Intraventricular Brain Tumor Resection | Vik Udani, MD

Live video of brain tumor resection by Vik Udani, MD, Division of Neurosurgery, Senta Clinic, San Diego, CA. A 79-year-old man presented with altered mental status and frequent falls. He was noted to have a large mass with obstructive hydrocephalus. Case and video provided courtesy of Vik Udani, MD.

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▬Beginning ▬▬▬▬▬▬▬▬▬▬▬▬

Firstly, cord academy has been made in the right frontal lobe and the right lateral ventricle is entered. The septum pellucidum can be seen underneath the suction and is bowing out laterally toward the right side.

The framing of Munro and Choroid Plexus on the right side are identified. An opening is then made into the septum pellucidum. This mass appeared to be originating from the septum and growing out laterally into the left ventricle. I chose to come in from the patient's right side so that we would encounter the base of the tumor early on. This allows us to devascularized the brain tumor and detach it from its base along the septum pellucidum. Here the tumor is carefully teased apart from its attachment to the septum.

▬Dissection ▬▬▬▬▬▬▬▬▬▬▬▬

Using gentle dissection, the lead tumor peels off nicely from its attachment. I chose only to use a single retractor entirely along the frontal lobe. This minimizes unnecessary retraction and the schemata injury to the brain. It also allows the tumor and surrounding brain tissue to move freely along with the instruments. The bipolar is used both to dissect. And also to coagulate any vascular attachments between the tumor and the septum. By devascularization of the tumor early on, bleeding is minimized.

▬Finishing the brain tumor resection ▬▬▬▬▬▬▬▬▬▬▬▬

At this point of brain tumor resection, the mass starts to become quite mobile. Coming along the medial surface underneath the tumor, we see the framing of Munro and Choroid Plexus from the left side. The tumor is completely free to posteriorly. And at this point, the last attachment to the brain is anterior. This final attachment is identified. Once this is done the tumor is essentially floating freely within the left lateral ventricle. The goal at this point is to try to remove it in one large piece.

This is done using a hand over hand technique to come underneath the tumor and deliver it whole. The cavity is then carefully inspected for any residual areas of abnormal tissue. It appears that a gross total resection has been accomplished. The framing of Munro is well decompressed and the fornices are preserved. The single retractor is removed and the cavity is irrigated and filled with saline solution. I did leave behind a ventriculostomy which was successfully weaned off after a few days.

Post Op scans show complete tumor resection with a resolution of the hydrocephalus. The patient did very well and was discharged home five days after surgery.

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  Brain Tumor