treatment for colloid cysts of the third ventricle: the experience of a decade . Neurosurgery 52 : 525 – 533 , 2003 10.1227/01.NEU.0000047671.27057.55 8 Luther N , Cohen A , Souweidane MM : Hemorrhagic sequelae from intracranial neuroendoscopic procedures forintraventriculartumors. Neurosurg Focus 19 : 1 E9 , 2005 9 MacArthur DC , Buxton N , Punt J , Vloeberghs M , Robertson IJA : The role of neuroendoscopy in the management of braintumours. Br J Neurosurg 16 : 465 – 470 , 2002 10.1080/0268869021000030276 10 Oi S , Shibata

T he modern era of neuroendoscopy was ushered in almost 50 years ago, prompted by advances in light and lens technology. At present, the endoscope is considered a safe neurosurgical tool that has demonstrated value in the treatment of obstructive hydrocephalus 5 and arachnoid cysts; 1 it is also a useful adjunct in skull base procedures. 2 The use of endoscopy for biopsy ofintraventriculartumorswas first reported by Fukushima 4 in 1978 as an innovative technique enabling biopsy procedures to be performed under directtumorvisualization in the CSF

M elanocytomas are raretumorsof the CNS. They typically originate in locations similar to meningiomas, reflecting their origin from pigmented cells in the leptomeninges. 4 , 10 The patient presented in this paper is the first reported case of the occurrence of anintraventricularmelanocytoma, which was found in the temporal horn of the lateral ventricle and was completely resected. The location of thetumorand its vascular supply suggest that similar to arachnoid cap cells, melanocytes may also migrate into the choroidal fissure and, infrequently, may

U nlike transsphenoidal endoscopic surgery, 4 , 6 in which significant strides have been made in technology and technique,intraventricularendoscopic surgery has been somewhat limited by the inability to bimanually handletumor. 5 Dual ports 2 have been described for the resection of colloid cysts, but traversing the brain bilaterally is not an attractive option. The use of a single large port 3 allowing multiple instruments and the endoscope to be placed within the same port is an effective strategy, limited by difficulty in cannulating small

. Case Report Examination and Operation This 67-year-old man with no significant medical history presented with headache and right hemiparesis that slowly worsened over a 2-month period. His family had noted a change in his personality. Neurological examination revealed right hemiparesis with facial involvement and hemihypesthesia. Cranial MR imaging displayed a large homogeneous contrast-enhancingintraventricularmass and hydrocephalus ( Fig. 1 ). The patient underwent left occipital craniotomy. Intraoperatively, thetumorappeared to be an encapsulated

T he best surgical approach tointraventricularmidlinetumorshas long been debated. The transcortical-transventricular approach, first described by Dandy 6 in 1922, was used by other authors 24 until the midline approach, incorporating the technique described in 1944 by Busch, 3 was adopted. This was later modified with the introduction of transcallosal dissection. 25 The arguments in favor of the midline approach largely overwhelm those for the transcortical route, which is preferable only in cases with enlarged ventricles. The transcallosal approach

. Neurosurgery 42 : 1288 – 1296 , 1998 10.1097/00006123-199806000-00051 5 Ferrer E , Santamarta D , Garcia-Fructuoso G , Caral L , Rumià J : Neuroendoscopic management of pineal regiontumours. Acta Neurochir (Wien) 139 : 12 – 21 , 1997 10.1007/BF01850862 6 Fukushima T : Endoscopic biopsy ofintraventriculartumorswith the use of a ventriculofiberscope . Neurosurgery 2 : 110 – 113 , 1978 10.1227/00006123-197803000-00006 7 Gaab MR , Schroeder HWS : Neuroendoscopic approach tointraventricularlesions . J Neurosurg 88 : 496 – 505

N euroendoscopy plays a critical role in the management ofintraventriculartumors. For lesions of the posterior third ventricle, a simultaneous ETV andtumorbiopsy procedure provides a means of discerning pathology and treating obstructive hydrocephalus. There is, however, a theoretical risk of increasing the potential for leptomeningealtumordissemination, which is purported to occur because of the newly formed communication between the ventricular and subarachnoid spaces. Such concern originates from the practical point that upontumormanipulation