Completely endoscopic resection of intraparenchymal brain tumors

Clinical article

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Object

The authors introduce a novel technique of intraparenchymal brain tumor resection using a rod lens endoscope and parallel instrumentation via a transparent conduit.

Methods

Over a 4-year period, 21 patients underwent completely endoscopic removal of a subcortical brain lesion by means of a transparent conduit. Image guidance was used to direct the cannulation and resection of all lesions. Postoperative MR imaging or CT was performed to assess for residual tumor in all patients, and all patients were followed up postoperatively to assess for new neurological deficits or other surgical complications.

Results

The histopathological findings were as follows: 12 metastases, 5 glioblastomas, 3 cavernous malformations, and 1 hemangioblastoma. Total radiographically confirmed resection was achieved in 8 cases, near-total in 6 cases, and subtotal in 7 cases. There were no perioperative deaths. Complications included 1 infection and 1 pulmonary embolus. There were no postoperative hematomas, no postoperative seizures, and no worsened neurological deficits in the immediate postoperative period.

Conclusions

Fully endoscopic resection may be a technically feasible method of resection for selected subcortical masses. Further experience with this technique will help to determine its applicability and safety.

Abbreviations used in this paper: CM = cavernous malformation; GBM = glioblastoma multiforme.
Article Information

Contributor Notes

Address correspondence to: Johnathan A. Engh, M.D., Department of Neurological Surgery, UPMC Presbyterian, 200 Lothrop Street Suite B-400, Pittsburgh, Pennsylvania 15213. email: enghja@upmc.edu.Please include this information when citing this paper: published online October 24, 2008; DOI: 10.3171/2008.7.JNS08226.
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References
  • 1

    Auer LMDeinsberger WNiederkorn KGell GKleinert RSchneider G: Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. J Neurosurg 70:5305351989

    • Search Google Scholar
    • Export Citation
  • 2

    de Oliveira JGRassi-Neto AFerraz FABraga FM: Neurosurgical management of cerebellar cavernous malformations. Neurosurg Focus 21:1E112006

    • Search Google Scholar
    • Export Citation
  • 3

    Harris AEHadjipanayis CGLunsford LDLunsford AKKassam AB: Microsurgical removal of intraventricular lesions using endoscopic visualization and stereotactic guidance. Neurosurgery 56:1 Suppl1251322005

    • Search Google Scholar
    • Export Citation
  • 4

    Jacques SShelden CHMcCann GDFreshwater DBRand R: Computerized three-dimensional stereotaxic removal of small central nervous system lesions in patients. J Neurosurg 53:8168201980

    • Search Google Scholar
    • Export Citation
  • 5

    Kassam ABSnyderman CHCarrau RLMintz AHGardner PAThomas AJ: Expanded Endonasal Approach to the Ventral Skull Base: Sagittal Plane Tuttlingen, GermanyEndo-press2007

    • Search Google Scholar
    • Export Citation
  • 6

    Kelly PJ: Technology in the resection of gliomas and the definition of madness. J Neurosurg 101:2842862004

  • 7

    Kelly PJGoerss SJKall BA: The stereotaxic retractor in computer-assisted stereotaxic microsurgery. J Neurosurg 69:301 3061988

  • 8

    Kelly PJKall BAGoerss SEarnest F: Computer-assisted stereotaxic laser resection of intra-axial brain neoplasms. J Neurosurg 64:4274391986

    • Search Google Scholar
    • Export Citation
  • 9

    Lacroix MAbi-Said DFourney DRGokaslan ZLShi WDeMonte F: A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 95:1901982001

    • Search Google Scholar
    • Export Citation
  • 10

    Morita AKelly PJ: Resection of intraventricular tumors via a computer-assisted volumetric stereotactic approach. Neurosurgery 32:9209271993

    • Search Google Scholar
    • Export Citation
  • 11

    Moshel YALink MJKelly PJ: Stereotactic volumetric resection of thalamic pilocytic astrocytomas. Neurosurgery 61:66752007

  • 12

    Naidich TPBrightbill TC: Systems for localizing fronto-parietal gyri and sulci on axial CT and MRI. Int J Neuroradiol 2:3133381996

    • Search Google Scholar
    • Export Citation
  • 13

    Nishihara TTeraoka AMorita AUeki KTakai KKirino T: A transparent sheath for endoscopic surgery and its application in surgical evacuation of spontaneous intracerebral hematomas: technical note. J Neurosurg 92:105310552000

    • Search Google Scholar
    • Export Citation
  • 14

    Otsuki TJokura HYoshimoto T: Stereotactic guiding tube for open-system endoscopy: a new approach for the stereotactic endoscopic resection of intra-axial brain tumors. Neurosurgery 27:3263301990

    • Search Google Scholar
    • Export Citation
  • 15

    Patchell RATibbs PAWalsh JWDempsey RJMaruyama YKryscio RJ: A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322:4945001990

    • Search Google Scholar
    • Export Citation
  • 16

    Porter RWDetwiler PWSpetzler RFLawton MTBaskin JJDerksen PT: Cavernous malformations of the brainstem: experience with 100 patients. J Neurosurg 90:50581999

    • Search Google Scholar
    • Export Citation
  • 17

    Russell SMKelly PJ: Volumetric stereotaxy and the supratentorial occipitosubtemporal approach in the resection of posterior hippocampus and parahippocampal gyrus lesions. Neurosurgery 50:9789882002

    • Search Google Scholar
    • Export Citation
  • 18

    Shelden CHMcCann GJacques SLutes HRFrazier REKatz R: Development of a computerized microstereotaxic method for localization and removal of minute CNS lesions under direct 3-D vision: technical report. J Neurosurg 52:21271980

    • Search Google Scholar
    • Export Citation
  • 19

    Teo CNakaji P: Application of endoscopy to the resection of intra-axial tumors. Op Tech Neursurg 8:1791852005

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