Fully Endoscopic Resection of Intra-Axial Brain Lesions Using Neuronavigated Pediatric Anoscope

To present a new simple disposable tubular retractor which provides fully endoscopic resections of the intraaxial brain lesions.

A total of 13 patients underwent surgical resection of an intraaxial brain lesion larger than 3 cm with a fully endoscopic approach using the navigation-guided pediatric anoscope. The anoscope was adapted to serve as a tubular retractor. All lesions were resected under endoscopic visualization and navigation guidance. There were 7 men and 6 women with a mean age of 49.6 years (range, 19-76 years). Lesion location was as follows: frontal (n=4), parietal (n=1), frontoparietal (n=2), temporal (n=2), and intraventricular (n=4).

With the use of this technique, preoperative goals of surgery were met in all patients. Gross total resection of the lesions was achieved in 7 of 13 patients (53.8%), near-total resection in 3 patients (23.1%) and subtotal resection in 3 (23.1%) patients. The histological diagnosis included 2 metastases, 5 (38.5%) glioblastomas, 3 meningiomas, 2 low grade gliomas and one oligodendroglioma. There were no complications related to the surgical procedure. Duration of surgery ranged from 60 to 110 minutes, with an average 90 minutes. The average postoperative hospital stay was 2.7 days.

Endoscopic resection of deep-seated brain lesions with the neuronavigated tubular retractor is a safe and an effective technique and may be a feasible alternative to conventional microsurgical or endoscope-assisted methods in selected patients. The modified transparent plastic pediatric anoscope can be used as a tubular retractor and it is easy to apply, simple, lightweight, inexpensive and effective.