The role of tumor biopsy in children with obstructive hydrocephalus treated with endoscopic third ventriculostomy: a single-center experience

PURPOSE: We aimed to present and analyze our institutional experience with endoscopic third ventriculostomy (ETV), performed alone or in combination with simultaneous tumor biopsy, for the management of obstructive hydrocephalus in pediatric patients. METHODS: A retrospective analysis was conducted of the medical records of pediatric patients with tumor-related obstructive hydrocephalus who underwent ETV between 2013 and 2024. RESULTS: Thirty-five children underwent ETV at a mean age of 9.2 years. Hydrocephalus was most commonly associated with lesions located in the tectal plate (65.7%). In 12 cases (34.3%), ETV was combined with an endoscopic tumor biopsy. Over a median follow-up of 3.3 years, the overall ETV effectiveness was 82.9% (n = 29). Postoperative complications occurred in 7 patients (20.0%), with the most frequent being transient cerebrospinal fluid (CSF) leakage from the surgical wound (n = 3; 42.9%). Histological results of endoscopic tumor biopsy were successfully obtained from 10 of 12 (83.3%) samples. No statistically significant differences in rates of reoperation, shunt implantation, or tumor resection were observed between patients with ETV alone and those with ETV with biopsy. CONCLUSIONS: ETV is an effective treatment for tumor-related obstructive hydrocephalus in children that may be safely combined with endoscopic tumor biopsy in selected cases, enabling early histopathological diagnosis and timely initiation of oncological treatment while potentially reducing the need for subsequent open surgical procedures.