Keyhole approach for removal of ventricular tumors

Abstract

Objective To investigate the feasibility and its technical methods of keyhole approach for removal of ventricular tumors. Methods A total of 25 patients with ventricular tumor admitted to the Department of Neurosurgery, the Second Affiliated Hospital of Soochow University from January 2010 to December 2014 were collected. The average tumor size was 38.04 cm3. All the tumors were resected via the keyhole surgical approach. The tumors of 8 patients were located in the lateral ventricles; one of them was operated via the interhemispheric transcallosal approach and 7 were operated via the cortical approach. Seven patients had the third ventricle tumor, 4 of them were resected via the interhemispheric transcallosal approach, and 2 via the supraorbital approach, and 1 via the occipital cortex. Ten patients with the fourth ventricle tumor were resected via the suboccipital midline approach. The surgical approach in 7 patients with lateral ventricle tumor and 5 with the third ventricle tumor were designed under the neuronavigation and were identified by the intraoperative navigation. Results Of the 25 patients with intraventricular tumor, 23 were totally removed and 2 were subtotally removed. Before procedure, 9 patients had obvious hydrocephalus. The hydrocephalus of 6 cases disappeared after procedure. One patient was performed ventricular puncture drainage and 1 was performed ventriclar-peritoneal drainage, and another one was performed preoperative ventricular-peritoneal drainage. One patient had residual tumor hemorrhage after procedure and was reoperated for hematoma evacuation and decompressive craniectomy. The consciousness of the patient was clear at discharge with partly aphasia and hemiparalysia. No neurologic morbidity was observed when other patients were discharged. Conclusions The position of the ventricular system is deep inside. It is suitable for using keyhole amplification effect to adequately and effectively expose surgical fields. It can effectively decrease intracranial pressure and increase surgical expose space by releasing cerebrospinal fluid through the ventricular system. Most of hydrocephalus can be subsided in patients with preoperative hydrocephalus after postoperative cerebrospinal fluid circulation smooth. There is no need for routine ventricular-peritoneal drainage. Key words: Cerebral ventricle neoplasms; Microsurgery; Keyhole approaches