Transcortical Endoscopic Surgery for Intraventricular Lesions

Abstract

To review recent advances in endoscopic techniques for treating intraventricular lesions via transcortical passage. Articles in PubMed published since 2000 were searched using the keywords ‘endoscopy,’ ‘endoscopic,’ and ‘neuroendoscopic.’ Of these articles, those describing intraventricular lesions were reviewed. Suprasellar arachnoid cysts (SACs) can be treated with ventriculo-cystostomy (VC) or ventriculo-cysto-cisternostomy (VCC). VCC showed better results compared to VC. Procedure type, fenestration size, stent placement, and aqueductal patency may affect SAC prognosis. Colloid cysts can be managed using a transforaminal approach (TA) or a transforaminal-transchoroidal approach (TTA). However, TTA may result in better exposure compared to TA. Intraventricular cysticercosis can be cured with an endoscopic procedure alone, but if pericystic inflammation and/or ependymal reaction are seen, third ventriculostomy may be recommended. Tumor biopsies have yielded successful diagnosis rates of up to 100%, but tumor location, total specimen size, endoscope type, and vigorous coagulation on the tumor surface may affect diagnostic accuracy. An ideal indication for tumor excision is a small tumor with friable consistency and little vascularity. Tumor size, composition, and vascularity may influence a complete resection. SACs and intraventricular cysticercosis can be treated successfully using endoscopic procedures. Endoscopic procedures may represent an alternative to surgical options for colloid cyst removal. Solid tumors can be safely biopsied using endoscopic techniques, but endoscopy for tumor resection still results in considerable challenges.

Surgical management of intraventricular neurocysticercosis: Two cases treated through transcallosal interhemispheric approach

“…is is supported by several studies showing recurrence rates ranging from 0% to 11.47%, with the highest average recurrence occurring in cases of partial resection (6.87%) compared to total resection (0.71%). [4,11,14,16] Finally, the interval between the resection and the follow-up MRI scan was quite long, reaching 1 year. Based on all these factors, it can be understood why the recurrence of the cyst was found on the follow-up MRI scan.…”

Gross Total Endoscopic Resection of a Left Lateral Ventricle Central Neurocytoma in an 18-Year-Old Filipino Male: A Case Report

“…Since most central neurocytomas are located within the lateral ventricles and are attached to the septum pellucidum, a transcallosal transcortical approach is commonly selected [2][3][4][5]18]. Compared to classic open surgery, endoscopic surgery is minimally invasive, provides superior visualization of intraventricular anatomy and the interface between normal and tumoral tissue, avoids brain retraction and parenchymal injury, reduces blood loss and leads to shorter operative times, eventually leading to rapid recovery and shorter hospital stay [12][13][14][15]19]. An additional advantage is the capability to treat altered cerebrospinal fluid circulation [13,19].…”

“…Aside from direct visualization of the intraventricular anatomy, the rigid neuroendoscope also enabled the visualization of a plane between the tumor and the normal ependyma, facilitating safe maximal piecemeal resection with preservation of surrounding neurovascular structures. Known limitations of endoscopic surgery are restricted working space, inability to perform bimanual dissection, and possibility of profuse hemorrhage necessitating conversion to open surgery [12,19]. However, with neurosurgeon expertise and advanced neuroendoscopic instruments, these limitations can be overcome and gross total endoscopic excision is attainable with low risk of morbidity.…”

Peculiarities of the third ventricle surgery in endoscopic frontal transcortical approach

“…o r t i c al approaches are widely used to treat pathology of the ventricular system. Each of these approaches has advantages and certain features, which are still under discussion [1,2].…”