Management of large intraventricular meningiomas with minimally invasive port technique: a three-case series
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TECHNICAL NOTE
Management of large intraventricular meningiomas with minimally invasive port technique: a three-case series Ali O. Jamshidi 1 & Andre Beer-Furlan 1,2 & Douglas A. Hardesty 1 & Leo F. S. Ditzel Filho 1 & Luciano M. Prevedello 4 & Daniel M. Prevedello 1,3 Received: 13 July 2020 / Revised: 14 September 2020 / Accepted: 30 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The use of minimally invasive transcranial ports for the resection of deep-seated lesions has been shown to be safe and effective. To date, most of the literature regarding the tubular retractors used in brain surgery is comprised of individual case reports that describe the successful resection of deep-seated lesions such as thalamic pilocytic astrocytomas, colloid cysts in the third ventricle, hematomas, and cavernous angiomas. The authors describe their experience using a tubular retractor system with three different cases involving large intraventricular meningiomas and examine radiographic and patient outcomes. A single-institution, retrospective case series was performed from a skull base database. Patients who underwent resection of intraventricular > 4cm meningiomas with port technology were identified. The authors reviewed three cases to illustrate the feasibility of minimal access port surgery for the resection of these lesions. Complete resection was achieved in all cases. None of the patients developed permanent neurological deficits. There were no major complications related to surgery and no mortalities. Good clinical and surgical outcomes for atrium meningiomas can be achieved through the minimally invasive port technique and tumor size does not appear to be a limitation. Keywords Brain port . Meningioma . Minimally invasive . Port technique . Tubular retractor . Ventricular tumor . Ventricular atrium
Introduction Intraventricular meningiomas originate from abnormal embryologic migration of arachnoid cap cells into the choroid plexus and account for 0.5–3.7% of all meningiomas [1–4]. Tumors located at the trigone of the lateral ventricle pose a challenge to neurosurgeons due to the complex anatomical * Daniel M. Prevedello [email protected]
boundaries of the ventricular atrium [5]. Intimate understanding of the anatomy is critical in avoiding surgery-related morbidity. There has been a strong trend towards expanding the use of minimally invasive and port techniques in neurosurgery. One of the advantages of its use for the resection of intra-axial lesions is limiting retractor-induced parenchymal injury associated with the use of blade or ribbon systems [6]. To date, most of the literature regarding the tubular retractors used in brain surgery is comprised of individual case reports that describe the successful resection of deep-seated lesions such as thalamic pilocytic astrocytomas, third ventricle colloid cysts, hematomas, and cavernous angiomas [7–14]. We present and discuss our experience with minimally invasive port technique resection of intraventricular meningiomas.
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