Microsurgical Tubular Resection of a Left Ventricular Large Subependymoma: 2D Operative Video

Abstract

Introduction: Intracranial subependymomas are rare, representing only 0.2-0.7% of all central nervous system tumorsand arise in the lateral ventricles in 30-40% of the cases. Symptoms depend on tumor location and usually arise when thecerebrospinal fluid (CSF) is blocked, generating a consequent intracranial hypertension. Microsurgical gross-total resection is possible and curative for these tumors. The transcortical/trans-sulcal approach is a safe approach for the access of deep-seated intraventricular lesions. The use of tubular retractor systems minimizes retraction injury when passing through the cortex and deep white matter tracts. This allows a decrease in the pressure on brain tissue that can occlude the brain vessels and produce local ischemia and a consequent permanent neurological injury.

Case description: We present a case of a 66-year-old woman who presented chronic headaches that increased in frequency in the last month. Enhanced-brain MRI demonstrated a large left ventricular lesion with signs of obstructive hydrocephalus.

Results:  Patient was positioned supine. A bicoronal incision was used to perform a left frontal craniotomy. An F1/F2 transcortical/trans-sulcal approach was used. A tubular retractor was placed and a microsurgical resection under neuronavigation guidance was done. Postoperative postcontrast MRI demonstrated a complete resection of the tumor. Histopathological analysis revealed a subependymoma (World Health Organization Grade I). The patient presented transient apathy and loss of urinary sphincter control that completely resolved 3 weeks after surgery. Written informed consent was obtained for publication of information used for this work.

Conclusions: We describe a complete microsurgical resection of a large left ventricular subependymoma through a trans-sulcal tubular approach.