Introduction: Histopathological investigation is basically essential in the management of brain tumors. However, some cases are not suitable to surgery with great extent of resection because of its location. Previously we had undertaken stereotaxic biopsy for deep-seated lesions which were not easily resected via open craniotomy. With development of computerized imaging, stereotaxic surgery has been established its role as useful and less invasive procedure, however, some problems are to be considered, for example, impossibility in direct observation of the lesion and in immediate adjustment of the target.
Methods: Retrospective chart review.
Results: Recently, we have introduced the endoscope into brain tumor biopsy for not only intra- and para-ventricular but also intraparenchymal lesion with assistance by surgical navigation system. Endoscopic surgery provides clear view of the target, and makes it easier to differentiate the tumor tissue from normal brain. Intra-operative histological investigation helped us adjust the region of biopsy when the difference between those tissues was minimal, and this adjustment was easily done by manual maneuver for the endoscopic sheath. Furthermore, endoscope helped us confirm hemostasis during the procedure, and enabled the simultaneous ventriculostomy for the cases with hydrocephalus associated with intra- and para-ventricular tumors. In the last six years, thirty cases underwent this procedure, and we obtained accurate histological and, when required, genetic diagnosis for all the tumors resected via endoscopic surgery.
Conclusions: We conclude that the endoscopic biopsy is more effective than stereotaxic biopsy in terms of reliability and safety, and that its role in the management of brain tumors should be widely acknowledged.
Patient Care: Hospital stay and cost will be shortened. Moreover, physical damage of patients will be reduced.
Learning Objectives: To obtain information on the safety and efficacy of endoscope-assisted tumor biopsy