Microsurgical removal of intraventricular lesions using endoscopic visualization and stereotactic guidance.

OBJECTIVE: To demonstrate the technique of stereotactic microsurgical endoscopic removal of intraventricular tumors or colloid cysts assisted by intraoperative computed tomography. METHODS: We adapted a tubular "ventriculoport" for stereotactic insertion of an endoscope into the ventricle. This facilitated microsurgical resection of 14 intraventricular tumors or colloid cysts by use of intraoperative stereotactic microsurgical endoscopic removal of intraventricular tumors or colloid cysts assisted by intraoperative computed tomography. RESULTS: Gross total resection was achieved in 12 patients and confirmed by intraoperative computed tomographic scanning and postoperative magnetic resonance imaging. Patients with preoperative hydrocephalus had relief of their symptoms. Perioperative morbidity was limited to mild headache associated with postoperative pneumocephalus. The average length of stay was 3.6 days. Twelve patients had significant improvement in their symptoms. CONCLUSION: The combination of intraoperative computed tomography-guided stereotactic technique and rigid endoscopy facilitated an accurate, minimally invasive, microsurgical removal of these intraventricular masses. This approach minimized retraction and provided satisfactory visualization.

Radiosurgery techniques and current devices.

Radiosurgery is a minimally invasive technique designed to elicit a specific radiobiologic response at the target tissue using focused ionizing radiation delivered in single procedure. Radiosurgery was originally devised to treat intracranial lesions by delivering a high dose of radiation precisely at the intracranial target using stereotactic guidance. The term was coined and the field defined by Lars Leksell, a visionary leader of neurosurgery at the Karolinska Institute in Stockholm. Refinements in stereotactic methodologies, major improvements in dose planning software, and advances in neurodiagnostic imaging, all facilitated the increasingly broad application of brain radiosurgical methodologies. New technologies have continued to evolve and are still emerging. A variety of different radiosurgery techniques have been developed during the past 4 decades. Radiosurgery is now being used even for extracranial lesions such as spinal tumors, lung, liver, and prostate pathologies. Numerous studies have examined the benefits and risks of radiosurgery performed with various devices. The long-term results of radiosurgery are now available and have established it as an effective noninvasive management strategy for many brain disorders. Radiosurgery is now considered a mainstream neurosurgical modality for treatment of vascular malformations, tumors, trigeminal neuralgia, movement disorders, and perhaps epilepsy. Its role as a tool for spine and body surgery is also under evaluation.

Microsurgical removal of intraventricular lesions using endoscopic visualization and stereotactic guidance.

OBJECTIVE: To demonstrate the technique of stereotactic microsurgical endoscopic removal of intraventricular tumors or colloid cysts assisted by intraoperative computed tomography. METHODS: We adapted a tubular "ventriculoport" for stereotactic insertion of an endoscope into the ventricle. This facilitated microsurgical resection of 14 intraventricular tumors or colloid cysts by use of intraoperative stereotactic microsurgical endoscopic removal of intraventricular tumors or colloid cysts assisted by intraoperative computed tomography. RESULTS: Gross total resection was achieved in 12 patients and confirmed by intraoperative computed tomographic scanning and postoperative magnetic resonance imaging. Patients with preoperative hydrocephalus had relief of their symptoms. Perioperative morbidity was limited to mild headache associated with postoperative pneumocephalus. The average length of stay was 3.6 days. Twelve patients had significant improvement in their symptoms. CONCLUSION: The combination of intraoperative computed tomography-guided stereotactic technique and rigid endoscopy facilitated an accurate, minimally invasive, microsurgical removal of these intraventricular masses. This approach minimized retraction and provided satisfactory visualization.