Dual Minicraniotomy for Resection of Ruptured Multicompartmental Intraventricular Epidermoid: A Technical Note.

Epidermoid tumors arising within the lateral ventricle are rare and pose unique surgical challenges, particularly when the bulk of the lesion involves both the atrium/body and the temporal horn, as these compartments are difficult to access through a single surgical corridor. We describe a dual minicraniotomy technique that provides orthogonal microsurgical corridors to the lateral ventricle body/trigone and temporal horn, facilitating complete resection of ruptured intraventricular epidermoid tumors. A 15-year-old boy presented with a 6-month history of headache, vomiting, and papilledema, and magnetic resonance imaging revealed a diffusion-restricting epidermoid involving the atrium/body and temporal horn of the right lateral ventricle with associated ventriculomegaly. A parieto-occipital minicraniotomy was used to access the body/atrium of the lateral ventricle, while a separate temporal minicraniotomy provided access to the temporal horn. Both ventricular compartments were accessed with minimal cortical retraction, allowing microsurgical removal of the pearly avascular epidermoid and its capsule. Gross total excision was achieved, and the ventricular system was irrigated from the parietal entry point until clear fluid egressed from the temporal horn. The postoperative course was uneventful, and the patient was discharged neurologically stable on postoperative day 5. Dual minicraniotomy offers safe, direct, and anatomically favorable microsurgical routes for resection of ruptured intraventricular epidermoids. A single surgical corridor is often inadequate because simultaneous access to both the atrium/body and temporal horn requires excessive cortical transgression and retraction, increasing the risk of injury to eloquent white matter tracts and limiting safe visualization for complete tumor removal. To our knowledge, this is the first report describing the use of a dual minicraniotomy technique to achieve complete resection of a multicompartment intraventricular epidermoid through anatomically optimized microsurgical corridors.