Abordaje endoscópico al atrio ventricular para toma de biopsia de tumor de la región pineal: a propósito de un caso / Endoscopic approach to ventricular atrium for biopsy of pineal region tumour: Case report

INTRODUCCIÓN: El abordaje endoscópico habitual para el manejo diagnóstico y terapéutico de los tumores pineales es a través del asta frontal del ventrículo lateral introduciendo el endoscopio por el agujero de Monro. Presentamos el caso de un paciente con esta patología en el que se realizó toma de biopsia de la lesión a través de la fisura coroidea mediante un acceso endoscópico al atrio ventricular. Caso clínico: Paciente varón de 25 años de edad que comienza con cefalea y diplopía. Al examen físico se constata signo de Parinaud y papiledema. La resonancia magnética demostró una lesión ocupante de la región pineal asociada a hidrocefalia. Inicialmente por vía endoscópica habitual (acceso frontal) se trató la hidrocefalia y se tomó biopsia del tumor. El espécimen tisular no fue útil, por lo que se planificó un segundo procedimiento endoscópico para la toma de tejido tumoral a través de la fisura coroidea introduciendo el endoscopio a través del atrio. CONCLUSIONES: El abordaje a los tumores pineales a través del atrio ventricular, mediante un agujero parietal, realizando apertura de la fisura coroidea permite la toma directa de biopsia, con una trayectoria endoscópica única, sin necesidad de atravesar otras estructuras neurales

INTRODUCTION: The usual endoscopic approach in the management of pineal region tumoursconsists of inserting the scope into the frontal horn of the lateral ventricle and advancing itthrough the foramen of Monro into the third ventricle. We report the case of a patient with a pineal tumour on whom we used an endoscopic approach through the ventricular atriumto obtain a biopsy by opening the choroidal fissure. CLINICAL CASE: This young 25-year-old man presented with headache and double vision. Papilloedema and Parinaud’s syndrome were found on physical examination. Cranial magneticresonance revealed a pineal mass and hydrocephalus. We initially performed a third ventriculostomy and a tumour biopsy through a frontal burr hole. The tissue sample was not useful for pathological diagnosis and we decided to perform a second endoscopic biopsy. CONCLUSIONS: The endoscopic approach to pineal region masses, reaching the ventricular atrium through a parietal burr hole and opening the choroidal fissure, makes it possible to take a biopsy using a single endoscopic approach without needing to cross other ventricular structures

[Endoscopic approach to ventricular atrium for biopsy of pineal region tumour: case report]. / Abordaje endoscópico al atrio ventricular para toma de biopsia de tumor de la región pineal: a propósito de un caso.

INTRODUCTION: The usual endoscopic approach in the management of pineal region tumours consists of inserting the scope into the frontal horn of the lateral ventricle and advancing it through the foramen of Monro into the third ventricle. We report the case of a patient with a pineal tumour on whom we used an endoscopic approach through the ventricular atrium to obtain a biopsy by opening the choroidal fissure. CLINICAL CASE: This young 25-year-old man presented with headache and double vision. Papilloedema and Parinaud's syndrome were found on physical examination. Cranial magnetic resonance revealed a pineal mass and hydrocephalus. We initially performed a third ventriculostomy and a tumour biopsy through a frontal burr hole. The tissue sample was not useful for pathological diagnosis and we decided to perform a second endoscopic biopsy. CONCLUSIONS: The endoscopic approach to pineal region masses, reaching the ventricular atrium through a parietal burr hole and opening the choroidal fissure, makes it possible to take a biopsy using a single endoscopic approach without needing to cross other ventricular structures.