• Jorge Tirado-Caballero, Mónica Rivero-Garvía, Marta González-Pombo, Eugenio Cárdenas-Ruiz-Valdepeñas, Ariel Kaen, and Javier Márquez-Rivas.
• Neurosurgery Service, Virgen del Rocío, University Hospital, Seville, Spain; Group of Applied Neuroscience, Biomedicine Institute of Seville, Seville, Spain. Electronic address: jtiradocaballero@gmail.com.
• World Neurosurg. 2020 May 1; 137: 164-172.

BackgroundThe surgical approaches to lesions located in the tectal area have remained controversial. The essential functions in the surrounding areas and the difficulties in obtaining a good surgical view during tumor removal have made these procedures risky and challenging. Endoscopic transforaminal approaches have been previously described for biopsy and intraventricular tumor removal. However, the endoscopic transforaminal-transchoroidal gross resection technique for such cases has barely been described.MethodsThe endoscopic entry points and trajectories were planned using preoperative magnetic resonance imaging. Once the endoscope was inside the ventricular system, the angles of work and tumor exposure of the upper posterior part of the third ventricle were carefully evaluated. If the angle of work was insufficient for tumor removal, the choroidal fissure was opened using endoscopic bipolar electrode and dissectors. Tumor removal was performed using an endoscopic ultrasonic aspirator. We have presented a 3-case series of patients affected by tectal tumors that were treated using a fully endoscopic transforaminal-transchoroidal approach.ResultsTotal gross resection of the tumors was achieved in 2 patients. Subtotal resection was achieved in the third patient. No major complications had developed in relationship to the procedure. No new cognitive impairment was reported secondary to this technique.ConclusionsIn our experience, a fully endoscopic transforaminal-transchoroidal approach was a suitable treatment for this complex pathological entity. Opening of the choroidal fissure added an extra angle of work and improved the exposure of the upper posterior part of the third ventricle.Copyright © 2019 Elsevier Inc. All rights reserved.

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