Endoscopic management of a pineal and suprasellar germinoma with associated hydrocephalus: technical case report

A patient with a synchronous pineal and suprasellar germinoma and symptomatic hydrocephalus underwent a minimally invasive endoscopic biopsy and third ventriculostomy. We performed multiple biopsies of both tumors and fenestration of the floor of the third ventricle with a flexible fiberoptic endoscope through a single burr hole. Postoperative quantitative cine-mode magnetic resonance imaging (MRI) confirmed the patency of the fenestration. Selected pineal/posterior third ventricle region tumors, especially radiosensitive germinomas, could be treated with this approach thereby obviating the need for either stereotactic or craniotomy/open biopsy and the subsequent placement of a permanent cerebrospinal fluid (CSF) shunt. The endoscopic approach to tumors in the pineal/posterior third ventricle region provides an accurate straightforward, and safe method of obtaining a diagnosis and treating the associated increased intracranial pressure.