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At least 217 records · Page 12Linked to original sources
PubMed2002

[Image-guided neuroendoscopy].

BACKGROUND AND PURPOSE: By definition, image-guided neuroendoscopy is a connection between a neuroendoscope and a neuronavigational system creating a computer-guided instrument. Our objective was to adapt our rigid endoscope with our neuronavigation system to perform computer-guided endoscopy. METHODS AND RESULTS: The rigid neuroendoscope, equipped with light emitting diodes, was connected to the work station. We report our early results with this device in 17 patients: 8 ventriculocisternostomies, 5 ventriculocisternostomies with biopsies of tumors of the posterior part of the third ventricule, 4 biopsies or tumor removal like colloid cysts. No technical complications were encountered. CONCLUSIONS: The development of image-guided neuroendoscopy has modified our approach to neuroendoscopy because the surgical procedure is facilitated. The use of fluoroscopy becomes unnecessary. The surgeon can choose, independent of the preestablish surgical technique, the entry point, the target and, of course, the optimal trajectory. The technique is adaptable to the individual anatomy of each patient, the location and the nature of the target. It is an undeniably useful teaching tool and represents a real progress in minimally invasive neurosurgery.

Adult↗
PubMed2003

[Surgery for giant intracranial aneurysms using advanced technology].

PURPOSE: Outcome of surgery for giant intracranial aneurysms is still unsatisfactory. The reason for complications is occlusion of perforators or parent arteries by the aneurysmal clipping itself or temporary occlusion of the main arteries. We report the surgical outcome of treatment of giant aneurysms using several advanced techniques which we devised to prevent these complications. MATERIALS AND METHODS: The subjects were eight patients with giant intracranial aneurysms who underwent surgery during the recent five years. Six patients had ruptured and two had unruptured aneurysms. Aneurysms were located at the ICA in five and the MCA in three patients. Aneurysmal sizes ranged from 25 to 50 mm. Preoperative 3DCTA was performed to investigate the aneurysm and the surrounding vessels in all cases. Patients with unruptured aneurysms at the ICA underwent balloon occlusion tests to check the potential for safe temporary occlusion of the parent artery, with SEP monitoring and Xe-SPECT. Intraoperative angiography and neuroendoscopes were used to prevent problems and complications which might be caused by aneurysmal clipping. RESULTS: In seven of eight cases, the aneurysmal neck was completely obliterated with clips and in one case the aneurysm was trapped with STA-MCA anastomosis. Glasgow Outcome Scale of the patients showed good recovery in six, moderately disabled (MD) in one and dead in one. The patient demonstrating MD developed hemiparesis due to vasospasm. One patient died from rebleeding of the aneurysm caused by slippage of the aneurysmal clip despite the confirmation of complete obliteration by intraoperative angiography. CONCLUSIONS: A better surgical outcome of treatment for giant aneurysms was obtained by temporary clips whose placement was based on the results of balloon occlusion test, as well as the use of intraoperative angiography and neuroendoscopes.

Aged↗
PubMed2005

[Endoscopic surgery for hypertensive cerebral hemorrhage].

OBJECTIVE: To evaluate the use of endoscopic surgery for hypertensive cerebral hemorrhage. METHODS: Sixteen patients with hyertensive intracerebral hematoma were evacuated with neuroendoscope. The surgical invasive markers, volume of remaining hematoma, and prognosis were compared with those of 19 comparable patients undergoing conventional craniotomy. RESULTS: Complete evacuation of hematoma was achieved in 9 patients, and partial evacuation in 7. All patients were followed up for 6 months. According to GOS, the result was excellent in 6 patients, good in 6, fare in 2, poor and dead in one respectively. The volume of remaining hematoa and invasive markers significantly decreased (P < 0.05); No difference was found in prognosis between the two groups (P > 0.05). CONCLUSION: Neuroendoscopic surgery for hypertensive intracerebral hematoma is characterized by mini-invasion, time-saving, and direct-vision, and is a new approach in this field.

Adult↗
PubMedDate not supplied

[Preliminary results of the treatment of occlusive hydrocephalus in children by endoscopic techniques].

The group of 20 patients with the preliminary diagnosis of occlusive hydrocephalus were treated by neuroendoscopic technique. Ten ventriculocystocisternostomies in cases with third ventricle arachnoid cysts accompanied by hydrocephalus, 9 ventriculostomies, and 1 ventriculostomy with fenestration of posterior fossa cystic lesion were performed. It was proven that the neuroendoscopic procedures were effective in 17 cases (85%) in the 10 months mean follow-up period of the study group. With no mortality, transient surgical complications were observed in 5 cases (25%). In 3 cases, inefficacy of the method was caused by false preoperative evaluation, and inappropriate surgical technique.

Acute Disease↗
PubMed2004

Basic principles and equipment in neuroendoscopy.

In sum, understanding some of the basic principles of endoscopy and awareness of available resources can potentially be of considerable help to experienced neurosurgeons as well as beginners in selection of the most appropriate tools for different procedures and making cost-effective choices when browsing through multiple commercial advertisements and purchasing new equipment. Although numerous advantages in science and industry have made it possible to offer a wide variety of neuroendoscopes and tools, we believe the major achievements in this field are yet to occur. This particularly refers to the development of smaller fiberoptic scopes with better image quality and three-dimensional endoscopes and to the invention of more efficient tools for endoscopic tumor removal with the same degree of safety as in open surgery.

Central Nervous System Diseases↗
PubMed2004

A newly designed disposable introducer sheath for a ventricular fiberscope.

We have developed a disposable plastic introducer sheath for use with a flexible endoscope during intraventricular procedures. The sheath is composed of a thin polypropylene tube passing through the center of a plastic stopper. The tube serves as a sheath through which the fiberscope is introduced into the ventricle. The stopper seats in the burr hole and prevents downward and lateral movement of the tube. The sheath can be placed safely in the ventricle with a drainage catheter used as an introducing guide. We used this sheath system in 10 patients and found it very useful. Manipulation of the fiberscope was not hindered, copious irrigation was allowed, and the sheath remained stable on the skull. This new introducer sheath may contribute to the increased use of a flexible endoscope in neuroendoscopic procedures.

Cerebral Ventricles↗
PubMed2005

Consideration of ergonomic aspects in the development of a new endoscopic navigation system.

During the development of new navigation systems, the ergonomic aspects of the accompanying software are seldom taken into account. The VN system is a navigation system working with real and previously stored neuroendoscopic images. The latter enable the module to execute virtual back movement, e.g. in case of bleeding. Several other modules are offered. The aim of the study was the ergonomic analysis of different modules and their learning curves in cadaveric heads. The endoscope was navigated by the neurosurgeon while another person operated the computer. A total of 128 experiments were performed with two software versions. When the landmark tracking module was used, a real learning curve could be observed. By contrast, testing the measurement module did not produce a learning curve. A significant reduction of the time required by the three modules investigated could be observed with software version 2. The module for virtual back movement works best with a minimum time of 20 s for image storage. During machine-human interactions ergonomic software use is important, especially if operative procedures are performed.

Clinical Competence↗
PubMed2005

Pineal region giant cell astrocytoma associated with tuberous sclerosis: case report.

Tuberous sclerosis complex is a genetic disorder characterized by the development of hamartomas in multiple organs including the brain, skin, eye, kidney, and heart. Neurological features include seizures and mental retardation. Cortical tubers and subependymal nodules are the characteristic intracranial lesions of tuberous sclerosis. Subependymal giant cell astrocytomas, typically located adjacent to the foramen of Monro, can enlarge and cause symptomatic ventricular obstruction. The authors describe the case of a 3-year-old boy with a history of tuberous sclerosis and retinal lesions who presented with an enlarging enhancing pineal region mass. Via an infratentorial supracerebellar approach, the mass was removed using both the operative microscope and a rigid neuroendoscope. Pathological examination showed a giant cell astrocytoma. To the authors' knowledge, this is the first reported case of tuberous sclerosis associated with a giant cell astrocytoma of the pineal region. Diagnostic considerations are discussed.

Astrocytoma↗
PubMedDate not supplied

[Observation of the ventricular system and subarachnoid space in the skull base by flexible neuroendoscopy: normal structures].

Worldwide in the last two decades, in Latin America in the last decade, and Mexico in particular cerebral endoscopy as part of the minimally invasive neurological surgery, has constituted a significant advance for the treatment of neurological diseases such as congenital or acquired hydrocephalus, Chiari malformation, neurocysticercosis, stroke, ventricular and paraventricular tumors and cysts, arachnoidal cyst and hydrocephalus secondary to shunt malfunction. The lateral ventricles, the third ventricle, the cerebral aqueduct, the fourth ventricle, and the subarachnoid basal cisterns are among the most non-accessible regions of the central nervous system. Due to light-rand fiber optic-systems in combination with the experiences of nine consecutive year's and more than 600 endoscopies, most of them flexible neuroendoscopies, we present the neuroendoscopic approach with flexible cerebral endoscope to the anatomy and its normal variants of the whole ventricle system and the subarachnoid basal cisterns including the subarachnoid space of the cervical spine. We also describe their site related structures including veins, arteries, cranial nerves, pituitary gland, choroidal plexus and their normal anatomic variants.

Cerebral Ventricles↗
PubMed1998

Development of an endoscopic navigation system based on digital image processing.

We developed a new system to couple the endoscope to an optical position measurement system (OPMS) so that the image frames from the endoscope camera can be labeled with the accurate endoscopic position. This OPMS is part of the EasyGuide Neuro navigation system, which is used for microsurgery and neuroendoscopy. Using standard camera calibration techniques and a newly developed system calibration, any 3-dimensional (3-D) world point can be mapped onto the view from the endoscope. In particular, we can display the coordinates of any anatomical landmark of the patient as it is viewed from the current position of the camera. This and other image-processing techniques are applied to the labeled frame sequence in order to offer the neurosurgeon a variety of control modules that increase the safety and flexibility of neuroendoscopic operations. Several modules, including a new motion alarm system and the "tracking" and "virtual map" modules, were tested in a human cadaveric model using the frontal and occipital approaches. A failure rate of 8.6% was experienced during testing of the first version of the software, but the second version was 100% successful. Thus, an endoscopic navigation system based on digital image processing has been developed that could be a revolutionary advance in image-guided surgery.

Cadaver↗
PubMed1998

Liliequist's membrane in minimally invasive endoscopic neurosurgery.

Liliequist's membrane, an arachnoid condensation extending from the upper border of the dorsum sellae to the anterior edge of the mammillary bodies and formerly a relatively insignificant structure, has been found to be extremely important in the neuroendoscopic management of hydrocephalus. Failure to open this membrane can lead to the failure of third ventriculostomies.

Arachnoid↗
PubMed1994

Endoscopic anatomy of the ventricles.

The endoscopic view offers a new anatomical dimension to the neurosurgeon. The fact makes it basically necessary to study the topographic anatomy under endoscopic conditions. In this paper attention was drawn to the ventricles because they are the most common region of clinical application. In 25 specimens neuroendoscopic explorations of the ventricles have been done. The dissections have been carried out through one- and two burr hole approaches (two working endoscopes at the same time). The instrumentation includes rigid 4 mm and 6 mm endoscopes. The procedures have been documented by continuous video recording and parallel photography.

Cerebral Ventricles↗
PubMed1994

Magnetic field guided endoscopic dissection through a burr hole may avoid more invasive craniotomies. A preliminary report.

The neuroendoscope, coupled with radiofrequency or laser dissecting tools, can effectively resect obstructing membranes, biopsy and debulk tumor, and evacuate hematomas when the pathology is within the ventricular system. This less invasive approach through a burr hole usually avoids craniotomies. When the abnormal condition is within parenchyma or in the presence of opacifying bloody fluid, landmarks are not recognizable and the neurosurgeon quickly becomes disoriented. A more extensive craniotomy or a stereotaxic-guided procedure is then necessary. We describe our preliminary experience with a geographic intracranial navigation system using realtime measurement of electromagnetic field strength in multiple planes to precisely indicate the position of the tip of the endoscope. A transmitting antenna is positioned beneath the patient's head. A 1.5 centimeter cubic antenna receiver is mounted upon a lenscope with instrument channel. The scope is guided into the surgical field after insertion through a burr hole. A square wave pulsed electromagnetic field measurement is made 140 times per second with correction for the earth's magnetic field once per second. Intracranial position data for the dissecting tip in regard to X, Y, Z, pitch, roll and yaw are output to a digitized computer map of the patient's MRI or CT scan. Also displayed on the computer screen is the video image from the endoscope. The neurosurgeon thus has simultaneous realtime geographic and near-field localization as he dissects. Electromagnetic field guided accuracy is within 2.0 mm inside the allowable 24 inch working sphere about the patient's head. Coupled with near-field video precision, accuracy is within 1 mm of recognizable dissection planes.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Diseases↗
PubMed1996

Complications of endoscopic neurosurgery.

Neuroendoscopy is rapidly becoming an essential part of the neurosurgeon's repertoire. Currently, very few studies have identified the complications of this new technique, yet many have warned of the steep learning curve associated with its practice. We have reviewed the last 173 neuroendoscopic procedures performed by one surgeon and identified two distinct groups of complications: those that have clinically significant sequelae and those that cause concern intraoperatively but no overt clinical problems. The 173 procedures were performed on 152 patients. Of these patients, 11 suffered significant complications (7%). Twenty-two of the procedures were complicated by intraoperative problems (13%). The incidence of insignificant complications appeared to decrease with experience, whereas that of the significant ones did not. These complications occurred in association with a wide variety of operations over a 2-year period. We conclude that neuroendoscopy is a relatively safe technique with an overall 7% complication rate and a steep learning curve, and that, with a few simple guidelines, it can be employed by all neurosurgeons for the betterment of their patients.

Adolescent↗
PubMed1995

Endoscopically assisted microneurosurgery.

Technological developments in neuroendoscopy are leading to an expansion of applications into the realm of microneurosurgical procedures. The new dimension that using an endoscope provides requires insight into different neuroanatomical aspects and a new kind of strategy in planning a microneurosurgical procedure. To gain some new insights into these exciting aspects of neurosurgery we have explored the sellar, parasellar, and posterior fossa regions in 50 fresh anatomical specimens and used various types of endoscopes to observe the surgically relevant neurotopographical details. We then utilized this experience in 33 clinical cases during microsurgical approaches for various lesions (posterior fossa tumors - 12 cases, sellar and parasellar tumors - 8 cases, trans-sphenoidal procedures for pituitary adenoma - 7 cases, transventricular procedures - 6 cases). In the laboratory we found that familiar neuroanatomical structures are seen in a completely different aspect from what we are accustomed. Orientation is at times difficult, which requires rehearsal and special handling of the endoscope for complex clinical procedures. We found that certain structures that are hardly noticed in routine anatomical views become very important when utilizing the endoscope (i.e., different arachnoid membranes and trabeculae). Importantly, the dimensions of a microsurgical approach can be greatly enlarged with the endoscope, making it possible to look behind structures and ''around corners''. We present our findings with respect to important anatomical details relevant to utilizing the endoscope as an adjunct to microneurosurgical procedures and our clinical data. We have concluded that the neuroendoscope can be a safe and helpful adjunct in many microneurosurgical procedures.

Endoscopy↗
PubMed2002

Diverticular enlargement of the foramina of Luschka and congenital hydrocephalus.

CASE REPORT: We report on a 9-month-old boy with congenital hydrocephalus involving cystic lesions in the bilateral cerebellopontine angle cisterns. Sequential CT cisternography demonstrated congenital obstruction of the fourth ventricular outlet and diverticular enlargement of the foramina of Luschka. DISCUSSION: The possibility of neuroendoscopic third ventriculostomy as a treatment for these pathologies is discussed.

Brain Diseases↗
PubMed2004

The role of neuroendoscopy in the management of tectal gliomas.

OBJECTIVES: The objective was to determine the role of neuroendoscopy in the management of tectal plate gliomas. METHODS: Clinical and radiological data of children and adults who underwent neuroendoscopy were reviewed. Successful outcome was defined as shunt-freedom and resolution of symptoms and signs of raised intracranial pressure. RESULTS: Between 1 April 1998 and 31 March 2003, 11 patients (6 males and 5 females) underwent endoscopic third ventriculostomy (ETV) for the management of hydrocephalus secondary to a tectal plate glioma. This comprises 4% of 258 patients who have undergone neuroendoscopic procedures in our unit. The median age at the time of surgery was 19 (range 9-59) years. In 4 patients endoscopic biopsy of the tumour was performed at the same time. During a median follow-up period of 31 months (range 2-45), 4 patients underwent a second ETV, of whom 2 subsequently required insertion of ventriculoperitoneal (VP) shunts. Nine patients (82%) remain shunt-independent. Of the 4 tumours that were biopsied, a histological diagnosis of low-grade astrocytoma was made with certainty in only 2 cases. All tumours remained unchanged on follow-up MR imaging. CONCLUSIONS: Endoscopic third ventriculostomy can result in excellent control of hydrocephalus in patients with tectal plate gliomas. Tectal gliomas appear to be very slow growing tumours that can be managed conservatively in adults as well as children. Longer follow-up in larger studies is required.

Adolescent↗
PubMed2005

The International Infant Hydrocephalus Study: concept and rational.

INTRODUCTION: During the recent meetings of the International Study Group on Neuroendoscopy and the International Society for Pediatric Neurosurgery, the consensus view emerged that there is a need to assess the value and efficacy of neuroendoscopic procedures against shunting in a scientific manner, to resolve long-lasting debates on the subject. MATERIAL AND METHODS: A prospective randomized, controlled trial of endoscopic third ventriculostomy vs shunting in children presenting under the age of 2 years with pure aqueduct stenosis is been proposed and organized (the International Infant Hydrocephalus Study, IIHS). The participating surgeons must adhere to the philosophy of randomization and be suitably experienced in endoscopic techniques in infants. The primary outcome of the trial will be the overall health-related quality of life of these children at 5 years of age. Hence, the study is focusing on the effect of surgery on neurodevelopment, rather than the less important issue of shunt or stoma survival, that has been debated extensively with no conclusion so far. Intention-to-treat analysis will be performed according to the first surgery. Secondary outcomes such as complication and reoperation rate, total hospitalization time and cost, need for repeat imaging, and others will be analyzed as well. RESULTS: Pure aqueduct stenosis is relatively rare, making recruitment problematic, but has been chosen to avoid other confounding factors that could influence outcome. More than 25 centers worldwide have committed already to patient recruitment to the study. It is anticipated that recruitment will last for 2 years, aiming for 91 patients per arm. The study has started recruiting patients already in some countries. CONCLUSION: It is hoped that the trial will not only provide answers to unsettled debates on the value of neuroendoscopy but also create a network of collaborating pediatric neurosurgeons for future initiatives.

Cerebral Aqueduct↗