Introduction: Endoscopic resection of intraparenchymal tumours has scarcely been reported(1). The need to overcome difficulties of creating and maintaining a safe operative access corridor, the requirement for bimanual microsurgical techniques to perform safe tumour resection and the difficulties of the monocular endoscopic surgical field have been cited as challenges to endoscopic intraparenchymal tumour resection.
We present our prospective study on the feasibility of performing minimally invasive, fully endoscopic, bimanual resection of intraparenchymal brain tumours on 32 patients.
Methods: Over a 14 month period (Dec 2011-Feb 2013), 33 fully endoscopic intraparenchymal tumour resections were carried out on 32 patients (17 F:15M).
All clinical, peri-operative and 30 day follow up data was collected prospectively. All tumours were resected through a 2 cm minicraniotomy using an 30 degree HD Karl Storz endoscope. Bimanual resection was performed using standard microsurgical technique. Patients with tumours in eloquent locations underwent a pre-op functional MR and DTIscan. Post-operative MR imaging or CT was performed to assess residual tumour.
Results: Mean patient age 52 years (range: 23 - 74). 26 tumours were supra-tentorial (11 frontal, 10 temporal, 2 occipital, 1 parietal and 2 parafalcine) and 7 infra-tentorial. Mean tumour size was 42mm and mean distance from cortical surface 7.3mm. There were 10 metastases, 13 glioblastomas, 5 low grade gliomas, 3 meningiomas and 2 haemangioblastomas. Total radiographically confirmed resection was achieved in 17 (51.5%) cases, near-total in 12 (36.3%) and sub-total in 4 (12.1%).
There were 3 wound infections (2 in patients with recurrent tumours post radiotherapy), 1 CSF leak and 1 patient had an anterior circulation infarct due to a vessel retraction injury (recovering now).
Conclusions: To our knowledge this is the largest case series of fully endoscopic intraparenchymal tumour resection published in the literature. Our experience demonstrates that resection of intraparenchymal tumours using a fully endoscopic technique is technically feasible, safe and achieves good tumour resection margins. We discuss the merits/demerits of our technique.
Patient Care: The development of this minimally invasive technique aims to allow patients with brain tumours to undergo surgical resection with small craniotomies thus hopefully decreasing the perioperative morbidity associated with a large craniotomy and decreasing the length of hospital stay. We feel that the better visualisation with the endoscope increases the ability to achieve good resection margins which is ultimately beneficial to patients.
Learning Objectives: By the conclusion of this session participants should be able to
1) understand the technical challenges of performing endoscopic intraparenchymal tumour resection,
2) understand a novel fully endoscopic, bimanual technique of intraparenchymal tumour resection and to evaluate the feasibility, safety and resection outcomes for this technique.