Senthil K. Selvanathan

Evolving instrumentation for endoscopic tumour removal of CNS tumours.

BackgroundOpen surgical approaches to intraventricular tumours are complex and challenging. Neuro-endoscopy, however, has enabled us to biopsy and resect small intraventricular tumours with potentially reduced morbidity. Nevertheless, suitable methods/ instrumentation for resection have limited the use of the endoscope. The authors report the utilisation of endoscopic ultrasonic aspirator in the resection of an intraventricular tumour. This technique was compared to another case that utilised conventional endoscopic techniques for removal of an intraventricular tumour.MethodsUsing an endoscope, the third ventricle was entered and visualised, with the tumours clearly seen. Tumours were then either debulked via conventional or novel technique.ResultsUsing the conventional technique, tumour was removed with rongeurs via the flexible scope. Irrigation was needed to improve vision due to bleeding. Postoperative magnetic resonance imaging (MRI) confirmed good excision. Histology was reported as anaplastic ependymoma World Health Organization (WHO) Grade III. Utilising the novel technique, the tumour was also debulked uneventfully. Histology confirmed Grade 1 glioneuronal tumour. Postoperative MRI revealed a small residuum.ConclusionsTo date, endoscopic resection of tumours has been limited by suitable tools. The advent of an ultrasonic aspirator that can be used down an endoscope increases the possibilities for such resections. This is the first reported case of endoscopic resection of an intraventricular tumour using this technique.

A rare case of anterior sacral meningocoele presenting as cauda equina syndrome

Abstract The authors present a case of anterior sacral meningocoele demonstrating a clinical picture of cauda equina syndrome. To the best of our knowledge, such presentation has not yet been reported.

Utilisation of intra-operative Doppler in the localisation of pericallosal artery during functional hemispherotomies for epilepsy: technical note

Functional hemispherotomy is an established technique for treating epilepsy secondary to hemispheric pathology. Corpus callosotomy and frontobasal disconnection are integral parts of this operation. To perform this, localisation of the pericallosal artery through the medial ventricular wall and subpial exposure of the A2 and A1 are required. Here, the authors present how intra-operative Doppler can be useful in helping to localise these arteries in the setting of abnormal neuroanatomy and significant brain shift.