J Korean Neurosurg Soc.  2017 May;60(3):327-334. 10.3340/jkns.2017.0101.008.

Transcortical Endoscopic Surgery for Intraventricular Lesions

• Kim MH

• KMID: 2382768
• DOI: http://doi.org/10.3340/jkns.2017.0101.008

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.

Keyword

Endoscopy; Arachnoid cysts; Cysticercosis; Colloid cyst; Intraventricular tumor

MeSH Terms

Arachnoid Cysts
Biopsy
Colloid Cysts
Cysticercosis
Diagnosis
Endoscopes
Endoscopy
Inflammation
Prognosis
Stents
Ventriculostomy

Figure

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  Fig. 1 Schematic drawing of the endoscopic transchoroidal approach. A: Coronal view: Under the endoscopic view in the lateral ventricle, after the careful dissection along the medial aspect of the choroid plexus, the roof of 3rd ventricle is exposed through the velum interpositum (dotted line). Arrows: choroid plexus of lateral and third ventricle, dotted line; dissection plane of transchoroidal approach. B: Endoscopic view of the right lateral ventricle: Between the fornix and choroid plexus, the velum interpositum can be exposed safely. Arrowed dotted line: dissection plane of transchoroidal approach. CC: corpus callosum, CN: caudate nucleus, LV: lateral ventricle, F: fornix, VI: velum interpositum, 3V: third ventricle, F: right fornix, FM: foramen Monro.

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  Fig. 2 Various endoscopic techniques combining an ETV and tumor biopsy. A: procedure with a rigid endoscope through a standard coronal burr hole. B: procedure with 2 rigid endoscopes through 2 separate burr holes (one standard coronal burr and one more anteriorly placed for a biopsy). C: procedure with a flexible endoscope through single burr hole. AC: anterior commissure, BS: brain stem, CC: corpus callosum, F: fornix, MI: massa intermedia, T: tumor, ETV: endoscopic third ventriculostomy.

Reference

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