The role of endoscopic biopsy and third ventriculostomy in the management of pineal region tumours

The best surgical strategy for treating patients with pineal tumours presenting with acute hydrocephalus remains undermined. During the past 17 years we have used transventricular endoscopic biopsy and third ventriculostomy as a onestep procedure in the initial management of these cases, and present the largest consecutive case series illustrating the value of this technique. We have successfully managed 34 consecutive patients with pineal region tumours, carrying out third ventriculostomy in 18 patients. Histological diagnosis was obtained in 32/34 (94%) of the cases. There were no deaths or major complications and only one patient required a ventriculo-peritoneal shunt owing to ventriculostomy failure. According to current management protocols and depending on histology, tumours were treated by a combination of resection via craniotomy followed by radiotherapy or chemotherapy, or by the latter therapies alone. This one step procedure is minimally invasive and safely achieves adequate biopsy with control of hydrocephalus, whilst definitive histology and biochemical marker studies are obtained. Definitive treatment for each tumour is designed according to diagnosis.