Neuroendoscopic approach to brain tumors

Objective: Although standard microsurgical approach is the established techniques to many brain tumor surgery, however, endoscopic brain tumor surgery is becoming the technique of choice to some skull base tumors and intraventricular tumors. The purpose of this study was to evaluate the efficacy of brain tumor surgery by endoscopic approach. In this paper, we like to share our experience regarding the management of patients with brain tumors by endoscopic approach. Methods: 12 cases of brain tumor patients were treated by endoscopic approach first time ever in Bangladesh. A total of 12 strictly endoscopic interventions were performed. Total tumor resections, partial resections, biopsies and endoscopic third ventriculostomies (ETV) were performed. Results: Endoscopically complete tumor resection was possible in five cases with eventless and quick postoperative recovery. Tumor biopsy or partial resection from the midbrain, thalamus, pineal region and intraventricular space through a single burr hole technique was possible without any postoperative neurological deficit. The hydrocephalus-related symptoms resolved in all of the 10 patients with cerebrospinal fluid pathway obstruction. One patient died on 5th postoperative day. Conclusions: In our preliminary experience, the endoscopic brain tumors surgery was found minimal invasive technique and superior to conventional microscopic surgery in terms of operative mortality and morbidity. Endoscopic third ventriculostomy (ETV) is the unique technique to manage tumor associated obstructive hydrocephalus rather than ventriculoperitoneal (VP) shunt. Introduction Surgical management of brain tumor is still a challenging issue to the neurosurgeons. Skull base tumors (e.g. pituitary tumors), thalamic, midbrain and pineal region tumors, tumors in the cerebellopontine angle and tumors in the ventricles of the brain present a challenging management scenario for the neurosurgeon. This is primarily because of the site of the lesions and critical neuroanatomic structures such as optic apparatus, hypothalamus, pituitary gland, fornices and midbrain, cranial nerves, vessels and other brainstem structure situated adjacent to the abnormality. Direct standard microsurgical approach (craniotomies) still not so appreciable to remove these tumors and sometimes fraught with severe complications. In the recent decades neuroendoscopy as a minimal invasive procedure is becoming the powerful tool to approach to many brain tumors because of less invasiveness, magnification and illumination best offered by neuroendoscope in comparison to operating microscope. In this context, as we started neuroendoscopic brain tumor surgery for the first time ever in Bangladesh, we would like to present a few cases of brain tumor treated with purely neuroendoscopic approach. We will discuss how neuroendoscope have influenced our approach to the treatment of brain tumor involving critical neural structures. Materials and methods Between May 2006 and July 2007, 12 patients with brain tumor were selected for endoscopic approach. The selection criteria mainly depended on tumor location, and size of the tumor. Average age at presentation was 22 years of age (range: 12 years to 42 years) and the male-to-female ratio was 2:1 (eight male and four female). The lesions included two pituitary giant macroadenoma, two lateral The ORION Medical Journal 2008 May;30:551-554 1. Dr. Aminur Rahman, MBBS, MS, F-FHU Specialist Neurosurgeon and Neuroendoscopic Surgeon, Department of Neurosurgery, Chittagong Medical College Hospital E-mail: [email protected] 2. Dr. Md. Zillur Rahman, MBBS, FCPS (S), MS (Neurosurgery), Professor & Head, Department of Neurosurgery, Chittagong Medical College Hospital 3. Dr. Md. Manzoorul Islam, MBBS Department of Neurosurgery, Chittagong Medical College Hospital 4. Dr. Asifur Rahman, MBBS Department of Neurosurgery, Chittagong Medical