Endoscopic Neurosurgery and Endoscope-assisted Microneurosurgery For The Treatment of Space Occupying Lesions of The Septum Pellucidum

The application of endoscopes in neurosurgery has improved the succesfull and atraumatic operative treatment of deep-seated intraventricular lesions. Moreover, endoscope-assisted microsurgery provided a high rate of efficiency in terms of removal of these lesions. We evaluated the role of endoscopic neurosurgery and endoscope-assisted microsurgery in the management of septum pellucidum lesions.Endoscopic surgery was used to treat four patients with symptomatic cysts of the septum pellucidum. All four patients underwent endoscopic cyst fenestration with a rigid endoscope. In two patients frameless neuronavigation was accomplished with the optical tracking system (Radionics, Burlington, USA). Additionally, four more patients with septum pellucidum tumours (two pilocytic astrocytomas, one subependymoma and one neurocytoma) were operated using the endoscope-assisted technique to remove them. In one of the four patients neuronavigation was used for guidance.All symptoms related to pressure effect of the septum pellucidum cysts to the neighbouring brain structures resolved after surgery. Regarding the tumours, complete excision was achieved in all patients and there were no postoperative complications.Endoscopic neurosurgery and endoscope-assisted microneurosurgery provide sufficient treatment of septum pellucidum space occupying lesions. Additionally, frameless neuronavigation is a usefull tool in planning and realizing the approach and improving intraoperative orientation.