Endoscopic excision of a lateral ventricular epidermoid - A case report of a novel technique

INTRODUCTION Epidermoids of the lateral ventricle are relatively rare tumours. As these tumours are soft and relatively avascular, they appear to be ideally suited for endoscopic surgical excision. At present the instruments available are specifically designed for endoscopic intra ventricular surgeries, limitations being inability to rapidly debulk the tumour and achieve adequate haemostasis. We present a case of lateral ventricular epidermoid that was excised endoscopically using a system originally designed for endoscopic disc surgery.

PRESENTATION OF CASE We describe a female patient who presented with recurrent headache and occasional episodes of vomiting since 6 years. Preoperative diagnosis of lateral intra ventricular epidermoid was made with the help of an Magnetic resonance imaging (MRI) of the brain. Intraoperatively, an incision was made over the right Kocher's point and a 2.5 cm dural opening was made following a small craniotomy and the Destaudeau endoscope was introduced. A 30° scope and gentle manipulation were used to view the ventricular cavity and ensure near total excision of the tumour. Here we record this novel technique.

DISCUSSION Lateral intra-ventricular tumours are usually approached through a trans-cortical or intra hemispheric approach, under microscope. The use of endoscopes have been largely restricted because of non-availability and relative difficulty in controlling troublesome bleeding, incase of vascular tumours.

CONCLUSION A multi portal endoscope that allows use of routine pituitary instruments would enable the surgeon to achieve haemostasis effectively and, in our opinion, should be a viable alternative to microscope for excision of intra ventricular tumours.