Purely Endoscopic Resection of Cavernoma of the Septum Pellucidum

Neuroendoscopic Surgery for Intraventricular Cavernous Malformations: A Review on Indications and Surgical Considerations

BACKGROUND

Intraventricular cavernous malformations (IVCs) are rare vascular lesions of the central nervous system. Surgical resection remains a challenging endeavor, with conventional microsurgical techniques associated with morbidity due to direct brain tissue manipulation. Neuroendoscopic approaches offer a minimally invasive alternative, though their efficacy and safety in treating IVCs remain underexplored.

METHODS

A narrative review was conducted to analyze all documented cases of IVCs treated exclusively with endoscopic transventricular approaches. Reviews, original research papers, and case reports published from 1990 to May 2024 were included. When available, surgical videos were also reviewed.

RESULTS

Seventeen patients with IVCs primarily located in the foramen of Monro were identified. The mean size of the IVCs was 17 mm (range: 7-29 mm). Neuroendoscopic procedures achieved gross total resection in all cases, leading to the resolution of clinical symptoms. Except for one patient who experienced memory impairment postsurgery, no persistent neurological dysfunctions were observed. Intraoperative bleeding, a significant challenge in IVC resection, was managed with continuous warm irrigation and dedicated coagulation instruments. Additionally, 6 cases of neuroendoscopic procedures such as endoscopic third ventriculostomy and septum pellucidotomy were reported for managing hydrocephalus.

CONCLUSIONS

Neuroendoscopic surgery offers several advantages in treating IVCs, including minimally invasive access, precise visualization, and reduced brain tissue manipulation. Our findings support the efficacy and safety of endoscopic transventricular approaches, underscoring its potential as a valuable therapeutic strategy for selected IVCs.

A Review of Common Endoscopic Intracranial Approaches

With the evolution of surgical techniques, endoscopy has emerged as a suitable alternative to many instances of more invasive methods. In this review article, we aim to discuss the endoscopic advancements, procedural details, indications, and outcomes of the most commonly practiced neuroendoscopic procedures. We have also summarized the uses, techniques, and challenges of neuroendoscopy in select neurosurgical pathologies.