Microsurgical removal of intraventricular lesions using endoscopic visualization and stereotactic guidance.

Abstract

To demonstrate the technique of stereotactic microsurgical endoscopic removal of intraventricular tumors or colloid cysts assisted by intraoperative computed tomography. We adapted a tubular "ventriculoport" for stereotactic insertion of an endoscope into the ventricle. This facilitated microsurgical resection of 14 intraventricular tumors or colloid cysts by use of intraoperative stereotactic microsurgical endoscopic removal of intraventricular tumors or colloid cysts assisted by intraoperative computed tomography. Gross total resection was achieved in 12 patients and confirmed by intraoperative computed tomographic scanning and postoperative magnetic resonance imaging. Patients with preoperative hydrocephalus had relief of their symptoms. Perioperative morbidity was limited to mild headache associated with postoperative pneumocephalus. The average length of stay was 3.6 days. Twelve patients had significant improvement in their symptoms. The combination of intraoperative computed tomography-guided stereotactic technique and rigid endoscopy facilitated an accurate, minimally invasive, microsurgical removal of these intraventricular masses. This approach minimized retraction and provided satisfactory visualization.