• Filippo Gagliardi, Martina Piloni, Michele Bailo, Cristian Gragnaniello, Nicola Boari, Carmine A Donofrio, Lina R Barzaghi, Jody F Capitanio, Anthony J Caputy, and Pietro Mortini.
• Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy. Electronic address: gagliardi.filippo@hsr.it.
• World Neurosurg. 2019 Nov 1; 131: e255-e264.

BackgroundResection of intraventricular lesions remains a challenge for modern neurosurgery. Endoscopy has provided great advantages in ventricular surgery, even if limited in terms of operability, due to the restricted working channel and impossibility for bimanual surgical manipulation. Tubular approaches have been considered as an option, enabling the use of microsurgical techniques, minimizing violation of brain tissue. The aim of our study was to describe and critically evaluate the use of portal surgery to access lateral ventricles in terms of surgical exposure and operability.MethodsA microanatomic laboratory cadaver study was conducted with a stepwise description of the surgical technique. The operability score was applied for quantitative analysis of surgical operability, and an illustrative case is reported.ResultsThrough the anterior approach, the neuroport provides maximal operability at the foramen of Monro and the posterior aspect of the frontal horn, while through the posterior approach maximal operability is achieved in the paratrigonal area. Endoscopic assistance does not affect operability but provides adjunctive exposure in blind spots, as the roof of the frontal horn, the most anterior aspect of the temporal and occipital horn.ConclusionsVentricular tubular systems provide adequate visualization, with minimal brain retraction, improving operability as compared with endoscopy. Endoscopic assistance critically widens surgical exposure in blind spots without providing concomitant significant advantage in terms of surgical operability.Copyright © 2019 Elsevier Inc. All rights reserved.

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