gms | German Medical Science

Objective: Maximal safe resection of intraventricular tumors is challenging because of the deep-seated location of these lesions, especially in cases involving large lesions with high vascularity. Endo-exoscopic port surgery (EPS) is a possible alternative to the conventional microsurgical approach. Here we summarize and evaluate the feasibility and efficacy of navigated EPS for the resection of intraventricular tumors.

Method: Assisted by frameless navigation, the authors developed a minimally invasive technique for intraventricular tumor resection with navigated EPS via a transparent expandable port system and achieved serial dilation along the trajectory to the ventricular system. Thirteen cases with intraventricular tumors had navigated endo-exoscopic surgery (EPS) for tumor resection. The equipment and techniques used and the clinical sequelae were recorded and analyzed.

Results: In all the cases, navigated EPS was successfully achieved. Ten of the 13 patients (76.9%) had gross total or near-total resection that was confirmed by post-operative and follow-up MRI. The remaining 3 cases (23.1%) had a subtotal resection. There were no technically related complications. Two patients (15.4%) suffered from post-operative trapped temporal horn and were managed with second-stage endoscopic treatment. None of the patients required delayed cerebrospinal fluid diversion, and no permanent neurological morbidity was recorded.

Conclusions: The use of navigated EPS for the resection of intraventricular tumors is feasible and safe. The use of a transparent working port with frameless navigation ensures an accurate and minimally invasive trajectory. The combination of endo- and exoscopic techniques enabled satisfactory visualization and bimanual instrument manipulation. The fusion of these multiple techniques may result in favorable outcomes.