Endoscopic stereotactic interventions in the treatment of 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 a lack of intraoperative visualization and direct monitoring of the procedures, and 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: minimally invasive (burrhole or small craniotomy surgery), direct intraoperative visualization, hemostasis, evacuation or resection assessment, and wide exploration of intracranial cavities or ventricles. ELS has been used in the management of 152 clinical cases including biopsy, aspiration, resection and internal decompression of deep and subcortical intracranial lesions, and different types of fenestration procedures. Image-guidance combined with endoscopic techniques may offer a safe, accurate alternative to conventional neurosurgical procedures in treating small solid, cystic, and intraventricular lesions as well as fenestration procedures.