Endoscopic supracerebellar transtentorial approach to the atrium of the lateral ventricle: Preliminary surgical and optical considerations

• Published in: World neurosurgery Vol. 105; pp. 805 - 811
• Main Authors: xie, Tao, M.D, zhou, Linjun, M.D, zhang, Xiaobiao, M.D, sun, Wei, ding, Hailin, M.S, liu, Tengfei, gu, Ye, M.D, sun, Chongjing, hu, Fan, M.D, zhu, Wei, M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2017
• Subjects: Aged; Atrium; Craniotomy - methods; Diffusion Tensor Imaging - methods; Dura Mater - surgery; Female; Glioblastoma - surgery; Humans; Lateral ventricle; Lateral Ventricles - surgery; Male; Meningioma - surgery; Microsurgery - methods; Middle Aged; Neuroendoscope; Neuroendoscopy; Neuronavigation - methods; Neurosurgery; Optical; Surgical approach; Atrium; 3-dimensional magnetization-prepared rapid gradient-echo; Optical; Neuroendoscope; DTT-FT; TOF; Lateral ventricle; MRV; endoscopic supracerebellar transtentorial approach; 3D-MPRAGE; magnetic resonance venography; time-of-flight; Surgical approach; diffusiontensortractography-fibertracking; ESTA; STA; MRI; DTI
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.06.093

Objective To report the operative techniques of the endoscopic supracerebellar transtentorial approach (ESTA) to the atrium of the lateral ventricle, especially focusing on the role of the endoscope and analyzing optically related issues. Methods A retrospective data review was performed on five patients with lesions in the atrium of the lateral ventricle undergoing the ESTA. The patients were positioned in the three-quarters prone position, and a paramidline linear incision was used. After performing a suboccipital craniotomy extending immediately above the transverse sinus and tentorium incision with precisely neuronavigation, corticotomy in the posterior mediobasal temporal region created a corridor to the tumor. All of the procedures were performed with an endoscope in a pneumatic arm holder. The pre-and post- operative perimetry test and DTI fiber tracking of the optic radiations were compared and analyzed. Results There were three patients with meningiomas and two patients with high-grade gliomas in the atrium. The meningiomas were totally removed, and the gliomas were subtotally resected. One patient with glioblastoma died two months later after surgery because of the tumor progression; the remaining four patients had a visual field deficit without any other neurological complications. The endoscope improved the surgical viewing angle, which was restricted by the microscope and the slope of the tentorium. Conclusions ESTA is an alternative route to the atrium of the lateral ventricle. However, the collateral sulcus is illegible in the limited area in the surgical space, it was highly relied on the neuronavigation. And the visual field deficit remains the primary challenge with this approach.