Endoscopic resection of cystic pontine tumour: three case reports and a proposal for minimally invasive dual-endoscopic surgery

• DOI: 10.1007/s00701-014-2085-x
• Publication Date: 2014-04-16T02:16:27Z
• Authors: Tadashi Watanabe; Taku Sato; Yugo Kishida; Eiji Ito; Masahiro Ichikawa; Jun Sakuma; Tetsuya Nagatani; Kiyoshi Saito
• Keywords: Endoscope; Chordoma; Pons; Neuroradiology

We describe a new endoscopic technique, the dual-endoscopic method, in which two independent endoscopic systems are simultaneously used in the subtemporal space and intraparenchymal field for patients with pontine cystic tumours. Tumours were successfully removed through a sheath placed in the brainstem via the subtemporal keyhole approach, with safety ensured by the second subtemporal endoscope.A purely endoscopic subtemporal approach was performed in three cases of pontine cystic tumour, including two low-grade gliomas and a recurrent chordoma. The gliomas showed nodules. Recurrent chordoma consisted of a mucinous component.Using a keyhole subtemporal approach and a 4.0-mm rigid endoscope with a high-definition camera, a transparent puncture needle containing a 2.7-mm rigid endoscope was inserted into the cyst. The tumour was removed using suction, biopsy forceps, and scissors simultaneously placed with the 2.7-mm endoscope in a transparent sheath.Since the 4.0-mm endoscope placed in the subtemporal space monitored all procedures of the 2.7-mm endoscope, tumour removal was performed safely without damaging the pons, cranial nerves, or vessels. We safely and successfully removed a cystic pontine tumour using a dual-endoscopic method. This new method ensures the safety of deep-seated endoscopic procedures via a minimally invasive transcranial approach.