Endoscopic Brain Surgery: Third Ventriculostomy and Colloid Cyst Removal

For spine surgery, major complications run around 2%, life-threatening complications around 0.5%, and neurological deficit around 1 to 1.5% — 98% of patients do well, 90% do very well, at a centre doing 400 to 500 spine surgeries a year. Patients should understand that surgery corrects the structural problem but can't always undo pre-existing nerve damage, so some residual tingling or numbness may persist even in a good outcome. For brain surgery, mortality is around 1 to 2% and total risk of neurological deficit is 5 to 7% at expert centres, with 93% of patients doing very well after tumour removal — the main caveat is that malignant tumours can recur despite surgery, since resection alone isn't curative and radiotherapy and chemotherapy are also required.

Complete spinal cord injuries will not result in complete neurological recovery, and some patients recover only minimally. What we can address is the secondary symptoms: pain and spasticity, managed with baclofen or morphine pumps, and dorsal cord stimulators, which can improve sensation and reduce spasticity, with some incomplete-injury patients regaining a degree of leg power combined with physiotherapy. If hand function is preserved, we train patients to manage daily life with their upper limbs and a wheelchair. But for complete injuries specifically, meaningful motor recovery is not something we can promise.

I conducted a study on this myself — we took stem cells from the iliac bone and implanted them at the injury site in around 20 patients. One patient showed some improvement, but it couldn't be separated from natural recovery under medication, and statistically we found no significant benefit. We discontinued the trial. Stem cell therapy for complete spinal cord injury is still not recommended anywhere in the world; for partial injuries there may be some benefit, but meaningful recovery from stem cells in complete injuries has not been demonstrated.

Awake craniotomy, used for tumours near the motor cortex or speech areas, requires full patient cooperation throughout — some patients become agitated under partial sedation and we've had to convert to general anaesthesia. For international patients, a translator has to be present in the operating room the entire time, which adds another layer of difficulty. Personally I'm not very keen on it given how demanding it is for the patient; we now prefer using preoperative functional MRI to map eloquent areas and then operate under general anaesthesia while avoiding those mapped regions, which reduces the need for awake craniotomy in many cases.

Small vertebral hemangiomas are benign and don't require treatment unless they cause problems. If it's a large hemangioma involving the pedicle, causing vertebral body destruction, or resulting in a fracture or neural compression, then decompression and spinal fixation are required. Share the MRI report with the Jivo team and we can assess based on size and extent.

Obstruction at the aqueduct of Sylvius. The procedure is also used for complex multiloculated hydrocephalus and intracranial cysts.

Through a small burr hole and the foramen of Monro, a fenestration is made in the floor of the third ventricle so cerebrospinal fluid can bypass the obstruction entirely.

They are benign lesions at the junction of the lateral and third ventricles that present with headache but carry a genuine risk of sudden loss of consciousness and death from acute raised intracranial pressure.

Yes. If a colloid cyst is found anywhere on imaging it must be removed, and endoscopy is the preferred route, requiring only a small burr hole, fenestration of the septum pellucidum, and aspiration of the deflated cyst.