Introduction: Pineal tumours are an uncommon presentation to even the largest neurosurgical service. They will often present with pressure symptoms and signs of obstructive hydrocephalus. This hydrocephalus is usually amenable to endoscopic third ventriculostomy (ETV). Wherever possible, we aim to take biopsies of the lesion in question during the same procedure. These are limited by access and by the small biopsy forceps available for endoscopic use, as well as the associated crush artefact these induce. Thus, this project set out to evaluate the efficacy of biopsies taken in this matter.
Methods: Retrospective chart review of patients undergoing combined ETV and pineal biopsy between 2006 and 2015.
Results: Twenty two patients underwent combined ETV and biopsy of a pineal tumour. Definitive histological diagnoses could be made in 17 (77%) of the patients. All the patients who had a failed endoscopic biopsy subsequently underwent stereotactic biopsy and obtained definitive diagnosis.
Conclusions: Whilst stereotactic biopsy is, overall, a safe procedure, the option to treat raised intracranial pressure and obtain a histological diagnosis at the same sitting for minimal additional risk makes surgical sense. More than three quarters of patients could obtain an accurate diagnosis from endoscopic biopsy, despite small sample size and crush artefact, and this should be the first option in such patients, where the surgical and neuropathological expertise exists to make use of it.
Patient Care: This aims to better inform the success rate of endoscopic biopsy of pineal tumours.
Learning Objectives: By the conclusion of this session, participants should be aware of the feasibility and efficacy of endoscopic pineal biopsy when performed as a synchronous procedure.