Endoscopic bimanual sharp dissection technique for gross-total resection of colloid cysts: technical note

2020 ◽  
pp. 1-9
Author(s):  
Sascha Marx ◽  
Henry W. S. Schroeder
Keyword(s):  
Surgical Technique ◽  
Endoscopic Resection ◽  
Technical Note ◽  
Gross Total Resection ◽  
Total Resection ◽  
Colloid Cysts ◽  
Cyst Recurrence ◽  
Sharp Dissection ◽  
Dissection Technique ◽  
Patient At Risk

Neuroendoscopic resection of colloid cysts has gained tremendous popularity over the last 2 decades because of good clinical outcomes and a low complication profile. However, in comparison to microsurgical resections, endoscopic resection has a lower rate of gross-total resection, which leaves the patient at risk for cyst recurrence. At present, there is still ongoing debate as to the best surgical approach for colloid cysts. Endoscopic resection as a technique has to compete with the good outcomes of microsurgical resections with respect to a long-term recurrence-free outcome. It is the authors’ belief that gross-total resection should be the aim of endoscopic cyst resection. In this technical note, they describe their surgical technique for achieving safe gross-total resection of colloid cysts by using a ventriculoscopic system. The surgical technique includes a far anterolateral entry point, navigational guidance, bimanual sharp dissection, use of the endoscopic sheath as a retractor, the small-chamber irrigation technique, and the dry-field technique for hemostasis.

Endoscopic treatment of colloid cysts of the third ventricle

1998 ◽  
Vol 89 (6) ◽  
pp. 1062-1068 ◽  
Author(s):  
M. Samy Abdou ◽  
Alan R. Cohen
Keyword(s):  
Surgical Technique ◽  
Endoscopic Resection ◽  
Endoscopic Treatment ◽  
Third Ventricle ◽  
Content Type ◽  
Stereotactic Aspiration ◽  
The Third ◽  
Endoscopic Evacuation ◽  
Colloid Cysts ◽  
Fine Print

✓ The surgical technique for the endoscopic evacuation of colloid cysts of the third ventricle in 13 patients is described. The authors conclude that endoscopic resection of these lesions is a useful addition to the current surgical repertoire and a viable alternative to stereotactic aspiration or open craniotomy.

scholarly journals Third ventricle colloid cysts: An endoscopic case series emphasizing technical variations

2021 ◽  
Vol 12 ◽  
pp. 376
Author(s):  
Samuel Tau Zymberg ◽  
Guilherme Salemi Riechelmann ◽  
Marcos Devanir Silva da Costa ◽  
Clauder Oliveira Ramalho ◽  
Sergio Cavalheiro
Keyword(s):  
Endoscopic Surgery ◽  
Third Ventricle ◽  
Case Series ◽  
Limited Resource ◽  
Gross Total Resection ◽  
Preoperative Imaging ◽  
Subtotal Resection ◽  
Total Resection ◽  
Female Ratio ◽  
Colloid Cysts

Background: Colloid cyst treatment with purely endoscopic surgery is considered to be safe and effective. Complete capsule removal for gross total resection is usually recommended to prevent recurrence but may not always be safely feasible. Our objective was to assess the results of endoscopic surgery using mainly aspiration and coagulation without complete capsule resection and discuss the rationale for the procedure. Methods: A retrospective review was conducted of 45 consecutive symptomatic patients with third ventricle colloid cysts that were surgically treated with purely endoscopic surgery from 1997 to 2018. Results: Mean age was 35.4 years. Male-to-female ratio was 1:1. Clinical presentation included predominantly headache (80%). Transforaminal was the most used route (71.1%) followed by transeptal (24.5%) and interforniceal (4.4%). Capsule was intentionally not removed in 42 patients (93.3%) and cyst remnants were absent on postoperative MRI in 36 (85%). Mild complications occurred in 8 patients (17.8%). Surgery was statistically associated with cyst volume and ventricular size reduction. There were no serious complications, shunts or deaths. Follow-up did not show any recurrence or remnant growth that needed further treatment. Conclusion: Gross total resection may not be the main objective for every situation. Subtotal resection without capsule removal seems to be safer while preserving good results, especially in a limited resource environment. Remnants left behind should be followed but tend to remain clinically asymptomatic for the most part. Surgical planning allows the surgeon to choose among the different resection routes and techniques available. Decisions are predominantly based on preoperative imaging and intraoperative findings.

Interhemispheric transcallosal subchoroidal fornix-sparing craniotomy for total resection of colloid cysts of the third ventricle

2009 ◽  
Vol 110 (1) ◽  
pp. 112-115 ◽  
Author(s):  
Scott Shapiro ◽  
Richard Rodgers ◽  
Mitesh Shah ◽  
Daniel Fulkerson ◽  
Robert L. Campbell
Keyword(s):  
Hospital Stay ◽  
Recurrence Rate ◽  
Short Term Memory ◽  
Third Ventricle ◽  
Memory Loss ◽  
Gross Total Resection ◽  
Long Term Results ◽  
Total Resection ◽  
Colloid Cysts ◽  
The Mean

Object Endoscopic surgery has been reported to be more cost-effective and safer than open craniotomy for resection of colloid cysts, despite a 5–10% conversion rate to craniotomy, a 5% recurrence rate, a 5–10% ventricular shunting rate, a 5–10% epilepsy rate, and a 3–4 day hospital stay. In 1985, the authors developed a interhemispheric, transcallosal, subchoroidal, fornix-sparing approach that allowed safe total resection of the colloid cyst and that appeared to be superior to the endoscopic approach. The long-term results are analyzed and compared with findings in the literature. Methods Fifty-seven consecutive colloid cysts were totally removed via a 3 ×3–in paramedian craniotomy flap and a microscopic interhemispheric, transcallosal, subchoroidal approach sparing the ipsilateral fornix. The length of the callosotomy was 1.5–2 cm in all patients. The mean follow-up duration was 12 years (range 2–22 years). A retrospective analysis comparing the authors' results with those reported in the endoscopic literature was performed. Results All patients had 1-year postoperative imaging studies (CT or MR imaging) documenting gross-total resection with no deaths, infection, hemiparesis, seizures, or disconnection syndrome. One surgery was complicated by bilateral subdural hematomas, which were successfully treated. There has been a zero recurrence rate. Three patients required a permanent ventriculoperitoneal shunt (including 2 who required emergency ventriculostomy before surgery). The mean hospital stay was 4.8 days (range 2–24 days). There was 1 patient with permanent short-term memory loss who presented with a herniation syndrome requiring emergency ventriculostomy. Conclusions The interhemispheric, transcallosal, subchoroidal, fornix-sparing approach to gross-total resection of colloid cysts is safe and led to a zero recurrence rate with no permanent neurological sequelae including epilepsy, and these results are superior to any reported results with endoscopy.

scholarly journals Shunt scissors: technical note

2018 ◽  
Vol 129 (5) ◽  
pp. 1200-1202
Author(s):  
Ralph G. Dacey ◽  
Oliver E. Flouty ◽  
M. Sean Grady ◽  
Matthew A. Howard ◽  
Marc R. Mayberg
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Technical Note ◽  
Shunt Surgery ◽  
Blunt Dissection ◽  
Technical Advance ◽  
Shunt Valve ◽  
New Device ◽  
Sharp Dissection ◽  
Dissection Technique ◽  
Subgaleal Space

OBJECTIVEWhen performing ventriculoperitoneal shunt surgery it is necessary to create a subgaleal pocket that is of sufficient size to accommodate a shunt valve. In most cases the valve is placed over the posterior skull where the galea begins to transition to suboccipital neck fascia. Dense fibrous attachments in this region of the skull make it technically awkward to develop the subgaleal valve pocket using standard scissors and a blunt dissection technique. In this report the authors describe a new device that enables surgeons to create the shunt valve pocket by using a simple semi-sharp dissection technique.METHODSThe authors analyzed the deficiencies of the standard valve pocket dissection technique and designed shunt scissors that address the identified shortcomings. These new scissors allow the surgeon to sharply dissect the subgaleal space by using an efficient hand-closing maneuver.RESULTSStandard surgical scissors were modified to create shunt scissors that were tested on the benchtop and used in the operating room. In all cases the shunt scissors proved easy to use and allowed the efficient and reliable creation of a subgaleal valve pocket in a technically pleasing manner.CONCLUSIONSShunt scissors represent an incremental technical advance in the field of neurosurgical shunt operations.

scholarly journals Clinical presentation and surgical outcomes of intramedullary neurenteric cysts

2015 ◽  
Vol 23 (1) ◽  
pp. 99-110 ◽  
Author(s):  
Tao Yang ◽  
Liang Wu ◽  
Jingyi Fang ◽  
Chenlong Yang ◽  
Xiaofeng Deng ◽  
...  
Keyword(s):  
Case Reports ◽  
Clinical Manifestations ◽  
Gross Total Resection ◽  
Neurological Deficits ◽  
Motor Deficit ◽  
Cervical Cord ◽  
Subtotal Resection ◽  
Total Resection ◽  
Cyst Recurrence

OBJECT Intramedullary neurenteric cysts (NECs) are exceedingly rare lesions and have been previously reported in case reports. The aim of this study was to determine the clinical manifestations, radiological features, and long-term prognosis of patients with such lesions. METHODS The authors retrospectively reviewed the records of 13 patients with an intramedullary NEC. Each patient underwent MRI, laminotomy, and microsurgery. The accurate diagnosis was based on imaging and pathology findings. Each patient's follow-up status was determined through individual office visits and a structured telephone interview. RESULTS The series included 7 male and 6 female patients. Progressive or intermittent motor deficit was the main symptom associated with or without pain or sensory disturbance. Five cysts were located in the cervical cord, 1 in the cervicothoracic cord, 3 in the thoracic cord, and 4 in the conus medullaris. Concurrent malformations included scoliosis (3 cases), fusion of rib (1 case), enlarged spinal canal (1 case), tethered spinal cord (1 case), and ectocardia (1 case). Gross-total resection of the cyst was achieved in 8 cases, and subtotal resection (STR) was achieved in 5 cases. All patients were followed up, with a mean duration of 66.5 months. Cyst recurrence was observed in 4 cases after STR. In 2 cases the patients underwent reoperation; the other 2 patients remained clinically stable and did not undergo reoperation. At the last evaluation, neurological function was improved in 11 patients and remained stable in 2 patients. CONCLUSIONS Intramedullary NECs should be considered in the differential diagnosis of a middle-aged patient with intermittent neurological symptoms and concurrent malformations. Early surgery is advocated to prevent permanent neurological deficits. When gross-total resection cannot be achieved, maximally safe removal under the protection of intraoperative neuromonitoring is advised. Because of the high risk of cyst recurrence, routine follow-up MRI is needed. If a residual cyst shows obvious regrowth and results in neurological deficits, timely reoperation with a goal of STR should be performed.

Recurrence of Rathke’s Cleft Cysts Based on Gross Total Resection of Cyst Wall: A Meta-analysis

2020 ◽  
Author(s):  
Victor Lu ◽  
Avital Perry ◽  
Christopher Graffeo ◽  
Krishnan Ravindran ◽  
Jamie Van Gompel
Keyword(s):  
Cyst Wall ◽  
Meta Analysis ◽  
Gross Total Resection ◽  
Total Resection ◽  
Rathke's Cleft Cysts ◽  
Rathke's Cleft
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