Roman BOSNJAK: Endoport-guided endoscopic removal of intraventricular tumor using expandable PVC roll

The endoport is a cylindrical device introduced stereotactically through brain tissue to access and remove deep‑seated tumors within the brain and ventricular system under endoscopic visualization.
It provides a stable surgical corridor and minimizes trauma to the surrounding brain tissue.

Although many commercial endoports exist today, this 2012 video demonstrates my original expandable PVC roll concept (no-cost improvisation).
A vinyl sheet, measuring 4 x 7 cm, is wrapped 3-4x around the tip of a navigation pointer or endoscope, and secured with a 7 cm long plastic straw cut longitudinally to function as a cuff. You can cut out the transparent vynil plate from the sterilisation bag.

In this case, a 3 cm subependymoma was removed through the tube under endoscopic vision from the left lateral ventricle, 6 cm deep.
A mini‑trephination, 20 x 25 cm, was performed in the left forehead.
Navigation was used to position the mini-trephination so that a symptomatic chronic subdural hematoma could also be evacuated during the same procedure.
The subependymoma itself was an incidental finding in this 64‑year‑old male patient.

A 5 mm transparent vinyl roll was first inserted, wrapped around the endoscope tip and guided stereotactically.
The cuff was then removed with forceps, and the endoscope withdrawn, leaving the empty roll in place.
The vinyl roll was subsequently unrolled and expanded using gradual Fogarty balloon inflation to a diameter of 10-12 mm.

A 4mm, 0‑degree endoscope was introduced into the expanded tube at the 12 o’clock position, accompanied by two instruments at 8 and 4 o’clock — an aspirator and a grasping forceps.
The tumor was removed completely using a piece‑meal technique, fragment by fragment and with suction.
The septum pellucidum was perforated to establish communication between the lateral ventricles.
At the end of tumor removal, the foramen of Monro, as well as the septal and thalamostriatal veins, were clearly visible.

The skin incision was placed within a natural forehead wrinkle, rendering it completely invisible and providing an excellent cosmetic result.
The procedure was uneventful.

Additional reading:

BOŠNJAK, Roman, ANTOLIN, Alenka, JEGLIČ, Arne, FELBABIĆ, Tomislav, VELNAR, Tomaž. Navigated endoport in the purely endoscopic microsurgery of intraventricular and other deep-seated brain lesions : a case report. V: Symposium Neuro-oncological aspects in modern neurosurgery of 21st century, 31 January 2020, Sarajevo. Sarajevo: Academy of Sciences and Arts of Bosnia and Herzegovina, 2020. Vol. 49, suppl. 1, str. 70-77, ilustr. Acta Medica Academica, vol. 49, suppl. 1 (2020). ISSN 1840-1848. http://www.ama.ba/index.php/ama/article/view/427/pdf, DOI: 10.5644/ama2006-124.309. [COBISS.SI-ID 51061251]

BOŠNJAK, Roman. Endoport-guided endoscopic transchoroidal fissure approach to the posterior third ventricle : WFNS Neuroendoscopy Committee, Webinar Series Session 14 - WFNS Neurosurgical Anatomy, 17th November 2021. [COBISS.SI-ID 85813251]