Endoscopic and Endoscopically-Assisted Resection of Intraventricular Lesions Using a Neuroendoscopic Ultrasonic Aspirator

Abstract

The development of minimally invasive neuroendoscopy has advanced in recent years. The introduction of the neuroendoscopic ultrasonic aspirator (NUA) broadened the treatment spectrum of neuroendoscopy. We aim to describe our experience with the use of NUA for the resection of intraventricular lesions. Here, we present consecutive retrospective case series of adult and pediatric patients undergoing resection of an intraventricular lesion with a NUA (Endoscopic Neurosurgical Pen, Söring GmbH, Quickborn, Germany) between January 2019 and April 2020. Eight patients between the age of 0.5 and 73 years underwent surgery using NUA and were included in this study. In four patients, an endoscopic assisted (EA) resection of the lesion was undertaken, while in four patients, the lesion was removed using purely endoscopic (PE) resection. In all cases, gross/near total resection was achieved. The average blood loss was 142.5 ± 90.4 mL (range 50–300 mL). Transient morbidity was seen in four patients (50%), while permanent morbidity or mortality did not occur. The NUA seems to be a safe and valuable tool for the minimally invasive resection of intraventricular lesions in selected cases. The type, size, consistency, and vascularization of the lesion limit at times the purely endoscopic use of the NUA.

Resection of brain lesions with a neuroendoscopic ultrasonic aspirator — a systematic literature review

“…This finally resulted in nine studies, which we included in the analysis (Fig. 2) [2,[14][15][16][17][18][19][20][21]. These studies consisted of 6 case series [2,15,[18][19][20][21] and three case reports [14,16,17].…”

“…2) [2,[14][15][16][17][18][19][20][21]. These studies consisted of 6 case series [2,15,[18][19][20][21] and three case reports [14,16,17]. A total of 40 patients were analyzed in the included studies, of whom 19 (47.5%) were children (Table 1).…”

“…Of the nine studies, seven (77.8%) reported on the extent of resection [14,15,[17][18][19][20][21] (Table 1). Information about the EOR was available in 38 (95%) patients.…”

“…No. of patients PE (%) GTR/NTR (%) Clinical outcome Ns/I/W (%) Morbidity (%) † Surgery-related mortality (%) Rec (%) FU (m) 20 8 50 ‡ 100 50/50/0 50 0 0 15.9 ± 6.3 Tirado et al 15 3 100 66.7 0/50/0 0 0 NA NA Oertel et al 2 1* 100 NA NA 0 0 NA NA Desse et al 16 1 100 NA --100 -2.9 Selvanathan et al 14 [16,17,[19][20][21]. Of the 40 tumors resected by NUA, the most frequent were colloidal cysts (17.5%), pilocytic astrocytomas (12.5%), subependymal giant cell astrocytomas (SEGA) (7.5%), subependymomas (7.5%), and craniopharyngiomas (7.5%) (Table 2).…”

Pediatric and Adult Low-Grade Gliomas: Where Do the Differences Lie?

“…On the other hand, pediatric neurosurgeons often encounter posterior fossa pLGG or exophytic brainstem pLGG and require a specific skillset for these approaches, as well as treating obstructive hydrocephalus or tumor biopsies with endoscopic procedures (e.g., ETV) [39]. Intraventricular tumors (e.g., pLGG within the third ventricle, thalamic pLGG) requiring an endoscopic or transventricular approach, are also more often encountered in children than in adults 40 [40]. It is therefore clear that LGGs show anatomical differences in different age groups which directly influences and dictates their treatment strategy.…”