5.3. Previously Reported Use of Variable Aspiration Tissue Resectors There have been limited reported case series on the use of variable-aspiration tissue resectors for the download catalog resection of intraventricular lesions. Lekovic et al. documented the use of a previous version to the current device in the resection of two hypothalamic hamartomas through a working channel endoscope [12]. Several studies have been performed on the use of the current variable aspiration tissue resector. Mohanty et al. described the sub- or near-total resection of large intraventricular tumors (two craniopharyngiomas and one subependymoma) [13]. Albright and Okechi described the resection of two pineal lesions without followup [14]. The two largest series to date were reported by Sood et al. and Dlouhy et al. [15, 16].

Sood et al. described their use of the device in resecting 23 lesions including brain and spinal lesions with good short-term follow-up results [15]. Dlouhy et al. describe their experience with the variable-aspiration tissue resector in fifteen patients [16]. These series, as with our series, all describe the benefits and limitations of the device, but our series is the largest to quantify extent of resection and how this relates to the use of the variable-aspiration tissue resector. 5.4. Strengths, Limitations, and Safety The ability to rotate the aperture and lengthen or shorten the length of the variable aspiration tissue resector permitted safe resection of all lesions described in this series. Proper visualization of the aperture and placement away from neurovascular structures permitted controlled tissue resection with the foot pedal control.

The console could be adjusted for greater or lesser aspiration and resection. In our limited experience, the variable aspiration tissue resector seemed to work best on soft tumors with minimal vascularity. One of the four tumors completely resected was a large colloid cyst, but, in our experience, colloid cysts can typically be resected without the use of the variable aspiration tissue resector. With larger cysts (>2cm), rapid debulking of the cyst contents and complete resection of the capsule can be performed well with the variable aspiration tissue resector. More vascular tumors, such as gliomas, were amenable to subtotal resection in our initial experience, which was often the goal of surgery.

However, cautery is not provided by the variable aspiration tissue resector. Tumor resection was halted intermittently for hemostasis with irrigation and endoscopic cautery through the working channel. Use of multiple channels simultaneously has been reported with the working channel endoscope to optimize lesion resection [17]. We felt that the introduction of endoscopic Anacetrapib cautery through a separate working channel with the variable aspiration tissue resector in place resulted in visual obstruction during tumor resection.