Stereotactic endoscopic interventions in cystic and intraventricular brain lesions

Image guided stereotaxis is an accurate and safe method of directing therapy to target volumes defined in two-dimensional (2D) multiplanes or three-dimensional (3D) perspectives using computer reconstruction of image data. The major limitations of stereotactic techniques are related to a lack of intraoperative visualization and direct monitoring of the procedures and to changes of intracranial coordinates after decompression of cystic lesions or aspiration of cerebrospinal fluid in the management of intraventricular lesions. Endoscopic laser stereotaxis (ELS) involves integration of rigid-flexible endoscopy and Nd-YAG laser to 3D-2D multiplanar image-guided stereotactic procedures. The major advantages of ELS include: direct intraoperative visualization, hemostasis, evacuation or resection assessment, and wide exploration of intracranial cavities or ventricles. The technique allows safe aspiration, biopsy, and resection or internal decompression of deep and subcortical intracranial lesions. ELS has proved to be safe and effective in the management of 76 clinical cases and appears to be a promising technique in the management of cystic and intraventricular lesions.