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Endoscopic approach via the interhemispheric fissure: the role of an endoscope in a surgical case of multiple falcine lesions

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Abstract

Background

For treating a patient with multiple falcine and parasagittal lesions, we believe that it is beneficial to resect the maximum possible number of lesions during one operation, even if some lesions are asymptomatic. This practice can potentially reduce the total number of operations during a patient’s lifetime.

Methods

We provide an introduction of a concurrent endoscopic approach via the interhemispheric fissure.

Conclusions

Applying this endoscopic approach concurrently with conventional microscopic surgery can enable the safe resection of as many lesions as possible during one operation.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho Showa-ku, Nagoya-shi, Aichi, 466-8650, Japan

    Junya Yamaguchi, Tadashi Watanabe & Tetsuya Nagatani

Authors
  1. Junya Yamaguchi
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  2. Tadashi Watanabe
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  3. Tetsuya Nagatani
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Corresponding author

Correspondence to Tadashi Watanabe.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent was not required and no identifiable information about the patient is included in the article; however, the patient has consented to the submission of this manuscript to the journal.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflict of interest

The authors have no conflicts of interest to declare.

Additional information

Summary - 10 key points

1. Applying the endoscopic approach via the interhemispheric fissure concurrently with conventional endoscopic surgery is feasible to remove as many falcine and parasagittal lesions as possible during one operation.

2. The interhemispheric fissure has structural characteristics that narrow space where there is no bridging structures is widespread in an anteroposterior direction.

3. In endoscopic surgery, a wide operative viewing angle and a well-lighted, clear operative view facilitate detailed observations, even in deep and narrow spaces.

4. A neuronavigation system is helpful in confirming the location of a main lesion, decide the size of craniotomy, and check the direction to remote asymptomatic lesions intraoperatively.

5. The use of an oblique endoscope can allow for access to lesions located nearby the SSS or beneath a PBV on the outside of a craniotomy.

6. The use of malleable tools designed for endoscopic surgery can improve the ease and safety of surgical manipulation in the interhemispheric fissure.

7. It is relatively difficult to obtain a wide and clear working space in the deep posterior interhemispheric fissure.

8. One disadvantage of endoscopic surgery is that an intracranial blind spot exists between the tip of the endoscope and the opening of the skull. Operators must thus pay special attention not to injure the PBV, especially during manipulating in deep areas.

9. Use of a second endoscope or an exoscope to avoid blind spot-related complications is helpful.

10. As the target of this endoscopic approach via the interhemispheric fissure is asymptomatic lesions, reception withdrawal is occasionally required if a wide and clear working space cannot be obtained.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

Video of endoscopic resection of multiple falcine meningiomas via the interhemispheric fissure in a 39-year-old female with neurofibromatosis type 2, explaining intraoperative key points. (MP4 44461 kb)

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Yamaguchi, J., Watanabe, T. & Nagatani, T. Endoscopic approach via the interhemispheric fissure: the role of an endoscope in a surgical case of multiple falcine lesions. Acta Neurochir 159, 1243–1246 (2017). https://doi.org/10.1007/s00701-017-3129-9

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  • DOI: https://doi.org/10.1007/s00701-017-3129-9

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