Completely endoscopic resection of glioblastomas using a transparent conduit: Proof of concept

Abstract

2066 Background: Completely endoscopic resection of high grade gliomas has not been reported in a neurosurgical case series. Methods: Using frameless image guidance, an 11.5 mm cylindrical transparent port (endoport) is established as a transcortical conduit into the lesion. The port is introduced through a small cortisectomy. Microsurgical instruments, suction, and bipolar cautery are all introduced through the port as needed to facilitate resection. Five patients (four female, one male) underwent tumor resection using the fully endoscopic method. Age varied from 37–74 years (mean 57.8 years). All patients presented with some degree of confusion (two with somnolence), two patients (40%) had significant headache, and 3 patients (60%) were hemiparetic at the time of evaluation. Three tumors were in the left frontal region, one tumor was a butterfly glioma, and one tumor was in the right centrum semiovale. Tumor size varied from 41 to 65 mm in greatest dimension (mean 51.4 mm). Results: All patients demonstrated pathologically confirmed glioblastomas. On post-operative MRI, one patient had a gross total resection, two patients had >95% radiographic resection, and two patients had subtotal resection. No patient demonstrated any radiographic evidence of injury to surrounding brain as a result of resection. No patient suffered a post-operative complication or a new neurological deficit. One patient was taken back to the operating room for tumor progression well after discharge. Conclusions: Fully endoscopic resection of high-grade gliomas through a minimal access port is feasible and may be a safe alternative to open surgical extirpation. The degree of underlying white matter injury and the size of the cortisectomy for tumor resection may be less than with conventional methods of tumor removal. Further studies are warranted to determine whether or not this technique is safer than a standard tumor resection in the setting of glioblastoma. No significant financial relationships to disclose.