Name:
10.3171/2023.1.FOCVID22140
Description:
10.3171/2023.1.FOCVID22140
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/07876afb-f05d-4b7d-81e8-0ea7985d8e82/videoscrubberimages/Scrubber_60.jpg
Duration:
T00H04M14S
Embed URL:
https://stream.cadmore.media/player/07876afb-f05d-4b7d-81e8-0ea7985d8e82
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/07876afb-f05d-4b7d-81e8-0ea7985d8e82/3. 22-140.mp4?sv=2019-02-02&sr=c&sig=fKfcmQ8S%2BZc61x73p6JrnBW24wpduwRbqgDIDeabZ98%3D&st=2025-05-11T02%3A05%3A30Z&se=2025-05-11T04%3A10%3A30Z&sp=r
Upload Date:
2023-02-27T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
[MUSIC PLAYING]
SPEAKER: This case addresses the endoscopic transventricular resection of a colloid cyst of the third ventricle. On admission, the patient suffered from headache and intermittent nausea. In the preoperative MRI, you can see the third ventricle colloid cyst with a dilated right lateral ventricle. We decided to perform a purely endoscopic navigation-guided transventricular resection. For preoperative preparation, planning of the trajectory was carried out based on a thin-sliced MRI.
SPEAKER: Our aim was to gain an optimal trajectory reaching the colloid cyst through foramen of Monro as far as possible. To achieve this approach, the initial trajectory is pointed not to the cyst itself, but further medial to the interventricular septum. Once the head of the caudate nucleus is passed, the trajectory is shifted downward to reach the colloid cyst. We chose to access the cyst via the dilated right ventricle, where the cyst lies directly at the foramen of Monro.
SPEAKER: In the preoperative MRI, you already see a very prominent thalamostriate vein, rendering this case particularly challenging. For endoscopic intraventicular procedures, we use the LOTTA system in combination with the pneumatic endoscope holder. For the approach, the patient is placed in supine position. The head is slightly anteflected so the planned burr hole is the highest point in order to minimize postoperative pneumocephalus.
SPEAKER: The correct entrance point is located with the help of our neuronavigation. For aesthetic reasons, the skin is incised in a straight fashion right behind the hairline. A burr hole is placed in the navigation-guided sheath while the endoscope is carefully inserted. Following the preplanned trajectory, reaching the third ventricle with direct view to the interventricular septum and the head of the caudate nucleus.
SPEAKER: Once the caudate nucleus head is covered by the endoscope sheath, the sheath is used as a retractor to dislocate the head of the caudate nucleus a little bit laterally to get the ideal approach to the colloid cysts attachment at the roof of the third ventricle. The anatomical landmarks for orientation are the fornix, the choroid plexus, as well as the thalamostriate and the septal veins. This case is complicated by the high-caliber thalamostriate vein partially covering the cyst.
SPEAKER: The main difficulty here is to mobilize the cyst into the lateral ventricle without injuring the thalamostriate vein or the fornix, both of which would result in severe consequences. At first, the choroid plexus covering the cyst surface is coagulated. After sharp incision, the content of the system is removed with the suction tube. Then the cyst is mobilized into the lateral ventricle.
SPEAKER: Using the pneumatic endoscope holder enables the surgeon to bimanually dissect the colloid cyst, exposing the cyst’s pedicle attached to the choroid plexus. Bimanually, the vascularized pedicle is coagulated and sharply dissected from the choroid plexus. Subsequently, the cyst can be removed. After complete removal of the cyst, the operative field is inspected. Here, you see the choroid plexus where the cyst was attached, intact fornix, and the unharmed caudate nucleus.
SPEAKER: Usually, we check the contralateral foramen of Monro and the aqueduct for blood clots, which may cause obstructive hydrocephalus. Here, this measure was waived due to the very narrow foramen of Monro to avoid injury to the fornix. Postoperatively, the patient is doing fine. In the postoperative MRI, the approaching canal placed relatively lateral can be seen without any caudate nucleus pressure-caused injury.
SPEAKER: In conclusion, a purely endoscopic procedure via the LOTTA ventriculoscope using a bimanual sharp dissection technique enables a gross-total resection of most colloid cysts.
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