Introduction: Endoscopy has been applied for the management of pineal tumors and the associated obstructive hydrocephalus. The techniques include endoscopic third ventriculostomy (ETV), endoscopic biopsy, and endoscopicassisted open surgery of tumor in selected cases. The purpose of this study is to report our experience and techniques of endoscopic surgeries for pineal tumors in children. Methods: This is a retrospective review of 36 ETVs, 25 endoscopic transventricular biopsies (ETB), 2 endoscopic transnasal transsphenoid biopsies, and 5 endoscopic-assisted open resections of pineal tumors. Results: One patient died of delay tumor hemorrhage after ETV and ETB were excluded. With a mean follow-up period of 5.4 years, ETV failure occurred in 7 of 35 patients with long-term success rate of 80.0%. Histological diagnosis was established in 21 of 25 (84.0%) patients through ETBs. Tissue diagnosis was obtained in two selected patients with bifocal germ cell tumors by endsocopic transnasal transsphenoid approach to the intrasellar lesion. Direct radical resections were achieved in four of five selected patients of pineal tumors with hydrocephalus by endoscopic-assisted open surgery.
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