title: Evolving instrumentation for endoscopic tumour removal of CNS tumours.
abstract: BACKGROUND
  Open surgical approaches to intraventricular tumours are complex and challenging. Neuro-endoscopy, however, has enabled us to biopsy and resect small intraventricular tumours with potentially reduced morbidity. Nevertheless, suitable methods/ instrumentation for resection have limited the use of the endoscope. The authors report the utilisation of endoscopic ultrasonic aspirator in the resection of an intraventricular tumour. This technique was compared to another case that utilised conventional endoscopic techniques for removal of an intraventricular tumour.
  
  
  METHODS
  Using an endoscope, the third ventricle was entered and visualised, with the tumours clearly seen. Tumours were then either debulked via conventional or novel technique.
  
  
  RESULTS
  Using the conventional technique, tumour was removed with rongeurs via the flexible scope. Irrigation was needed to improve vision due to bleeding. Postoperative magnetic resonance imaging (MRI) confirmed good excision. Histology was reported as anaplastic ependymoma World Health Organization (WHO) Grade III. Utilising the novel technique, the tumour was also debulked uneventfully. Histology confirmed Grade 1 glioneuronal tumour. Postoperative MRI revealed a small residuum.
  
  
  CONCLUSIONS
  To date, endoscopic resection of tumours has been limited by suitable tools. The advent of an ultrasonic aspirator that can be used down an endoscope increases the possibilities for such resections. This is the first reported case of endoscopic resection of an intraventricular tumour using this technique.
authors.affiliation: Department of Neurosurgery, Leeds General Infirmary, LS1 3EX, Leeds, United Kingdom. Senthil-kumar@doctors.org.uk
authors.forename: Senthil K
authors.initials: SK
authors.lastname: Selvanathan
authors.forename: Ramesh
authors.initials: R
authors.lastname: Kumar
authors.forename: John
authors.initials: J
authors.lastname: Goodden
authors.forename: Atul
authors.initials: A
authors.lastname: Tyagi
authors.forename: Paul
authors.initials: P
authors.lastname: Chumas
mesh_terms: D000328:Adult; D002551:Cerebral Ventricle Neoplasms / Q000473:pathology / Q000601:surgery*; D019723:Endoscopes; D004724:Endoscopy / Q000295:instrumentation*; D005260:Female; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D013396:Suction / Q000295:instrumentation*; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation*; D014696:Ventriculostomy / Q000295:instrumentation