PubMed · 13646382
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C RICHARD. 1959. Choledoscopy.. https://pubmed.ncbi.nlm.nih.gov/13646382/
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STUDY DESIGN: To determine the effectiveness of an endoscopic option in an anterior approach to the thoracolumbar spine for scoliosis treatment, 50 patients with follow-ups of 24-45 months were studied retrospectively. OBJECTIVE: The objective was to develop a safe, reproducible, and effective endoscopic technique for the treatment of scoliosis that will provide equal or better outcomes compared with formal open surgical techniques. Techniques for endoscopic treatment of spinal disorders have been under development since 1993. The benefits of thoracoscopic surgery in treating spinal deformities have been documented as improved visualization of the spine, enhanced access to the extremes of the curve, decreased operative times and blood loss, shorter hospital stays and recuperative periods, and decreased overall costs. Following more than 150 endoscopic procedures for the treatment of these spinal deformities, the next progression was to develop a thoracoscopic technique of instrumentation, correction, and fusion for primary thoracic scoliosis. The goals are to gain comparable results, fusion rates, and degrees of correction that meet or exceed the current gold standards of an open procedure. METHODS: From October 1996 to October 1998, 50 patients with a diagnosis of primary thoracic scoliosis were selected to undergo a thoracoscopic technique of instrumentation, correction, and fusion. Postoperatively, patients were assessed for restoration of spinal alignment, axial derotation, pain management, and incidence of complications. RESULTS. Successful endoscopic instrumentation occurred in all patients. Curve correction averaged 50.2%, improving to 68.6% in the last ten cases. Patients with hypokyphosis averaged 20.7 degrees of correction. The preoperative axial rotation, based on the scoliometer, averaged 16 degrees , which was corrected to 5 degrees postoperatively. Postoperative pain was less; patients were off all pain medication by 1-3 weeks compared with patients with a formal open procedure requiring pain medication for 6-12 weeks. The hospital stay averaged 2.9 days. Our initial complication rate was high, which can be attributed to the development of a new technique. The keys to successful fusions included total discectomy, complete endplate removal, and autogenous bone graft. CONCLUSIONS: Although still in early development, the initial results of thoracoscopic techniques are promising. With experience, surgical times are decreasing and fusion and curve correction rates are improving. With further evolution, patients should realize shortened hospitalization, decreased rehabilitation times, and decreased levels of postoperative pain. This is a technically demanding procedure and requires demonstrated skills in endoscopic discectomy and fusion.
INTRODUCTION: In the last 10 years the endoscopic endonasal transsphenoidal approach has been proposed as a minimally invasive procedure for the treatment of pathologies of the sellar region. This procedure introduces various advantages compared with the transsphenoidal microsurgical approach such as a wider vision of the surgical field, less traumatism of the nasal structures, greater facility in the treatment of possible recurrences, and reduced complications. Nevertheless, as for any new procedure, there is an initial learning curve that is somewhat steep, due to the necessity of acquiring the specific endoscopic skills. It is equally essential to be supplied with dedicated endoscopic equipment and appropriate surgical instrumentation, in order to optimize the different stages of the operation. DISCUSSION: Therefore, after our extensive experience with over 250 patients treated by means of the endoscopic endonasal transsphenoidal approach for pathologies of the sellar region, we describe herein the characteristics of the proper endoscopic instrumentation, as well as a set of surgical instruments intentionally conceived to respond to the specific characteristics of this new procedure.
OBJECTIVES: Endoscopic third ventriculostomy (ETV) is a successful method of treatment for obstructive hydrocephalus. In infants, however, it is reported to have a higher failure rate. On the basis of our own data and a meta-analysis of the literature, we try to define factors prognosticating potential failure in infants aged less than 1 year. METHODS: Data were collected retrospectively. Between October 1994 and October 2002, 20 ETVs were performed in 16 patients younger than 1 year. Ages ranged from 8 to 311 days (median 103). Etiology was aqueductal stenosis in all 16 patients (idiopathic in 7, posthemorrhagic in 3, postmeningitic in 3, and related to CNS or vascular malformation in 3). ETV failure was defined as subsequent need for shunt implantation. For non-shunted patients, follow up was 16-52 months (median 25). RESULTS: ETV was successful in 5 patients and eventually failed in 11. There was no mortality or permanent morbidity following ETV. In the successful cases, etiology was idiopathic aqueductal stenosis in 4 and postmeningitic aqueductal stenosis in 1; the median age was 206 days (range 82-311). In the 11 unsuccessful patients, it was idiopathic aqueductal stenosis in 3, posthemorrhagic in 3, postmeningitic in 2 and CNS/vascular malformation in 3 cases; median age was 94 days (range 8-299). Median time interval between (last) ETV and shunt was 38 days (range 2-70). The difference in median age between the success group and the failure group roughly corresponded to data gained from a meta-analysis of the literature. Four patients underwent a second ETV. In intraoperative ventriculoscopy, the stoma was closed or there were new membranes below the floor of the third ventricle and a second ETV was performed. But finally, all re-ETVs failed and the patients needed a shunt. CONCLUSION: Factors indicating potential failure of ETV were very young age and etiology other than idiopathic aqueductal stenosis. Probability of success seems to increase during the first 2 or 3 months of life. Ventriculoscopy with the option of a second ETV should be regularly performed after failure of ETV.