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J Neurol Surg A Cent Eur Neurosurg 2015; 76(05): 353-360
DOI: 10.1055/s-0035-1549304
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Approaches to Intraventricular Lesions

Natale Russo
1   Department of Neurosurgery, S Camillo-Forlanini Hospital, Rome, Italy
,
Andrea Brunori
1   Department of Neurosurgery, S Camillo-Forlanini Hospital, Rome, Italy
,
Alberto Delitala
1   Department of Neurosurgery, S Camillo-Forlanini Hospital, Rome, Italy
› Author Affiliations
Further Information

Publication History

26 March 2014

30 December 2014

Publication Date:
22 May 2015 (online)

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Abstract

Background Endoscopy is becoming increasingly popular for the neurosurgical management of intraventricular lesions and has recently been accepted as an effective alternative approach to open surgery. The deep location of intraventricular lesions makes the microsurgical approach difficult. Moreover, many intraventricular tumors do not require aggressive neurosurgical treatment. Some of these lesions are even associated with hydrocephalus or an enlarged ventricular system.

Methods We collected the data of 32 patients affected by purely intraventricular lesions in the lateral or third ventricles who underwent 33 endoscopic intraventricular procedures from 2006 to 2011. We classified the lesions according to their location within the ventricles so as to plan the best endoscopic trajectory. We approached the lesions using rigid and flexible endoscopes through precoronal or supraorbital trajectories according to their localization and the presence of hydrocephalus. In many procedures we used neuronavigation.

Results Thirty-three endoscopic intraventricular procedures were performed in 32 patients; 27 procedures were performed via the precoronal, and 6 procedures via the supraorbital frontopolar approach. A complete excision of the lesion was obtained in only three cases. In all other cases, a biopsy was taken.

Conclusions Our series shows that an endoscopic approach to intraventricular lesions should be tailored according to localization of the lesion and ventricular size. The complete excision of intraventricular lesions is often impossible with the endoscope, but biopsies allow diagnoses to be obtained in almost all cases.

Keywords

endoscopy - intraventricular lesions - supraorbital approach - brain tumors
 

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