Domagoj Jugović Andrej Porčnik Marjan Koršič University Medical center Ljubljana, Slovenia

Domagoj JugovićDomagoj JugovićAndrej PorčnikAndrej PorčnikMarjan KoršičMarjan KoršičUniversity Medical center Ljubljana, SloveniaUniversity Medical center Ljubljana, Slovenia

Combined microsurgical and endoscopic Combined microsurgical and endoscopic removal of large brain lesions in children: a removal of large brain lesions in children: a

report of two cases report of two cases

Introduction

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• Recent developments in neuroendoscopy have greatly impacted the diagnosis and treatment of brain lesions.

• Treating children in early childhood presents a challange in neurosurgery.

• We presented two cases in which neuroendoscopy was a helpful additional tool in adjunct to microsurgery.

First Case report

Magnetic resonance imaging showed a large cyst causing non-communicating hydrocephalus.

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A cyst in the cisterna ambiens was detected with ultrasonography at the 29th week of gestation in a male fetus.

First Case report

A planed caesarean section was performed at the 35th week of gestation.

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A combined endoscopic and microsurgical approach was performed 2 days after birth with good outcome.

First Case report

• The neurological development was normal and no neurological deficits were present.

• MRI 2 years after the operation showed a marked expansion of the brain parenchyma with no hydrocephalus.

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Before the operation

After the operation

Second Case report

A 13-month old female child presented with a signs and symptoms of increased intracranial pressure.

Magnetic resonance imaging showed a large intra-ventricular solid tumor in the left lateral ventricle.

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Second Case report

A complete microsurgical removal was achieved with the help of neuroendoscopy.

A pathohistological examination revealed a choroid plexus papilloma.

No neurological deficits were present after surgery.

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MRI after the operation showed no residual tumor mass.

Conclusion

• In microsurgical treatment of pediatric brain tumors a neuroendoscopy can provide an additional view of tight anatomic spaces frequently present in infant patients.

• With less brain retraction, smaller operative exposures and better visualisation offered, neuroendoscopy may reduce operative morbidity.

Domagoj JugovićAndrej PorčnikMarjan KoršičUniversity Medical center Ljubljana, Slovenia

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