Solid Tumors of the Lateral Ventricle: Endoscopic Assisted Microsurgical Excision through Transcortical and Transcallosal Approaches

Background: Solid neoplasms of lateral ventricles are relatively not common and usually reach a large size before clinical diagnosis. Conventional microsurgical techniques are effective option for their management but still need some retraction and dissection of the important brain structures. Endoscopic technique when used in conjunction with standard microsurgery throws the light directly and deeply within the ventricular cavity. Moreover, it helps accurate navigation within the hidden and unfeasible corners of the ventricular cavities. Objective: We retrospectively reviewed twenty six patients with solid tumors of the lateral ventricle (fifteen males and eleven females) treated by endoscopic assisted microsurgical resection during the period from February 2008 through December 2013. Surgery was conducted through transcortical approach in seventeen patients and transcallosal approach in nine patients. The age of our patients at the time of surgery ranged from 3 months up to 70 years (mean 38 years). Mean follow up period was 39 months (range 12-70 month). Results: Total tumor resection was achieved in nineteen patients (73%) and subtotal resection was feasible in the other seven patients (27%). Twenty-two patients (84.6%) experienced good outcome and returned to their normal activity while three patients (11.6%) had fair outcome and only one patient (3.8%) deteriorated postoperatively (poor outcome). Our complications included seizure in five patients, postoperative permanent hemiparesis in one patients, ventriculitis in one patient and hydrocephalus which needed insertion of ventriculo-peritoneal shunt was encountered in three patients. Conclusion: Endoscopic assisted transcortical and transcallosal microsurgical approaches seem to be a reliable and safe minimal invasive surgical technique for tumor removal in all regions of the lateral ventricle including the hidden curves and angles of the ventricular cavities. With direct illumination and better visualization this approach enhances the chance of complete tumor excision with better clinical outcome and minimal postoperative morbidity and mortality.