a subset of tumors in children does not require aggressive surgical removal, and the endoscopic procedure may be the only tumor surgery needed. These considerations play a role in decisions regarding individual patients' treatment. On the other hand, when considering whether or not to perform an endoscopic biopsy in the context of a newly diagnosed

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Edward S. Ahn and Liliana Goumnerova

fenestration. For example, in the management of pineal region tumors that cause obstructive hydrocephalus, it is common to treat them initially with an ETV along with an endoscopic biopsy. Germinomas and NGGCTs in this region, for instance, can be effectively treated with adjuvant therapy alone after successful tumor diagnosis and treatment of hydrocephalus ( Fig. 1 ). 6 , 12 F ig . 1. Images obtained in a 19-year-old man who presented with headaches, blurry vision, and vomiting. Left: Sagittal T1-weighted MR image with Gd enhancement revealed a large pineal mass

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Justin F. Fraser, Vijay K. Anand, and Theodore H. Schwartz

remains fundamental, while surgical intervention is typically reserved for patients with neurological symptoms related to mass effect or evidence of spinal instability. However, Jacobs et al. 6 reported on a patient with an unstable odontoid fracture secondary to gout and spastic quadriparesis who refused surgery and improved dramatically with medical therapy. Conclusions Tophaceous gout of the odontoid process, although rare, is important to consider in a patient with a history of gout who presents with an inflammatory mass in the odontoid process. Endoscopic

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Donncha F. O’Brien, Caroline Hayhurst, Barry Pizer, and Conor L. Mallucci

: 233 – 242 , 1993 10.1159/000120738 18 Pople IK , Athanasiou TC , Sandeman DR , Coakham HB : The role of endoscopic biopsy and third ventriculostomy in the management of pineal region tumors . Br J Neurosurg 15 : 305 – 311 , 2001 10.1080/02688690120072441 19 Quigley M , Riegel D , Kortyna R : Cerebrospinal fluid shunt infections. Report of 41 cases and a critical review of the literature . Pediatr Neurosci 15 : 111 – 120 , 1989 10.1159/000120455 20 Regis J , Bouillot P , Figarella-Branger D , Dufour H , Levrier O

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Neal Luther, William R. Stetler Jr., Ira J. Dunkel, Paul J. Christos, John C. Wellons III, and Mark M. Souweidane

, cells are disseminated into the CSF. This wide dispersal has been documented during the resection of brain metastases. 43 Furthermore, when an endoscopic biopsy or partial resection is performed, a limited amount of the tumor is removed as compared with that debulked in cytoreductive surgery, and thus a relatively larger tumor burden is retained. 35 This point is particularly problematic in primary CNS germ cell tumors of the pineal region, where limited or involved-field irradiation is commonly used as a therapeutic option. The notion of an iatrogenic conduit for

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Aaron Mohanty, Vani Santosh, B. Indira Devi, Satyanarayana Satish, and Arundhati Biswas

A variety of pathologies are often encountered in paraventricular and intraventricular tumors. Their deep locations inside the brain often make these lesions difficult to access microsurgically. Because the tumors often obstruct the CSF pathways, they are accompanied by ventriculomegaly, requiring a CSF diversion procedure in either the preoperative or the postoperative period. Given their proximity to the ventricular system, these tumors can often be accessed neuroendoscopically. In 1978 Fukushima 5 was one of the first to describe an endoscopic biopsy

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Alexandre Varella Giannetti, Alexandre Yugo Holayama Alvarenga, Thiago Oliveira Lemos de Lima, Hugo Abi-Sáber Rodrigues Pedrosa, and Mark M. Souweidane

the final analysis for accuracy. The endoscopic biopsy was considered accurate when it met the following criteria: 1) histopathological diagnosis matched that of the sample obtained during craniotomy; 2) the response to the treatment was consistent with the diagnosis; and 3) the follow-up symptoms and images were compatible with the diagnosis. The endoscopic biopsy was considered inaccurate when any of the following were true: 1) the new sample obtained during craniotomy suggested a new diagnosis or substantial change in tumor grade (thereby indicating changes that

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Rainer Ritz, Guenther C. Feigl, Martin U. Schuhmann, André Ehrhardt, Soeren Danz, Susan Noell, Antje Bornemann, and Marcos S. Tatagiba

-sided hemiparesis with spasticity. Magnetic resonance imaging showed a poorly delineated contrast-enhancing mass with necrosis, a cystic formation, and a thick irregular wall in the midbrain and thalamus consecutively causing an occlusive hydrocephalus. Fluorescence-Guided Endoscopic Biopsy and Ventriculocisternostomy Preoperatively, T1-weighted 3D magnetization-prepared rapid gradient echo MR imaging with and without contrast enhancement was performed using fiducials on the patient's head as reference points for the neuronavigation system. Images were loaded into the CBYON

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Nakamasa Hayashi, Hisayuki Murai, Shoichiro Ishihara, Takayuki Kitamura, Tamotsu Miki, Tomoru Miwa, Masakazu Miyajima, Kenichi Nishiyama, Takayuki Ohira, Shigeki Ono, Tomonari Suzuki, Shingo Takano, Isao Date, Naokatsu Saeki, and Shunro Endo

paraventricular tumors. A nationwide investigation by the case registration method has therefore been planned to investigate cases of intra- and paraventricular tumors in which endoscopic biopsy was performed. We attempted to obtain evidence of the diagnostic accuracy and safety of endoscopic tumor biopsy as well as the usefulness of neuroendoscopy for associated hydrocephalus. Methods This was an observational study by retrospective investigation of relevant cases, and it was approved by the administrative committee of the Japanese Society of Neuroendoscopy. All

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Piero Andrea Oppido, Alessandro Fiorindi, Lucia Benvenuti, Fabio Cattani, Saverio Cipri, Michelangelo Gangemi, Umberto Godano, Pierluigi Longatti, Carmelo Mascari, Enzo Morace, and Luigino Tosatto

tumor 5 inconclusive 6 Following diagnosis of the biopsy specimen, 21 patients (35%) underwent a specific treatment regimen: 10 (17%) underwent surgical removal, while 11 (18%) (with pure germinoma or lymphoma) were treated using chemotherapy or radiotherapy alone. Complications Due to the nature of the endoscopic procedure, no mortality or permanent morbidity was reported. On postoperative imaging, 8 patients (13%) presented with intraventricular hemorrhagic complications due to endoscopic biopsy. In 4 (50%) of these, the hemorrhage was related to