CLINICAL ARTICLE A restricted neuroendoscopic approach for pathological diagnosis of intraventricular and paraventricular tumours Alessandro Fiorindi & Pierluigi Longatti Received: 24 April 2008 / Accepted: 21 October 2008 / Published online: 11 November 2008 # Springer-Verlag 2008 Abstract Background There is increasing interest in the use of neuroendoscopic techniques in neuro-oncology. We report our experience of endoscopic biopsy in patients harbouring intraventricular and paraventricular brain tumours in order to define criteria for the use of this technique. Methods We identified 23 patients (aged 7–78 years) who underwent endoscopic biopsy for intraventricular or para- ventricular lesions considered not suitable for surgical removal and too risky for a stereotactical approach. All of the biopsies were obtained with a flexible endoscope using a free-hand technique. Findings In 16 patients specimens were adequate and led to a diagnosis; in three patients they were informative but not completely diagnostic; a pathological diagnosis was un- available in four patients. In 13 patients with a lesion causing an obstruction of the aqueduct, a third ventriculostomy was performed during the same procedure; in one patient with a lesion occluding the Monro foramen, a septostomy was done, while in another case multiple cystostomies were required. No specific complications were observed, either clinically or radiologically, in particular no major bleeding occurred. Conclusions In our experience, endoscopic biopsy could provide a pathological diagnosis in 19 of 23 patients. Endoscopic biopsy sampling sufficient tissue should be considered as the first choice in selected lesions that are otherwise difficult to approach. Keywords Endoscopic biopsy . Hydrocephalus . Indications . Intraventricular tumour . Neuroendoscopy Introduction Since the first report by Fukushima of an intraventricular method of tumour biopsy [4, 5], neuroendoscopy has extended its use. Its proper and precise role is, however, unclear. This is because of the lack of dedicated instruments, particularly for tumour removal [1]. Nevertheless it is generally considered an appropriate method, especially when hydrocephalus is associated [3, 6, 8]. An extra advantage is that some authors have reported more or less complete removal of small tumours or malformations endoscopically [6, 11]. We report a consecutive series of patients with an intraventricular or paraventricular tumour, in order to attempt to define the use of criteria for endoscopy. Patients and methods We retrospectively analyzed 23 patients (aged 7–78 years) who underwent endoscopic biopsy for an intraventricular or paraventricular lesion. The technique was applied in seven patients with an intraventricular tumour and in 16 with a paraventricular lesion extending into the ventricles. 11 lesions were in the tectal–pineal region, two in the infundibulum and one in thalamic, prepontine and diffuse multifocal lesion, respectively. All but two of the lesions (patient 2 and patient 18) were considered unsuitable for stereotactic biopsy or open surgery, due either to position or diffusion (Figs. 1, 2 and 3). Our experience with benign intracranial cysts and colloid cysts of the third ventricle (28 Acta Neurochir (2008) 150:1235–1239 DOI 10.1007/s00701-008-0155-7 A. Fiorindi (*) : P. Longatti Neurosurgical Department, Treviso Hospital, Padova University, P.le Ospedale, 31100 Treviso, Italy e-mail: alessandro.fiorindi@gmail.com