Full-Endoscopic Trans-Magendie Four-Hands Surgical Technique for Fourth Ventricle Lesions Removal: Two Case Reports

The traditional telovelar microscopic approach to the resection of fourth ventricle lesions has been shown to be safe and effective. We present 2 cases of fourth ventricle lesions treated with a full-endoscopic trans-Magendie 4-hands technique, never before described in the literature.

The first patient, a 32-year-old man, with a 7-year history of a slight but stable deficit in the right lateral gaze, had in the previous month suffered an episode of peripheral paresis of the right facial nerve, which subsequently improved but did not completely resolve. A magnetic resonance imaging (MRI) scan revealed a lesion of the fourth ventricle floor. The second patient, a 43-year-old man, had a 1-year history of headaches and subjective visual impairment. At admission, the neurological examination was negative. The MRI scan showed a lesion of the fourth ventricle roof. A complete exeresis of the 2 lesions was obtained in the absence of postoperative complications.

A full-endoscopic 4-hands approach passing through the foramen of Magendie can be a valid alternative for the removal of fourth ventricle lesions with the advantage of reaching the roof of the fourth ventricle with minimal retraction of the surrounding structures.