Fully endoscopic transforaminal-transchoroidal approach for tectal area tumors removal.

Abstract Background Surgical approaches to lesions located in the tectal area are still controversial. The essential functions in surrounding areas and the difficulties to get a good surgical view during tumor removal makes these procedures risky and challenging. Endoscopic transforaminal approaches have been previously described for biopsy and intraventricular tumor removal surgery. However, the endoscopic transforaminal- transchoroidal gross-resection technique in these cases is barely described. Methods Endoscopic entry points and trajectories were planned on MRI previously to the procedure. Once the endoscope was inside ventricular system, angles of work and tumor exposure of the upper-posterior part of the third ventricle were carefully evaluated. If the angle of work was insufficient for tumor removal, choroidal fissure was then opened using endoscopic bipolar and dissectors. Tumor removal was performed using an endoscopic ultrasonic aspirator (Sonoka®). We present a three-cases series affected by tectal tumors treated by a fully endoscopic transforaminal-transchoroidal approach. Results Total gross-resection of the tumors was achieved in two cases. Subtotal resection was achieved in the resting case. No major complications were related after any procedure. No new cognitive impairment was described secondary to this technique. Conclusion In our experience, a fully endoscopic transforaminal-transchoroidal approach was a suitable treatment for this complex pathology. Opening of choroidal fissure added an extra angle of work and improved the exposure of the upper-posterior part of the third ventricle.