title: Minimally invasive endoscopic resection of intraparenchymal brain tumors.
abstract: OBJECTIVE
  To report a minimally invasive, nontubular endoscopic technique to resect intraparenchymal brain tumors and assess the feasibility, safety, and surgical resection margins achievable by this novel technique.
  
  
  METHODS
  Over a 21-month period, 48 patients underwent 50 consecutive endoscopic intraparenchymal tumor resections. Data on surgical morbidity and mortality and length of stay were collected prospectively. The percentage of surgical resection and residual tumor volumes were calculated using preoperative and postoperative volume computed tomography or magnetic resonance imaging. All tumors were resected through a 2-cm minicraniotomy using a high-definition rigid endoscope with a 30-degree viewing angle. Bimanual resection was performed using standard microsurgical technique.
  
  
  RESULTS
  Mean patient age was 53 years. There were 42 supratentorial (19 frontal, 17 temporal, 3 occipital, 1 parietal, and 2 parafalcine) tumors and 8 infratentorial tumors. Mean tumor volume was 41 cm(3). There were 12 metastases, 24 glioblastomas, 4 World Health Organization grade III gliomas, 5 World Health Organization grade I-II gliomas, 3 meningiomas, and 2 hemangioblastomas. On volumetric analysis, the overall mean percent resection was 96%. In 70% of cases, >95% resection was achieved; total resection was achieved in 48% of cases. At 30 days postoperatively, there was 1 new postoperative neurologic deficit; there were no deaths during this period.
  
  
  CONCLUSIONS
  Our experience demonstrates that resection of intraparenchymal tumors using a minimally invasive endoscopic technique is technically feasible and safe, achieves good tumor resection margins, and has some potential advantages over a traditional microscopic technique.
authors.affiliation: Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom. Electronic address: Puneet.Plaha@ouh.nhs.uk.
authors.forename: Puneet
authors.initials: P
authors.lastname: Plaha
authors.affiliation: Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
authors.forename: Laurent J
authors.initials: LJ
authors.lastname: Livermore
authors.affiliation: Oxford Centre for MRI of the Brain, Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.
authors.forename: Natalie
authors.initials: N
authors.lastname: Voets
authors.affiliation: Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
authors.forename: Erlick
authors.initials: E
authors.lastname: Pereira
authors.affiliation: Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Cudlip
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D001932:Brain Neoplasms / Q000601:surgery*; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D009362:Neoplasm Metastasis; D044582:Neuroendoscopes; D038361:Neuronavigation / Q000379:methods; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Brain tumor; Endoscopy; Intraparenchymal; Minimally invasive