 The cyst in the lateral ventricle which moves from place to place, what is that cyst? A cyst in the lateral ventricles moves from place to place. Cystic circle cyst that is common in India and also it is originally from the Brazil that is the commonest majority of the literature is from the Brazil. So, we are also having some cases of neurocystic circle cysts. So, for that surgery is the only thing which is effective not the medicine which cannot penetrate it. So, I will show you that cyst see that is the one say when I tapped that already it is broken. So, that is why that cyst what you are seeing inside all crumpled one see here see it is lying there it is a quite big cyst see how nicely it is so whitish in colour it is like hydraticist like the very big one multiple actually this is you see and when I am taking out the whole tube was blocked with the cyst wall see this cyst this is one another cyst see you can see whole tube inside and that was attached to that our cannula itself. I brought out cannula along with the cyst cavity then I placed in the plate see the so much cyst and so dirty colour the natural colour is so dirty when it is inside so bright it is that is one another one is I took a chance see the cyst which 4 ventricles is here this is the craniotomy of how I was doing it and always we have to do in a different way when we are going for posterior so anteriorly this is like a mini refining like this so that I can take out that bone and replace it back so that there is no depression see this is the bone what we have taken nearly around 1 centimetres. So, after refining this is the picture see raising the dura see tapping see it was under pressure now I am entering inside the quarat plexus what you are seeing is this is the from in one row that is the aqueduct this is the one this is the cyst wall which is projecting in the fourth ventricle just I am penetrating that it is not easy when I am going this I have taken a flexible forceps to catch that itself I took nearly half an hour then subsequently I could penetrate the thing see I am opening it still it is not coming after that I am rotating it is see part of the cyst wall I could catch it see that is the opening then subsequently I did third ventricle osteomyelitis see when we are inside the what is that after perforating the floor we should not increase the balloon size that causes rupture of the vessel so we should be very careful when we are inflating in the space again visualizing the third ventricle osteomyelitis see once you start visualizing the blood vessels means you have ruptured the liliquids membrane if you do not ruptured it you will never see the blood vessels sometimes anatomy of the liliquid membrane is different sometimes it will be perforated liliquids membrane will be there so that then so that is the end part following surgery patient has developed ptosis subsequently has improved not all colloid cysts are easy to excise it gives a lot of problem when it is situated posteriorly sometimes you may get fluid sometimes the colloid material itself it is so solid see the blood vessels how it protrudes into the canal itself that is the last part of the cyst which has taken out this is also a pineal tumor first and one third of the tumor again selecting the space is very very important you have to go more anteriorly when you are experienced then you can negotiate anteriorly or so and you can do third ventricle osteomyelitis but in the initial period if you start doing it we will end up with a problems definite that is that is the tumor what you are seeing this see very vascular tumor that see coagulating on the surface with a bipolar now a lot of bipolar which has come is nice but negotiating inside is impossible see that is the aqueduct it is sitting on the aqueduct more the if the lesion is in the lower part of the third ventricular and posterior easy to take a biopsy if it is in the upper part negotiation of the area is very difficult we may not be able to do any biopsy and literature wise is there using laser and all these things if that first and with a flexible endoscope those can be tried see I am using this very good biopsy force if it is see the blood vessels and all so always try to irrigate that area so if there is any bleeding and all not to be panic but it is like a hydrotherapy lighting with little flushing that area that with that pressure itself the bleeding from the capillaries it will stop not to try to coagulate that area so that that will create more problems thank you.