The Procedure is performed through a small incision (approximately 1 inch) behind the hairline. From this site, the endoscope is inserted into the ventricular compartment of the brain and then navigated toward the tumor. The tumor is readily identified due to the difference in appearance from the surrounding tissue. Biopsy forceps are then used to sample the tumor. Because direct vision is being used, samples can be selected avoiding any small blood vessels or other important structures within the ventricle, features that cannot be done with standard “Closed” needle biopsies. The endoscope is then removed and the wound is closed.
Endoscopic biopsy for intraventricular brain tumors avoids many of the inherent risks associated with conventional surgical approaches. Because these tumors are typically situated deep within the brain, the ability to approach these tumors with a minimally invasive technique offers a very significant advantage to the patient.
Endoscopic Excision of Colloid Cysts:
The most common tumor located within the third ventricle is the colloid cyst. This benign tumor can cause a blockage of cerebrospinal fluid (CSF) leading toward increase intracranial pressure and potentially death. The definitive method for treating colloid cysts is surgical removal.Prior to the advent of endoscopic neurosurgery, the removal of colloid cysts relied on an open surgical procedure achieved by way a craniotomy, an open procedure which requires removal of a portion of the skull.
Colloid cyst Resection:
The procedure is performed through a small incision behind the hairline. From this site, the endoscope is inserted into the ventricular compartment of the brain and then navigated toward the tumor surface. The wall of the tumor is then coagulated with an electrical current and the cyst is then open with sharp dissection. A variety of suction catheters are then used to empty the contents of the cyst. The cyst wall is then removed and any remnants are destroyed using an electrical current. The endoscope is then removed and the wound is closed.
Endoscopic Treatment of Arachnoid cysts:
Developmental cysts of the brain, or arachnoid cysts, cause symptoms based upon the location and size of the cyst. Weakness decreased cognitive performance, Spontaneous hemorrhage, and seizure, are common presentations for individuals with intracranial arachnoid cysts. Most common locations include the temporal fossa, the posterior fossa, and the suprasellar region. Treatment has typically involved either the placement of a permanent drainage system (Cystoperitoneal shunt) or an open surgical procedure to fenestrate the walls of the cyst. Cyst fenestration is typically favored due to high success rate of this procedure. However shunt placement is appealing due to the simplicity of the operation.
Endoscopic Cyst Fenestration: The Procedure is performed through a small incision the location being dictated based upon the location of the cyst. From this site the endoscope is inserted into the cyst and the wall of the cyst is then opened into one of the natural fluid chambers of the brain. With this opening, the fluid can then exit the cyst and get absorbed through normal means. This procedure averages 30 minutes to 1 hour and patients can return home the following day.
Dr. Rahul Gupta is senior Brain, Spine & Endovascular Surgeon and Additional Director of the department of neurosurgery at Fortis Hospital Noida.
Dr. Gupta,has rich experience of working as faculty in teaching government institutes. He has performed thousands of complex vascular, Endo-vascular, skull base and minimally invasive brain surgeries.