Neuronavigation-guided endoscopy for intraventricular tumors in adult patients without hydrocephalus

Introduction : Intraventricular endoscopic operations are usually undertaken in patients with an enlarged ventricular system that provides good access to the ventricles, proper anatomic orientation and safety of maneuvers within the ventricles. Aim : The preliminary assessment of the feasibility of endoscopic procedures in cases occurring without hydrocephalus. Material and methods: Eleven patients with intraventricular tumor diagnosed in neuroimaging studies were included in the study. None of these cases was accompanied by hydrocephalus. Surgery was performed with a rigid neuroendoscope using a neuronavigation system. The purpose of the operation was tumor removal or histological verification. Results : The colloid cyst of the third ventricle was removed in 5 patients. In 1 patient a glial-derived tumor adjacent to the interventricular foramen was partially resected. In 1 case a tumor of the lateral ventricle was totally removed, and in another case the resection of such a tumor was partial. In 2 cases, a biopsy of the tumor of the posterior portion of the third ventricle was undertaken, while in 1 case the biopsy was abandoned due to the risk of injury of structures surrounding interventricular foramen. There were no intraoperative or postoperative complications. None of the patients developed hydrocephalus in the long-term follow-up. The results of treatment in the study group did not differ from those obtained in patients operated on with hydrocephalus. Conclusions : The presence of hydrocephalus is not necessary to perform endoscopic surgery. However, in each case it should be preceded by a thorough analysis of the feasibility of the endoscopic procedure and should be supported by a neuronavigation system

Endoscopic third ventriculostomy : effectiveness of the procedure for obstructive hydrocephalus with different etiology in adults

INTRODUCTION: After a time of domination of shunt placement, endoscopic third ventriculostomy (ETV) has been increasingly applied in treatment of obstructive hydrocephalus. AIM: To assess the effectiveness of ETV in treatment of adults with three-ventricle hydrocephalus of different etiology. MATERIAL AND METHODS: Ninety-six patients with obstructive hydrocephalus were studied: 24 with primary aqueductal stenosis, 61 with brain tumor, and 2 with basilar tip aneurysm. In 9 patients the etiology of hydrocephalus remained undetermined. The assessment of treatment results was based on clinical and radiological criteria. RESULTS: Clinical improvement was observed in 74 (77.1%) patients, and radiological improvement in 52 (54.2%). One patient died. Follow-up of 24 patients with primary aqueductal stenosis has shown that in 20 (83.3%) of them clinical improvement has been stable, and in 14 (58.3%) radiological improvement has been observed. Two patients required shunt placement due to hydrocephalus recurrence 12–24 months after the ETV procedure. Among 9 patients with undefined hydrocephalus, 3 required shunt placement within 6 months after ETV (2 shunted previously). Endoscopic third ventriculostomy treatment in a patient with hydrocephalus caused by basilar tip aneurysm succeeded. The assessment of ETV effectiveness in oncological patients has been indirect in view of the underlying disease. CONCLUSIONS: The best results of ETV treatment have been demonstrated for patients with primary aqueductal stenosis. Ventricle size cannot determine the effectiveness of treatment as an individual requirement. Endoscopic third ventriculostomy is effective in previously shunted patients although the prediction of outcome should be cautious. Endoscopic third ventriculostomy enables preparation for further therapy and is palliative treatment in oncological patients with secondary hydrocephalus

The reliability of the specimens for neuropathological evaluation in pituitary adenomas treated via transphenoidal route

Introduction: There are some discrepancies between immunohistochemical staining results and clinical picture of pituitary adenomas. Such a discordance may be caused by multiple factors. The problem of securing the histopathological material during the transsphenoidal pituitary surgery and its reliability for neuropathological evaluation deserves a special attention. The surgical biopsy does not always meet the criteria required for a immunohistochemical staining and sometimes not even for the routine histopatho-logical examination. Aims: To determine the frequency of unreliable material for histopathological examination and factors influencing the reliability of histopathological specimens after surgery for pituitary adenomas. Material and methods: The hematoxylin and eosin sections were examined in detail. with a special attention to the presence of incidental findings, i.e. admixture of normal pituitary gland tissue, signs of hemorrhage, necrosis, thermal artifacts, inflammatory changes, respiratory epithelium, vessels or cholesterol granuloma. The impact of incidental findings on further immunohistochemical analysis was investigated. The relationship between the magnetic resonance imaging (MRI)- determined tumor size and the area of histopathological specimen was assessed and considered as a reliability parameter. Results: The unreliable material was estimated at the level of 11.8%. It was assessed that hemorrhages, neurohypophysis, necrosis and quantity of collected histopathological material had the statistically sig-nificant impact on the reliability of the histopathological material. The statistical analysis did not show any relation between the reliability of the histopathological material and the MRI-determined volume of the tumor. Conclusions: The presence of some additional tissue elements and artifacts in the histopathological specimen makes the immunohistochemical evaluation difficult or even impossible. However, this problem is related to a relatively low percentage of cases, mainly small tumors

Związek między inwazyjnością gruczolaków przysadki a indeksem proliferacyjnym mierzonym immunoekspresją topoizomerazy IIα

Introduction: Cavernous sinus invasion by pituitary adenoma affects surgical procedure radicality and consequently the postoperative course and prognosis in pituitary adenoma treatment. The search for pituitary adenoma aggressive behaviour markers is still a matter of debate. Material and methods: This study evaluates the relation of pituitary adenoma invasiveness to the expression of topoisomerase IIα in 72 patients who underwent transsphenoidal pituitary surgery. The assessment of tumour growth was conducted according to the Hardy scale as modified by Wilson and the Knosp scale. Topoisomerase IIα expression in tumour specimens was evaluated using immunohistochemical staining. Results: There was a correlation between the Knosp scale degree and the topoisomerase IIα expression (Spearman R = 0.3611, p &lt; 0.005). The Kruskal-Wallis H test (p = 0.0034) showed that there was a statistically significant topoisomerase IIα expression increase in tumours classified as grade E on the Hardy scale. The topoisomerase IIα expression correlated also with tumour size (Spearman R = 0.4117, p &lt; 0.001). Higher levels of expression were observed in macroadenomas, as compared to microadenomas (p &lt; 0.05, Mann-Whitney test). Topoisomerase IIα expression correlated with cavernous sinus invasion. Conclusions: The topoisomerase IIα expression correlated more with invasiveness than with extensiveness, which might make it an eminently useful marker in the assessment of aggressive pituitary adenoma behaviour.Introduction. Cavernous sinus invasion by pituitary adenoma affects surgical procedure radicality, and consequently the postoperative course and prognosis in pituitary adenomas treatment. The search for pituitary adenoma aggressive behaviour markers is still a matter of debate. Material and methods. This study evaluates the relation of pituitary adenoma invasiveness to the expression of topoisomerase IIα in 72 patients who underwent transsphenoidal pituitary surgery. The assessment of tumour growth was conducted according to the Hardy scale as modified by Wilson and the Knosp scale. Topoisomerase IIα expression in tumours specimens was evaluated using immunohistochemical staining. Results. There was a correlation between the Knosp scale degree and the topoisomerase IIα expression (Spearman R=0.3611, p < 0.005). The Kruskal-Wallis H test (p=0.0034) showed that there was a statistically significant topoisomerase IIα expression increase in tumours classified as grade E on the Hardy scale. The topoisomerase IIα expression correlated also with tumour size (Spearman R=0.4117, p < 0.001). Higher levels of expression were observed in macroadenomas, as compared to microadenomas (p < 0.05, Mann-Whitney test). Topoisomerase IIα expression correlated with cavernous sinus invasion. Conclusions. The topoisomerase IIα expression correlated more with invasiveness than with extensiveness, which might make it an eminently useful marker in the assessment of aggressive pituitary adenoma behaviour