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Endoscopic transcortical expanded transforaminal transvenous transchoroidal approach to third ventricle lesion resection using an endoport

      Highlights

      • Preliminary application of combined endoscopy, endoport, and expanded transforaminal transvenous transchoroidal approach with third ventricle tumors.
      • Elaborating the advantages of using endoport technology and recommendations.
      • Putting forward our views and experience on whether to sever the anterior septal vein.
      • Some key points are proposed for the surgical approach.

      Abstract

      Objective

      To investigate the clinical experience and application value of endoscopic resection of lesions in and around the third ventricle using a transcortical expanded transforaminal transvenous transchoroidal approach with an endoport.

      Methods

      Clinical data and follow-up results of seven patients who underwent the removal of lesions in the third ventricle and its adjacent area with an endoport-guided endoscopic system from January 2018 to December 2020 in the Department of Neurosurgery, Zhongshan Hospital Affiliated to Fudan University, were analyzed retrospectively. Two other patients from the Affiliated Pediatric Hospital of Fudan University and the Affiliated Hospital of Guizhou Medical University, respectively, were included in the analysis.

      Results

      A total of nine cases of third ventricle tumors were included in the study, including six women and three men, with an average age of 37.8 years (4–84 years old) and a follow-up time of 6–44 months. These nine tumor cases included two pilocytic astrocytomas, one diffuse midline glioma (H3 K27-altered), two craniopharyngiomas, two choroid plexus (CP) papillomas, one germinoma, and one pineal parenchymal tumor of intermediate differentiation. Total resection was completed in eight cases, with one near-total resection. There were no complications related to the surgical approach, such as epilepsy, aphasia, or hemiplegia.

      Conclusions

      The endoscope transcortical expanded transforaminal transvenous transchoroidal approach using an endoport can safely and effectively remove third ventricle lesions. This approach can reach a wide area, from the anterior to the posterior third ventricle.

      Keywords

      Abbreviations:

      ASV (anterior septal vein), CP (choroid plexus), ICV (internal cerebral vein), TSV (thalamostriate vein)
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