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PubMed2002

Virtual endoscopy for planning neuro-endoscopic intraventricular surgery.

To evaluate the usefulness of virtual endoscopy (VE) in planning neuroendoscopic intraventricular surgeries, the technique was applied in 20 of 22 consecutive procedures. Thirteen endoscopic third ventriculostomies (ETV) in 12 patients, 3 endoscopic colloid cyst removals, 1 third ventricular arachnoidal cyst fenestration, 1 endoscopic ventricul-cysto-cisternostomy (suprasellar arachnoidal cyst), 1 endoscopic tumor biopsy, one third ventricular gross total tumor removal and 2 septostomies at the foramen of Monro due the septal occlusion were performed. Contrast medium-enhanced MR images (3DMPRAGE, Siemens, Germany) were semi-automatically segmented with a surface-rendering technique ("Navigator" software, General Electric Medical, Buc, France) to produce the virtual endoluminal views. Surgery was performed with cerebral ventriculoscopes by Wolf (Richard Wolf, Knittlingen, Germany). VE was feasible in all patients and the virtual endoscopic images were comparable with the real intraventricular views obtained by standard rod lens systems. After contrast medium administration intra- and paraventricular vessels such as the thalamocaudate vein, the septal veins, the basilar artery and its branches (distal BA complex) and the choroid plexus were identified on the virtual endoscopic images. In 8 patients, the additional anatomic information provided by VE profoundly influenced surgical planning. VE provides the neurosurgeon with additional morphological information supporting the planning process of neuroendoscopic intraventricular surgeries, contributing to the safety of the procedures.

Adolescent↗
PubMed2003

Application of endoscopy for a midbrain tumor.

OBJECTIVE AND IMPORTANCE: It has been difficult to obtain a biopsy of a midbrain lesion. In addition, proper cerebrospinal fluid diversion should be secured because progressing tumor in the midbrain causes obstructive hydrocephalus. We report on the superiority of flexible neuroendoscopy to treat progressing midbrain tumor. CLINICAL PRESENTATION: A 64-year-old man presented with an occasional double vision. A magnetic resonance imaging scan disclosed an enhancing lesion in the midbrain. INTERVENTION: We performed a neuroendoscopic biopsy of the tumor and third ventriculostomy. Neuroendoscopy confirmed a bulging of the posterior commissure, which caused stenosis of the entrance of the aqueduct. Histological examination of the specimen obtained disclosed a diffuse astrocytoma. No permanent postoperative complications occurred although the patient felt slight double vision for 2 days after the operation. Conventional radiation therapy was supplemented. CONCLUSION: Flexible neuroendoscopic biopsy with third ventriculostomy was a less-invasive and safer alternative for the progressing midbrain tumor bulging into the ventricles.

Astrocytoma↗
PubMed2005

Application of a newly developed visual navigation system in humans. First results.

A visual navigation system (VN) was developed which uses intraoperatively stored endoscopic images together with their specific 3D-address. A special calibration enables one to recalculate the distortion of the endoscopic images. Several modules (e. g., landmark tracking, virtual back-movement) are offered to the neurosurgeon. The system was tested in 12 human subjects during neuroendoscopic interventions and worked without problems in nearly all cases. The possibilities of digital image navigation can be used especially for control of instrument movement in case of red-out situations or blurred vision. Many further developments of the VN system are possible in order to increase the safety of neuroendoscopic interventions.

Adolescent↗
PubMed1999

Application of new electrosurgical devices and probes in endoscopic neurosurgery.

Complex demands and new indications in neurosurgery have led to the need for new electrosurgical generators (ESUs). For the first time, newly developed, automatically controlled ESUs make it possible to use extremely small and flexible instruments safely and to achieve reproducible microcuts and microcoagulations. These specifications make them suitable for neuroendoscopic interventions. In a series of more than one hundred patients with different intracranial and intraspinal pathologies the new electrosurgical devices and probes were used not only for coagulation but also for cutting. The main indications were endoscopic ventriculo-cisternostomy, ventriculo-cystostomy, and membranectomy. The electrosurgical generators as well as the bipolar microcoagulation and -cutting probes proved to be safe and effective for neuroendoscopic interventions.

Electrocoagulation↗
PubMed2004

Endoscopic and stereotactic neurosurgery.

PURPOSE OF REVIEW: Review of the anesthetic considerations for neuroendoscopy and stereotactic procedures. RECENT FINDINGS: Minimally invasive procedures are increasingly applied in novel ways in the diagnosis and treatment of neurological pathologies. Endoscopic third ventriculostomy, endoscopic shunt revisions and drainage of intraventricular hematoma using a neuroendoscope have become routine neurosurgical procedures. Stereotaxis has expanded its scope from simple brain biopsy to functional neurosurgery and psychiatry. While these procedures are 'minimally invasive', perioperative critical events may still occur. SUMMARY: Vigilance in preoperative assessment and intraoperative monitoring is essential in minimizing perioperative morbidity and mortality in patients undergoing neuroendoscopic and stereotactic procedures.

Journal Article↗
PubMed1997

Computer-assisted endoscopy for neurosurgical procedures: technical note.

OBJECTIVE: As neuroendoscopy technology evolves, the ventriculoscope is playing a greater role in the diagnosis and treatment of disorders affecting the ventricular system. However, even with direct visualization, correctly orienting and safely navigating an endoscope may be difficult with abnormal anatomy, in small ventricles, or when searching for small periventricular lesions identified on neuroimaging studies. The ability to define the location of the endoscope during such procedures enhances its effectiveness and safety. INSTRUMENTATION: We report the successful adaptation of an image-guided stereotactic wand to a rigid neuroendoscope. With computer-assisted neuroendoscopy (CANE), the tip position and orientation of a rigid ventriculoscope were visualized in real-time on neuroimaging studies that were obtained before surgery. Because computer guidance may also be used with the neuroendoscope obturator during ventricular access, uncertainty in accessing small ventricles is minimized. RESULTS: Eleven patients were operated on at The Cleveland Clinic Foundation using the CANE system. All patients except one were improved after surgery. Early experience suggests that CANE is useful for certain endoscopic procedures by aiding in trajectory planning, ventricular navigation, and localizing certain pathological conditions. CONCLUSION: Even with direct visualization, ventriculoscopy in abnormal anatomy may be difficult. Although the CANE system may not always be necessary in neuroendoscopy, correlation of the endoscope tip location, with an intraoperative magnetic resonance image via continuous computer updates, may enhance the safety, as well as the efficiency, of neuroendoscopy in the future.

Adolescent↗
PubMed1998

Endoscopic management of colloid cysts.

OBJECTIVE: Several surgical approaches have been proposed for the treatment of colloid cysts, which still remains controversial. The most recent technique used is endoscopy. By its nature, endoscopy cannot offer complete removal, as compared to microsurgical techniques, but can do more than puncture. To evaluate the usefulness of endoscopy for colloid cyst surgery, a series of 15 patients who were operated on for colloid cysts under endoscopic control since 1994 was reviewed. METHODS: The presenting symptoms of our patients (10 men and 5 women) were intermittent headache (10 patients), nausea (3 patients), short-term memory loss (4 patients), coma (2 patients), gait disturbance (3 patients), blurred vision (2 patients), and mental status changes (3 patients). The sizes of the cysts ranged from 4 to 50 mm (median, 22.93 mm). Depending on the radiological appearance, the procedure was performed via a right (10 patients) or left (5 patients) precoronal burr hole. A rigid neuroendoscope was used. Initial stereotactic placement of the neuroendoscope was used in two patients who had moderate hydrocephalus. In the other patients, hand-guided endoscopy was performed using an articulated arm. The cysts were perforated with a needle. The opening was enlarged with microscissors. The cyst material was aspirated, and the remaining capsule was coagulated. RESULTS: The average follow-up was 15.26 months (range, 1-28 mo). Total aspiration of the cysts was achieved in 12 patients, as revealed by normal postoperative magnetic resonance imaging. Control magnetic resonance imaging revealed residual cysts in three patients. One patient presented with an asymptomatic recurrence at 1 year. Resolution of the symptoms was obtained in all patients except for two of the four patients with preoperative memory deficit (improvement without complete recovery). There was no mortality or morbidity. CONCLUSION: These results show that endoscopy is a safe and promising percutaneous technique for the treatment of colloid cysts of the third ventricle. Longer follow-up is, however, still required.

Adult↗
PubMed2001

Endoscopic treatment for a huge neonatal prepontine-suprasellar arachnoid cyst: a case report.

A huge prepontine-suprasellar arachnoid cyst was identified by fetal sonography and magnetic resonance imaging. It was successfully treated with a two-stage operation using a neuroendoscope. The first operation during the neonatal period consisted of implantation of a cyst-peritoneal shunt. In the second operation, the cyst was fenestrated with the aid of a neuroendoscope. The cyst membrane was seen to cover the foramen magnum and to extend continuously to the ventral surface of the brain stem. At the foramen magnum, it was pulsating synchronously with the pulsation of the vertebral artery, which was suggestive of the mechanism of cyst growth. A ventriculo-peritoneal shunt was inserted to replace the cyst-peritoneal shunt. Endoscopic cyst fenestration is a less invasive alternative for the treatment of arachnoid cysts and can also be used for young children. In that case, however, special care should be taken to avoid complications, especially if the cyst exerts considerable pressure on the critical areas of the brain.

Adult↗
PubMed2002

Endoscopic intraventricular surgery for treatment of hydrocephalus and loculated CSF space in children less than one year of age.

Controversy exists regarding whether children under 1 year of age have a higher risk of treatment failure after neuroendoscopic procedures for the treatment of hydrocephalus than older children. We retrospectively reviewed the surgical management and clinical outcome of 15 infants who underwent neuroendoscopic surgery for the treatment of CSF space loculation and hydrocephalus. We performed 8 third ventriculostomies, 3 endoscopic arachnoid cyst fenestrations, 2 aqueductoplasties, 1 septostomy and in 1 patient, three endoscopic fenestrations for isolated ventricular compartments. Two of the third ventriculostomies, 1 of the aqueductoplasties and the 1 septostomy failed, and these patients underwent placement of a ventriculoperitoneal shunt. In all other patients, symptoms and signs related to hydrocephalus or CSF space loculation were relieved effectively after the endoscopic procedure. We conclude that neuroendoscopy presents an effective alternative for the treatment of hydrocephalus and CSF loculation in infants less than 1 year of age.

Cerebrospinal Fluid Shunts↗
PubMed2005

Multiple epidermoid cysts located in the pineal and extracranial regions treated by neuroendoscopy.

A 22-year-old woman presented with a rare case of multiple epidermoid cysts located in the pineal and extracranial regions. Magnetic resonance (MR) imaging showed a lesion in the pineal region as hypointense on the T(1)-weighted image and hyperintense on the T(2)-weighted image, without enhancement. Neuroendoscopic treatment was performed under a diagnosis of pineal cyst. However, the cyst wall was too thick to perforate, although third ventriculostomy was performed. Diffusion-weighted MR imaging demonstrated the lesions in the pineal and extracranial regions as marked hyperintensity. The diagnosis was epidermoid cyst. Subsequently, neuroendoscopic treatment of the pineal epidermoid cyst was performed. Careful preoperative diagnosis of epidermoid cysts based on diffusion-weighted MR imaging is required.

Adult↗
PubMed2004

The use of a head-mounted display for visualization in neuroendoscopy.

OBJECTIVE: To evaluate the clinical use of a head-mounted display (HMD) for visualization in all neuroendoscopic procedures. MATERIALS AND METHODS: We retrospectively evaluated all endoscopic and endoscope-controlled procedures in which the HMD was used in our department between July 1999 and June 2002. RESULTS: A total of 269 endoscopic procedures were performed. In 147 cases intraventricular endoscopic procedures were carried out, mostly third ventriculocisternostomies, for which a fiberscope was used exclusively. Thirty intracranial cysts were fenestrated or removed (colloid cysts) with the help of various endoscopes. A total of 87 endoscopic transsphenoidal surgeries were performed with a lensscope. In only one case was it necessary to abandon use of the HMD due to inferior visualization; in all other cases visualization by the HMD was thought to be sufficient. Fatigue of the surgeon due to wearing the helmet did not occur. All surgeons had the impression that visual strain was decreased in comparison to looking at a monitor from a distance. The working position was considered to be more comfortable when wearing the HMD, and eye-hand coordination was improved. No technical problems occurred with the system. CONCLUSIONS: The HMD is a new visualization tool in neurosurgery that may improve the ergonomics of neuroendoscopic and endoscope-controlled procedures.

Adolescent↗
PubMed2001

Frameless neuronavigation in intracranial endoscopic neurosurgery.

OBJECT: Frameless computerized neuronavigation has been increasingly used in intracranial endoscopic neurosurgery. However, clear indications for the application of neuronavigation in neuroendoscopy have not yet been defined. The purpose of this study was to determine in which intracranial neuroendoscopic procedures frameless neuronavigation is necessary and really beneficial compared with a free-hand endoscopic approach. METHODS: A frameless infrared-based computerized neuronavigation system was used in 44 patients who underwent intracranial endoscopic procedures, including 13 third ventriculostomies, nine aqueductoplasties, eight intraventricular tumor biopsy procedures or resections, six cystocistemostomies in arachnoid cysts, five colloid cyst removals, four septostomies in multiloculated hydrocephalus, four cystoventriculostomies in intraparenchymal cysts, two aqueductal stent placements, and fenestration of one pineal cyst and one cavum veli interpositi. All interventions were successfully accomplished. In all procedures, the navigational system guided the surgeons precisely to the target. Navigational tracking was helpful in entering small ventricles, in approaching the posterior third ventricle when the foramen of Monro was narrow, and in selecting the best approach to colloid cysts. Neuronavigation was essential in some cystic lesions lacking clear landmarks, such as intraparenchymal cysts or multiloculated hydrocephalus. Neuronavigation was not necessary in standard third ventriculostomies, tumor biopsy procedures, and large sylvian arachnoid cysts, or for approaching the posterior third ventricle when the foramen of Monro was enlarged. CONCLUSIONS: Frameless neuronavigation has proven to be accurate, reliable, and extremely useful in selected intracranial neuroendoscopic procedures. Image-guided neuroendoscopy improved the accuracy of the endoscopic approach and minimized brain trauma.

Adolescent↗
PubMed2001

Frameless navigation and endoscopy.

OBJECT: Frameless computerized neuronavigation has been increasingly used in intracranial endoscopic neurosurgery. However, clear indications for the application of neuronavigation in neuroendoscopy have not yet been defined. The purpose of this study was to determine in which intracranial neuroendoscopic procedures frameless neuronavigation is necessary and really beneficial compared with a free-hand endoscopic approach. METHODS: A frameless infrared-based computerized neuronavi- gation system was used in 44 patients who underwent intracranial endoscopic procedures, including 13 third ventriculostomies, nine aqueductoplasties. eight intraventricular tumor biopsy procedures or resections, six cystocisternostomies in arachnoid cysts, five colloid cyst removals, four septostomies in multiloculated hydrocephalus, four cystoventriculostomies in intraparenchymal cysts, two aqueductal stent placements, and fenestration of one pineal cyst and one cavum veli interpositi. All interventions were successfully accomplished. In all procedures, the navigational system guided the surgeons precisely to the target. Navigational tracking was helpful in entering small ventricles, in approaching the posterior third ventricle when the foramen of Monro was narrow, and in selecting the best approach to colloid cysts. Neuronavigation was essential in some cystic lesions lacking clear landmarks, such as intraparenchymal cysts or multiloculated hydrocephalus. Neuronavigation was not necessary in standard third ventriculostomies, tumor biopsy procedures, and large sylvian arachnoid cysts, or for approaching the posterior third ventricle when the foramen of Monro was enlarged. CONCLUSIONS: Frameless neuronavigation has proven to be accurate, reliable, and extremely useful in selected intracranial neuroendoscopic procedures. Image-guided neuroendoscopy improved the accuracy of the endoscopic approach and minimized brain trauma.

Biopsy↗
PubMed2002

Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma.

OBJECT: Nonfunctioning pituitary adenomas comprise approximately 30% of all pituitary tumors. The purpose of this retrospective study is to evaluate the efficacy and role of gamma knife radiosurgery (GKS) in the management of residual or recurrent nonfunctioning pituitary adenomas. METHODS: A review was conducted of the data obtained in 42 patients who underwent adjuvant GKS at the University of Pittsburgh between 1987 and 2001. Prior treatments included transsphenoidal resection, craniotomy and resection, or conventional radiotherapy. Endocrinological, ophthalmological, and radiological responses were evaluated. The duration of follow-up review varied from 6 to 102 months (mean 31.2 months). Fifteen patients were observed for more than 40 months. The mean radiation dose to the tumor margin was 16 Gy. Conformal radiosurgery planning was used to restrict the dose to the optic nerve and chiasm. Tumor control after GKS was achieved in 100% of patients with microadenomas and 97% of patients with macroadenomas. Gamma knife radiosurgery was equally effective in controlling adenomas with cavernous sinus invasion and suprasellar extension. No patient developed a new endocrinological deficiency following GKS. One patient's tumor enlarged with an associated decline in visual function. Another patient experienced a deterioration of visual fields despite a decrease in tumor size. CONCLUSIONS: Gamma knife radiosurgery can achieve tumor control in virtually all residual or recurrent nonfunctioning pituitary adenomas. Dose sparing facilitates tumor management even when the adenoma is close to the optic apparatus or invades the cavernous sinus.

Adenoma↗
PubMed2003

Feasibility of using the potassium titanyl phosphate laser with micromanipulators in robotic neurosurgery: a preliminary study in the rat.

OBJECT: Robotic surgery can be used as a novel technology in ultramicrosurgery. A microscopic-manipulator (micromanipulator) system, which has a rigid neuroendoscope and three guiding manipulators, was developed in Japan for less invasive telerobotic neurosurgery. To apply this system in a clinical setting, it is necessary to confirm that it is capable of performing various surgical procedures including cutting, coagulation, and bleeding control. The authors chose the potassium titanyl phosphate (KTP) laser for such procedures. The aim of this paper was to evaluate the feasibility of this system mounted with the KTP laser. METHODS: A prototypical micromanipulator system was tested in rats. Two kinds of in vivo experiments were performed using the KTP laser: coagulation and biopsy. The coagulated lesions were precisely aligned and their maximum depths were proportional to the energy applied during the coagulation experiment. The diagnosable specimens were obtained during the biopsy experiment. The micromanipulator system was able to perform all surgical procedures accurately. There was no complication relating to the use of the micromanipulator system such as brain injury or uncontrollable bleeding. CONCLUSIONS: The results from this study proved that this system works precisely and safely and will become a new neurosurgical tool in managing lesions that are difficult to treat using conventional microsurgery or neuroendoscopic surgery.

Animals↗
PubMed1998

Provision of a neuroendoscopy service. The Southampton experience.

BACKGROUND: A series of 21 patients (aged 1 week to 80 years) underwent a total of 22 neuroendoscopic procedures in our Unit in the period July 1993 to January 1996. METHODS: The procedures were performed by one surgeon familiar with the technique using the Stortz rigid neuroendoscope system. The most common indication for neuroendoscopy was obstructive hydrocephalus. The most frequently performed procedure was third ventriculostomy and tumor biopsy. The intended surgical procedure was successfully performed in all but two of the cases (attempted septostomy and internal cyst drainage) were both abandoned due to unrecognisable anatomy. RESULTS: Of the 19 patients treated by fenestration or ventriculostomy to relieve hydrocephalus, 5 eventually required definitive shunting procedures. CONCLUSIONS: Complications relating directly to the neuroendoscopy occurred in 2 patients (bleeding requiring temporary external ventricular drain) and there were no surgical deaths.

Adolescent↗
PubMedDate not supplied

[Colloid cysts in the 3rd ventricle: a microsurgical series and new perspectives].

Colloid cysts are rare benign CNS lesions (0.5-2% of tumors), mostly located within the third ventricle. Although sometimes asymptomatic they may cause life-threatening complications and sudden death and therefore require active treatment in the vast majority of cases. Microsurgical removal warrants excellent radicality at low morbidity/mortality rates but emerging neuroendoscopic techniques have been applied successfully worldwide although longer follow-up of these patients is needed. We present out personal microsurgical series from last decade and discuss the results in the light of current knowledge and preliminary neuroendoscopic experiences.

Brain Diseases↗
PubMed2002

[Application of neuroendoscopy in brain surgery].

OBJECTIVE: To investigate the effect of neuroendoscope on surgery. METHODS: 315 patients were treated with neuroendoscope. Endoscopic neurosurgery (EN) was used in 219 patients, endoscope-assisted microneurosurgery (EAM) in 72, and endoscope-controlled microneurosurgery (ECM) in 24. RESULTS: 201 (91.8%) of the 219 patients underwent EN effectively. In 72 patients who underwent EAM there was less retraction during tumor removal and visual control was improved. 21 (87.5%) of the 24 patients underwent ECM effectively. No severe complications were observed. CONCLUSION: Neuroendoscopy can reduce tissue trauma, improve visualization during tumor removal, and reduce complications.

Brain Neoplasms↗