O5.09VENTRICULAR HIGH GRADE GLIOMA: NEUROENDOSCOPY AND ADJUVANT THERAPY

INTRODUCTION: In ventricular high grade glioma the obstructive hydrocephalus and the subsequent neurological worsening are usually the limit for chemotherapy and radiotherapy. Recently, in ventricular tumours causing obstructive hydrocephalus neuroendoscopy has gained even more appeal as a first choice procedure since it is possible to simultaneously perform tumour biopsy and endoscopic third ventriculostomy (ETV) or septostomy. The immediate relief of intracranial hypertension and the availability of specimens for a pathological diagnosis allow time for planning the most suitable treatment strategy based on histological diagnosis and CSF tumour markers. METHODS: Since 2001 in 35 patients affected by hydrocephalus due to a ventricular tumour the neuroendoscopic biopsy was performed. In 15 patients ( age 17 - 79 yrs) the NMR showed hydrocephalus due to an infiltrating tumour with contrast enhancement: in 7 inside the third ventricle, in 8 inside the lateral ventricle. In all patients the clinical signs of progressive intracranial hypertension at admission were present. After neuroendoscopy and histological diagnosis radiotherapy and/or chemotherapy were performed. RESULTS: In 14 patients the biopsy was performed, while in one case of occipital corn tumour was abandoned. In 9 cases tumour biopsy the Tu laser for bleeding control and tumour ablation was used. The histology was: in 10 GBM, in 1 malignant PNET, in 1 malignant xanthoastrcytoma, in 1 anaplastic ependymoma, 1 metastasis. During the same neuroendoscopic procedure in 7 cases the third ventricolostomy (ETV) and in 4 the septostomy were realized. In 12 patients the clinical outcome improved and radiotherapy and chemotherapy were possible. The median overall survival was 4 months (2 - 12) for progression disease. CONCLUSION: Based on our experience, the neuroendoscopic biopsy should be considered in the diagnosis and therapy of ventricular tumours, allowing subsequent tumor therapy. Furthermore, CSF pathways can be restored by ETV or septostomy to control intracranial hypertension. By improving the clinical outcome radiotherapy and /or chemotherapy in high grade glioma is possible.