Initially, endoscopic cautery inhibitor licensed of the colloid cyst capsule was performed to shrink the colloid cyst permitting dissection off the roof of the third ventricle and the fornix. Due to the large size of the colloid cyst, en block resection was not possible. Evacuation of the contents of the colloid cyst was first performed followed by complete resection of cyst capsule with the variable aspiration tissue resector (Figure 4). Figure 4 Patient 15, large colloid cyst. (a) Preoperative contrast enhanced coronal T1-weighted magnetic resonance imaging (MRI) showing a lesion with obstructive hydrocephalus. (b) 3-month follow-up MRI shows gross total resection of lesion and resolution of … 5. Discussion 5.1.

Microsurgical Approaches to Intraventricular Lesions Use of a craniotomy and a transcallosal or transcortical microsurgical approach provides access to intraventricular pathology for resection purposes. These commonly used approaches have the advantage of allowing the surgeon to perform bimanual dissection with the microscope for tumor or cyst resection using a wide range of microscopic instruments and bipolar cautery. Microsurgical approaches to intraventricular lesions after a craniotomy can be associated with significant neurologic deficits due to brain retraction and possibly increased seizure risk postoperatively [3�C6]. Others have described the use of tubular retractors in pediatric and adult patient populations for deep-seated lesions, but with limited experience with intraventricular lesions [7, 8]. 5.2.

Endoscopic Approaches to Intraventricular Lesions There have been multiple reports of the resection of intraventricular lesions using a pure endoscopic approach with conventional working channel instruments, including suction, grasping forceps, and cutting instruments [1]. Souweidane and Luther reported the resection of 7 solid intraventricular brain tumors and outlined the difficulties associated with resecting these lesions given the restrictive instruments available to them at that time [2]. Their experience was also similar to that of Gaab and Schroeder who reported the purely endoscopic resection of intraventricular lesions [9]. In both series, the attempted resection of solid lesions with diameters greater than 20mm was extremely difficult due to the small working channels of the endoscopes used and the length of surgery required in these cases.

The endoscope has also been used for assistance and visualization of deep GSK-3 structures while using a bimanual conventional open surgical technique. Interhemispheric endoscopic-assisted approaches have been reported, but this requires a large craniotomy and access near the superior sagittal sinus [10]. Mclaughlin et al. recently evaluated the use of a port-assisted endoscopic technique for the resection of intraventricular lesions, allowing the use of bimanual technique [11]. This approach requires a craniotomy and placement of a 1.