Hemostasis management during completely endoscopic removal of a highly vascular intraparenchymal brain tumor: technique assessment.
BACKGROUND
Recently, stereotactic-guided removal of intraparenchymal lesions using endoscopic visualization through a brain port has been successfully reported. Although endoneurosurgical tumor resection uses the same principles as those used in microneurosurgery, the ability to control bleeding through the port requires an adapted technique.


METHODS
We present a patient that underwent a completely endoscopic resection of a vascular brain tumor through a brain port and describe the hemostatic technique.


RESULTS
A 68 year-old female presented with progressive gait difficulties. She had been previously treated for a breast cancer. Magnetic resonance imaging (MRI) showed a right subcortical solitary cerebellar lesion that homogeneously enhanced. The patient underwent an endoscopic brain port removal of a supposed brain metastasis. After port cannulation, the tumor partly delivered itself into the port. Following initial tumor biopsy, active bleeding occurred. Irrigation and application of Surgifoam allowed to control the bleeding. Coagulation with an adapted bipolar and removal of coagulated tissue with the side-cutting aspiration device were sequentially repeated. Once the tumor was resected, the suction served as counter-traction elongating the vessels whereas the bipolar cauterized them over a long segment. Hemostasis was performed circumferentially along the cavity's walls from deep to superficial, benefiting from the endoscope's dynamic properties and magnification. Pathology confirmed intraoperative suspicion of hemangioblastoma.


CONCLUSIONS
Removal of vascular tumors is feasible through the brain port, despite a relatively narrow corridor of 11.5 mm. However, specific hemostasis techniques are required and adapted instruments are needed to ensure hemostasis through these small corridors.
Brain Tumor Center and Pituitary Disorder Program, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, United States.
Nancy
N
McLaughlin
Brain Tumor Center and Pituitary Disorder Program, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, United States.
Daniel F
DF
Kelly
Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, United States.
Daniel M
DM
Prevedello
Department of Otolaryngology, Wexner Medical Center at the Ohio State University, Columbus, Ohio.
Ricardo L
RL
Carrau
Department of Surgery, Division of Neurosurgery, University of Ottawa, Ontario, Canada.
Amin B
AB
Kassam
D000368:Aged; D002528:Cerebellar Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D018325:Hemangioblastoma / Q000473:pathology / Q000601:surgery*; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D044583:Neuroendoscopy / Q000379:methods*; D016896:Treatment Outcome