Endoscope-assisted Microsurgical Transcortical Resection of Third and LateralVentricular Tumors with Hydrocephalus: Surgical and Clinical Outcome

Background: Intraventricular tumors presented great challenge for neurosurgeons sincedecades due to their deep location, associated morbidity and limitation of operativefield, however modern neurosurgery using the endoscope and/or the microscope servedin minimizing perioperative morbidities and improving the clinical outcome. Objective:To demonstrate the value endoscope-assisted microsurgical transcortical technique forresection of third and lateral ventricular tumors. Patients and Methods: A retrospectivestudy included twenty three patients with tumors in the third ventricle (eight cases) andlateral ventricle (fifteen cases) associated with hydrocephalus. All patients hadendoscope-assisted microsurgical transcortical resection of the tumor through a 4-6 cmcraniotomy using a rigid endoscope for inspection of tumor boundaries and vascularityin addition to confirm extent of resection. Tumor resection was tried in all cases.External ventricular drain was placed and followed for the amount of intraventricularblood until clearing as well as intracranial pressure (ICP) monitoring. Clinical andradiological outcome was assessed 3 and 6 months postoperatively then in 6 monthlyintervals thereafter during follow up period (12-30 months). Results: Total grossresection was possible in eighteen patients (78.3%). Subtotal resection was done in theother five cases due to excessive bleeding and severe bradycardia. After 12 months,relief of symptoms was complete in thirteen patients (56.5%) and partial in nine(39.1%); only one patient had clinical deterioration. Seizures were the most frequentcomplication (26.1%) followed by weakness (17.4%) in addition to one case ofventriculitis (4.3%). Conclusion: Endoscopic-assisted microsurgical transcorticalapproach is a reliable, safe and effective option for adequate surgical resection of thirdand lateral ventricular tumors. The technique allowed proper inspection of the tumorrelations and vascularity, detection of any residual portions, providing better chance forgross total resection with minimal tissue damage or vascular injury as well asconvenient clinical outcome.