Intracranial Tumors: Treatment with Endoscopic Neurosurgery

Abstract

Neuroendoscopy is presently a routine procedure in most neurosurgical services. It was originally developed to deal with obstructive hydrocephalus, but modern technical advancements have made possible to face also other neurological diseases including brain tumors. Presently, small endoscopes with exquisite detail visualization, high resolution screens, 3D cameras, dedicated ultrasonic aspirators and laser beams offer therapeutic options which could be just dreamed a few years ago. The friendly interface with image-guided systems further improves the technique. Nowadays, the golden standard treatment of ventricular tumors includes biopsy under endoscopic control and (if necessary) treatment of the associated hydrocephalus during the same procedure. Endoscopic biopsy may be followed (if indicated) by traditional microsurgery, but it may also remain the only surgical procedure needed since several midline tumors either do not require surgical excision or may be managed by radiosurgery, chemotherapy, and/or radiation-therapy. Another endoscopic option is the fenestration/aspiration of cystic space occupying lesions. This technique may result very useful in selected cases of craniopharyngioma, metastases, abscesses and cystic tumors in general. This treatment aims to the endoscopic cyst shrinkage followed by radiosurgery or other adjunctive therapies. Moreover, there are particular expansive lesions which may be even endoscopically excised. This is especially the case of 3rd ventricle colloid cysts, for which endoscopy has become the first choice treatment in a lot of neurosurgical units. Finally, most CSF-cysts (arachnoid, choroid, ependymal, post-surgical, post-hemorrhagic) may be endoscopically treated thus avoiding open surgery or cysto-peritoneal shunting.