Endoscopic removal of third ventricular tumors: a technical note

Abstract

Object: An endoscopic surgical technique utilizing a rollable vinyl tube as a surgical corridor is described for removal of third ventricular tumors.

Surgical technique: Transcortical transventricular access is made via a burr hole placed at the point which is one inch lateral from the midline at the coronal suture area. A one-cm-diameter vinyl tube is slit longitudinally, rolled like a cigarette, and tied at its ventricular end with a release tie. With image-guided stereotactic assistance, this rolled vinyl tube is inserted into the lateral ventricle near the foramen of Monro. When the release tie is untied, the vinyl tube expands to its original 10-mm-diameter tube by recoil assisted with a balloon dilatation technique. Through this tube, a rod-lens endoscope is placed to visualize the surgical target and is mounted to an endoscope holder. Surgical instruments are inserted next to the endoscope for surgical dissection. Compared to endoscopy through fixed working-channel devices, this technique allows increased flexibility for the surgeon when maneuvering surgical instruments for delicate dissection and tumor removal. Two patients with colloid cysts and one patient with an epidermoid tumor are reported as demonstrative cases.

Conclusion: An endoscopic technique utilizing a soft vinyl tube which can be rolled into a small diameter and then unrolled to its original size by its own recoil when a release tie is removed and by balloon dilatation, is reported for removal of third ventricular tumors.