Resection of an Intraventricular Metastatic Tumor with Minimally Invasive Port Technique: 2-Dimensional Operative Video

The use of minimally invasive port technology has been proposed as a safe method to reduce retractor-induced parenchymal injury, particularly for the resection of deep-seated lesions.1-6 A 69-year-old woman with a history of previous colon cancer surgery presented with gait disturbances and progressive headaches. Magnetic resonance imaging revealed a tumor involving the right ventricular atrium that appeared consistent with metastasis. A parieto-occipital craniotomy was performed on the basis of the preoperatively planned surgical trajectory (Video 1). After the dural incision, the arachnoid was opened down to the sulcus under visualization with microscope. Next, the ViewSite Brain Access system tubular retractor (VBAS; Vycor Medical Inc., Boca Raton, Florida, USA) was introduced toward the lesion under navigation guidance. Once the ventricular atrium was entered, the surface of the tumor came into view. It was coagulated and progressively debulked with ultrasonic aspirator. After the mass was adequately decompressed, a plane of dissection between the ependyma and the tumor could be developed with dynamic angulation of the port in order to allow better visualization. Finally, the tumor could be gently rolled away from the choroid plexus and removed. Meticulous hemostasis was achieved, and the tubular retractor was slowly removed. The patient recovered uneventfully without neurologic deficits on follow-up, and the postoperative magnetic resonance imaging evidenced a complete resection of the tumor. The video illustrates technical nuances and demonstrates the feasibility of minimal access port surgery for the resection of intraventricular lesions with low morbidity and mortality using microsurgical techniques. The patient consented to the publication of her image.