Combined microsurgical and endoscopic
removal of large brain lesions in children: a
report of two cases
Domagoj Jugović
Andrej Porčnik
Marjan Koršič
University Medical center Ljubljana, Slovenia
Introduction
• 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.
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First Case report
A cyst in the
cisterna ambiens
was detected
with
ultrasonography
at the 29th week
of gestation in a
male fetus.
Magnetic resonance imaging showed a large cyst causing non-communicating
hydrocephalus.
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First Case report
A planed caesarean section was
performed at the 35th week of
gestation.
A combined endoscopic
and microsurgical
approach was performed
2 days after birth with
good outcome.
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First Case report
Before the operation
• 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.
After the operation
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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 intraventricular 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.
MRI after the operation showed
no residual tumor mass.
No neurological deficits
were present after
surgery.
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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 Jugović
Andrej Porčnik
Marjan Koršič
University Medical center Ljubljana, Slovenia
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