Endoscope-assisted microsurgery for tumors of the septum pellucidum: surgical considerations and benefits of the method in the treatment of four serial cases

Abstract

Neoplasms that primarily originate from the septum pellucidum are extremely rare. Generally the septum pellucidum is involved in direct extension of tumors that arise from the neighboring structures, principally the corpus callosum. Endoscope-assisted techniques form a useful adjunct to common microsurgical procedures to completely remove intraventricular lesions. There are two main advantages of endoscope-assisted surgery over common microsurgical techniques: reduction of superficial brain retraction with less iatrogenic trauma to the neighboring structures and inspection of hidden corners depict simultaneously anatomical details which are not precisely visible in the zoomed and thus light-reduced beam of the microscope. Four patients with septum pellucidum tumors underwent surgery by a transcallosal approach. In all four patients the endoscope-assisted microsurgery technique was used to remove the tumor. In one of the four patients neuronavigation was additionally used for guidance. Complete tumor excision was achieved in all patients. The histological findings showed pilocytic astrocytoma in two cases, one subependymoma and one neurocytoma, respectively. There were no postoperative complications. Endoscope-assisted microsurgery provides maximum efficiency to remove the septum pellucidum tumors with minimum invasiveness.