Endoneurosurgical resection of intraventricular and intraparenchymal lesions using the port technique

Abstract

Objective: Deep-seated intraventricular and intraparenchymal lesions have traditionally been resected via transcortical routes, often requiring the use of retractors to maintain the corridor created to reach the lesion and proceed with a bimanual microsurgical resection. A transparent cylindrical conduit (port) has been developed to resect deep-seated lesions using the endoscope or, more recently, Video Telescopic Operating Microscopy (VTOM) for visualization. We describe the surgical technique of the port technique and discuss the evolution of the concept of intraaxial brain surgery performed through a conduit.

Methods: Detailed description of the ventriculoport and brainport technique with illustrative cases.

Results: Results of intraventricular and intraparenchymal port surgery have been published and document the feasibility and safety of this technique. Over the years, the technique has been improved. The port technique offers numerous potential advantages, including: 1) minimizing white matter disruption as the tip design minimizes the risk of fascicles injury during cannulation; 2) ensuring stability as the rigidity prevents inadvertent expansion of the initial diameter of the corticectomy and white fiber tract dissection throughout surgery; 3) protecting the surrounding tissues against iatrogenic injuries caused by instrument entry and reentry; 4) affording constant visualization of the tissue traversed given the transparent conduit design; 5) enabling homogeneous radial dispersion of the pressure on the surrounding tissue to minimize injury.

Conclusion: The port technique is an option for resection of intraventricular and intraparenchymal lesions. Additional studies are required to assess its impact on adjacent cerebral tissue morphology, blood flow, and metabolism. Quality-of-life assessments are also needed. High-definition fiber tracking, new visualization techniques (VTOM), and new instrumentation will add to the progress of endoscopic port surgery. We have already seen a significant evolution of the technology even since the preparation of this article.