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J. Javier Cuellar-Hernandez1, Miguel Angel Lopez-Gonzalez2, J. Ramon Olivas-Campos3, Paulo M. Tabera-Tarello3, Carlos Seañez-Prieto3, Timothy Marc Eastin2, Minwoo Song2
  1. Department of Neurosurgery, Swiss Hospital, Monterrey, Mexico,
  2. Department of Neurosurgery, Loma Linda University School of Medicine, Loma Linda, California, United States,
  3. Department of Neurosurgery, Northeast National Medical Center, Monterrey, Nuevo Leon, Mexico.

Correspondence Address:
J. Javier Cuellar-Hernandez, Department of Neurosurgery, Swiss Hospital, Monterrey, Mexico.

DOI:10.25259/SNI_642_2021

Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: J. Javier Cuellar-Hernandez1, Miguel Angel Lopez-Gonzalez2, J. Ramon Olivas-Campos3, Paulo M. Tabera-Tarello3, Carlos Seañez-Prieto3, Timothy Marc Eastin2, Minwoo Song2. The use of exoscope combined with tubular retractor system for minimally invasive transsulcal resection of an ventricular atrium atypical choroid plexus papilloma: Three-dimensional operative video. 06-Sep-2021;12:444

How to cite this URL: J. Javier Cuellar-Hernandez1, Miguel Angel Lopez-Gonzalez2, J. Ramon Olivas-Campos3, Paulo M. Tabera-Tarello3, Carlos Seañez-Prieto3, Timothy Marc Eastin2, Minwoo Song2. The use of exoscope combined with tubular retractor system for minimally invasive transsulcal resection of an ventricular atrium atypical choroid plexus papilloma: Three-dimensional operative video. 06-Sep-2021;12:444. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=11084

Date of Submission
28-Jun-2021

Date of Acceptance
20-Aug-2021

Date of Web Publication
06-Sep-2021

Abstract

Background: Choroid plexus papilloma represents 1–4% of pediatric brain tumors, mostly located in the ventricular atrium.[1] Intraventricular tumors represent a challenge due to the poor visualization of the surgical field and damage to surrounding structures.[2] Use of tubular retraction reduces cerebrovascular trauma to the surrounding parenchyma by distributing pressure uniformly, allowing less invasive corticotomy, and more stability on surgical corridors that allow the surgeon to use both hands and external visualization devices.[2-5]

Case Description: We present the case of a 3-year-old boy with progressive headache, vomiting, and loss of control in the left hand for 3 months, with a history of ventricular shunt placement for acute obstructive hydrocephalus. The MRI revealed large lobulated lesion, which was hypointense on T1, hyperintense on T2, marked enhancement on T1 C+ (Gd) within the atrium of the right lateral ventricle, and spectroscopy with a peak of choline. Written consent for the use of photos and videos on this work was obtained from the patient’s mother. A high-definition two-dimensional exoscope (VITOM® Karl Storz, Tuttlingen) was used during the surgical approach and throughout tumor removal, which was aided by ViewSite Brain Access System (VBAS®; Vycor Medical Inc.).[3] We performed a transparietal minimally invasive transsulcal parafascicular approach through the Frazier point for direct access to the ventricular atrium. Histological examination confirmed atypical choroid plexus papilloma. Postoperative imaging shows no residual tumor. The postoperative course was satisfactory with improvement of the headache and control of the left hand, leading to discharge home 1 week after surgery.

Conclusion: The tubular transparietal minimally invasive approach obviates the need for traditional approaches to the atrium. This technique is safe and effective for the treatment of intraventricular and periventricular lesions, thus making this challenging target in more accessible to neurosurgeons, avoiding structure damage and any associated morbidity or mortality.

Keywords: Atypical papilloma, Exoscope, Tubular retraction, Ventricular atrium

Video 1

Annotations[1-5]

00:00 – Introduction and Case presentation

01:02 – Differential diagnosis

01:08 – Rationale for the procedure

01:46 – Risks of the procedure and its potential benefits

01:53 – Alternatives and why they were not chosen

02:06 – Positioning

02:18 – Necessary equipment

02:37 – Key Surgical Steps

06:00 – Disease background

06:30 – Postoperative MRI and outcome.

Declaration of patient consent

Patient’s consent not required as patients identity is not disclosed or compromised.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

[Video 1]-Available on:

www.surgicalneurologyint.com

References

1. Bahar M, Hashem H, Tekautz T, Worley S, Tang A, de Blank P. Choroid plexus tumors in adult and pediatric populations: The Cleveland clinic and university hospitals experience. J Neurooncol. 2017. 132: 427-32

2. Eliyas JK, Glynn R, Kulwin CG, Rovin R, Young R, Alzate J. Minimally invasive transsulcal resection of intraventricular and periventricular lesions through a tubular retractor system: Multicentric experience and results. World Neurosurg. 2016. 90: 556-64

3. Güngör A, Baydin S, Middlebrooks EH, Tanriover N, Isler C, Rhoton AL. The white matter tracts of the cerebrum in ventricular surgery and hydrocephalus. J Neurosurg. 2017. 126: 945-71

4. Marenco-Hillembrand L, Prevatt C, Suarez-Meade P, Ruiz-Garcia H, Quinones-Hinojosa A, Chaichana KL. Minimally invasive surgical outcomes for deep-seated brain lesions treated with different tubular retraction systems: A systematic review and meta-analysis. World Neurosurg. 2020. 143: 537-45.e3

5. Shapiro SZ, Sabacinski KA, Mansour SA, Echeverry NB, Shah SS, Stein AA. Use of Vycor tubular retractors in the management of deep brain lesions: A review of current studies. World Neurosurg. 2020. 133: 283-90

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