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  • Title: Neuroendoscopic management of posterior third ventricle ependymoma with intraaqueductal and fourth ventricle extension: a case report and review of the literature.
    Author: Prat-Acín R, Evangelista R, Conde R, Ayuso-Sacido A, Galeano I.
    Journal: Childs Nerv Syst; 2017 Nov; 33(11):2057-2060. PubMed ID: 28721597.
    Abstract:
    INTRODUCTION: Posterior third ventricle ependymomas with intraaqueductal extension are relatively infrequent lesions. Its surgical management represents a formidable technical challenge and includes a wide variety of approaches. Minimally invasive surgery including the endoscopic management can play a crucial role to obtain an optimal clinical outcome. PATIENTS AND METHODS: We report the clinical outcome of an 11-year-old female patient with a 6-year history of recurrent episodes of headache and vomiting. On brain MRI a posterior third ventricle lesion with extension to the aqueduct of Sylvius and fourth ventricle, and associated hydrocephalus was observed. RESULTS: Our management of the lesion included a two-step endoscopic surgery: first an anterior third ventriculostomy and biopsy of the lesion that was reported to be a low-grade ependymoma, and posteriorly an endoscopic-assisted resection of the lesion. Clinical outcome was optimal without neurological sequelae. The postoperative MRI showed a thickened ependymal area on the tumor base of implantation. It was considered to be a remnant of the lesion and subsequently treated with radiotherapy. CONCLUSION: Posterior third ventricle ependymomas with intraaqueductal extension can be endoscopically managed to obtain a successful outcome.
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