Stereotactically Guided Endoscopic Port Surgery for Intraventricular Tumor and Colloid Cyst Resection

Engh, Johnathan A.; Lunsford, L. Dade; Amin, Devin V.; Ochalski, Pawel G.; Fernández-Miranda, Juan C.; Prevedello, Daniel M.; Kassam, Amin

doi:10.1227/01.neu.0000382974.81828.f9

Cited by 37 publications

(41 citation statements)

References 36 publications

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“…There is increased range of viewing angles of the endoscope that facilitates resection of the cyst through a smaller opening. A transparent retractor provides a safer and effective alternative that is not limited by the vascularity, friability, or size of the lesions (15). A Nd:YAG laser can be used for total removal of third ventricle colloid cysts without any increase in morbidity (44).…”

Section: Intra-ventricular Bleedingmentioning

confidence: 99%

Management of colloid cyst of third ventricle

Yadav

Yadav²,

Parihar³

et al. 2014

Turkish Neurosurgery

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Colloid cysts are usually located in third ventricle and are believed to be derived from either primitive neuroepithelium or endoderm. Patients may remain asymptomatic for long time while some can present with paroxysmal headache, gait disturbance, nausea, vomiting, behavioral changes, weaknesses of lower limbs, impaired memory, new learning disability and sudden death. Computed tomography usually reveals a well-defined round or oval nonenhancing lesion. Although magnetic resonance imaging (MRI) signal intensity of colloid cysts is variable, the most common appearance is hyperintensity in T1-weighted sequences and iso to hypointensity in T2-weighted sequences. Observation, stereotactic aspiration, microscopic or endoscopic approaches and shunt surgery are various management options. Transcallosal and transcortical microscopic (with or without tubular retractor) approaches are mainly useful in normal-sized and dilated ventricles respectively. Endoscopic technique is an effective alternative to microsurgical technique but total resection and long-term recurrence remains a concern. Utilization of two instruments, the bi port technique and tubular retractor can be helpful in selected patients to overcome limitations. Although total excision should be aimed, subtotal excision and coagulation of residual cyst wall usually results in good long-term results without any growth of remnant wall. Conversion to an open procedure may be required in some patients.KEywords: Central nervous system cyst, Central nervous system neoplasm, Colloid cyst, Nervous system diseases, Third ventricle ÖZKolloid kistler genellikle üçüncü ventrikülde bulunur ve primitif nöroepitel veya endodermden köken aldıklarına inanılmaktadır. Hastalar uzun süre belirtisiz kalabilirler veya durum paroksismal baş ağrısı, yürüme bozukluğu, bulantı, kusma, davranış değişiklikleri, alt ekstremitelerde kuvvetsizlik, hafıza kaybı, yeni şeyler öğrenme zorluğu ve ani ölümle ortaya çıkabilir. Bilgisayarlı tomografi genellikle iyi tanımlanmış yuvarlak veya oval, kontrast tutmayan bir lezyon gösterir. Kolloid kistlerin manyetik rezonans görüntüleme (MRG) sinyal şiddeti değişkendir ama en sık rastlanan görünüm T1 ağırlıklı dizilerde hiperintens ve T2 ağırlıklı dizilerde izo ila hipointenstir. Gözlem, stereotaktik aspirasyon, mikroskopik veya endoskopik yaklaşımlar ve şant cerrahisi çeşitli tedavi seçenekleridir. Transkallosal ve transkortikal mikroskopik (tübüler retraktörle veya olmadan) yaklaşımlar temel olarak sırasıyla normal büyüklükte ve dilate ventriküllerde faydalıdır. Endoskopik teknik, mikrocerrahi tekniğe etkin bir alternatiftir ama total rezeksiyon imkanı ve uzun dönemde nüks olasılığı endişe yaratmaya devam etmektedir. İki alet kullanımı, iki portlu teknik ve tübüler retraktör bazı hastalarda sınırlamaları aşmak açısından faydalı olabilir. Total eksizyon hedeflenmelidir ama subtotal eksizyon ve kalan kist duvarının eksizyonu genellikle kalan duvarda bir büyüme olmadan uzun dönemli iyi sonuçlar verir. Bazı hastalarda açık cerrahiye dönmek de gerek...

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Section: Intra-ventricular Bleedingmentioning

confidence: 99%

Management of colloid cyst of third ventricle

Yadav

Yadav²,

Parihar³

et al. 2014

Turkish Neurosurgery

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“…5,6,9,13,14,16,17,20,27,28,34 Although each treatment modality has shown fairly good clinical outcome, there has been discussion about which approach is the procedure of choice, especially between transcallosal or transcortical and endoscopic excision. In comparison with the traditional transcallosal-transventricular or transcortical-transventricular approach and cyst aspiration with stereotactic guidance, the role of neuroendoscopy in removal of colloid cysts only started recently.…”

Section: Discussionmentioning

confidence: 99%

“…8,12,24 There are different surgical treatments, including microsurgical resection, endoscopic resection, stereotactic aspiration, and ventriculoperitoneal shunt im plan tation. 5,6,9,10,13,[15][16][17]20,23,[26][27][28][29][30]34 Nowadays, the most popular approaches are microsurgical and endoscopic resection. Transcortical or transcallosal are the two microsurgical approaches for colloid cyst resection.…”

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confidence: 99%

Endoscopic approach to colloid cyst: what is the optimal entry point and trajectory?

Rangel-Castilla

Chen

Choi

et al. 2014

JNS

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Object. An optimal entry point and trajectory for endoscopic colloid cyst (ECC) resection helps to protect important neurovascular structures. There is a large discrepancy in the entry point and trajectory in the neuroendoscopic literature.Methods. Trajectory views from MRI or CT scans used for cranial image guidance in 39 patients who had undergone ECC resection between July 2004 and July 2010 were retrospectively evaluated. A target point of the colloid cyst was extended out to the scalp through a trajectory carefully observed in a 3D model to ensure that important anatomical structures were not violated. The relation of the entry point to the midline and coronal sutures was established. Entry point and trajectory were correlated with the ventricular size.Results. The optimal entry point was situated 42.3 ± 11.7 mm away from the sagittal suture, ranging from 19.1 to 66.9 mm (median 41.4 mm) and 46.9 ± 5.7 mm anterior to the coronal suture, ranging from 36.4 to 60.5 mm (median 45.9 mm). The distance from the entry point to the target on the colloid cyst varied from 56.5 to 78.0 mm, with a mean value of 67.9 ± 4.8 mm (median 68.5 mm). Approximately 90% of the optimal entry points are located 40-60 mm in front of the coronal suture, whereas their perpendicular distance from the midline ranges from 19.1 to 66.9 mm. The location of the "ideal" entry points changes laterally from the midline as the ventricles change in size.Conclusions. The results suggest that the optimal entry for ECC excision be located at 42.3 ± 11.7 mm perpendicular to the midline, and 46.9 ± 5.7 mm anterior to the coronal suture, but also that this point differs with the size of the ventricles. Intraoperative stereotactic navigation should be considered for all ECC procedures whenever it is available. The entry point should be estimated from the patient's own preoperative imaging studies if intraoperative neuronavigation is not available. An estimated entry point of 4 cm perpendicular to the midline and 4.5 cm anterior to the coronal suture is an acceptable alternative that can be used in patients with ventriculomegaly.

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“…The conduit (sheath) creates a space that allows for Collectively, these reports emphasize the usefulness of the translucent tubular retractor for ventricular and deep-seated brain tumors. While the procedures for this surgery have been published previously, [15][16][17][18] our study provides data from more cases and offers a more detailed, step-by-step description of the techniques than previous studies. We also show, for the first time, how much tissue can be obtained when using this method.…”

Section: Discussionmentioning

confidence: 99%

Rigid endoscopic resection of deep-seated or intraventricular brain tumors

Akiyama

Wanibuchi

Mikami

et al. 2014

Neurological Research

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Rigid endoscopic resection using a thick sheath (ViewSite) may be a viable method for the resection or biopsy of selected deep-seated brain tumors, such as thalamic gliomas and malignant lymphomas. Neuroendoscopic biopsy is one technique used for the histological verification of suspected brain tumors. There are a number of advantages to using this technique. For example, under direct vision, it is possible to carefully observe the tumor surface and avoid vessels during tumor resections. It is also possible to collect enough specimens for a pathological diagnosis. Eighteen consecutive patients safely underwent rigid endoscopic resection or biopsy using a thick sheath (ViewSite). The two-handed endoscopic technique that utilized a mounted rigid endoscope proved very useful and safe, since it enabled easy stanching of hemorrhages. The aim of this study was to demonstrate how to use a thick sheath for deep-seated or intraventricular tumors. The rigid endoscopic approach with a thick sheath provides an alternative medial approach with improved visualization and a wider working space.

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Stereotactically Guided Endoscopic Port Surgery for Intraventricular Tumor and Colloid Cyst Resection

Abstract: SEP surgery for colloid cysts and intraventricular tumors proved to be a safe and effective alternative to conventional microsurgical resection. This technique was not limited by the vascularity, friability, or size of any of the lesions.

Cited by 37 publications

References 36 publications

Management of colloid cyst of third ventricle

Management of colloid cyst of third ventricle

Endoscopic approach to colloid cyst: what is the optimal entry point and trajectory?

Rigid endoscopic resection of deep-seated or intraventricular brain tumors

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