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At least 253 records · Page 14Linked to original sources
PubMed2002

Interventional MR-guided neuroendoscopy: A new therapeutic option for children.

Neuroendoscopic treatment of hydrocephalic children is an established surgical modality. Open magnetic resonance imaging (MRI) technology introduces new imaging features that, in combination with endoscopy, seem particularly valuable for performing these operations. "Near" real-time production of MR images in 3 dimensions during the procedure allows real-time neuronavigation, thus, facilitating guidance of an endoscope. Additionally, intraoperative changes such as brain shift, effects of perforation, and drainage of cysts are shown during an ongoing procedure. The patency of cysts or fluid compartments inside the ventricular system can be controlled by intraoperative injection of diluted gadolinium into the cystic compartments. These new therapeutic options were applied in 2 hydrocephalic children with complex ventricular cysts: a 3-month-old girl with a large, septated arachnoidal cyst and internal hydrocephalus and a boy of 7 years, 2 months with congenital hydrocephalus and premature closure of the coronary sutures.

Arachnoid Cysts↗
PubMed2001

Mobile intracranial oily substances from a ruptured teratoma.

A patient with a ruptured intracranial teratoma is presented. The distinctive imaging and neuroendoscopic findings of mobile fatty or oily globules in the subarachnoid or ventricular space are described. Fat suppression magnetic resonance imaging (MRI) and MRI performed with the patient prone was helpful in distinguishing tumour tissue from floating oil.

Adult↗
PubMed2000

Transient hyponatriemia complicated by seizures after endoscopic third ventriculostomy.

We present an infant who underwent endoscopic third ventriculostomy due to symptomatic hydrocephalus secondary to aqueductal stenosis. This is the first reported case of inappropriate secretion of antidiuretic hormone complicated by hyponatriemia and seizures following endoscopic surgery. The possibility of such a neuroendoscopic complication should alert neurosurgeons and close observation of serum electrolytes is highly recommended in the acute postoperative period, particularly in infants.

Endoscopy↗
PubMed2000

Endoscopic third ventriculostomy with ultrasonic contact microprobe.

The authors describe their first clinical experiences in endoscopic third ventriculostomy (ETV) with the original ultrasonic contact microprobe (UCM) designed at the Department of Neurosurgery in Zagreb. The analysis includes the clinical course of disease in eight patients submitted to surgery from May to September 1999 (3 men and 5 women, from 14 to 61 years of age). Surgery was performed in patients with neurological symptoms of elevated intracranial pressure and neuroradiological evidence of non-communicating hydrocephalus caused by mesencephalic aqueduct stenosis. The perforation in the base of the third brain ventricle made by the ultrasonic contact microprobe was widened by a balloon catheter. The authors have come to conclusion that the ETV when performed by contact ultrasonic microprobe is a small risk procedure in case of non-communicating hydrocephalus. For its small diameter (1.6 mm) and simple handling the newly designed contact ultrasonic microprobe is very suitable for use in neuroendoscopy as it enables fenestration of the third brain ventricle with minimal thermal and ultrastructural damage to the adjacent neurovascular structures. Further research will be focused on defining indications for the use of the device in other neuroendoscopic procedures as well.

Adolescent↗
PubMed2001

[MRI with cerebrospinal fluid measurement before and after endoscopic ventriculostomy and aqueductal stenosis].

PURPOSE: Evaluation of MR imaging and CSF flow measurement for planning and follow-up of neuroendoscopic third ventriculostomy in occlusive triventricular hydrocephalus. METHOD: 17 patients with occlusive hydrocephalus due to idiopathic or neoplastic aqueductal stenosis were examined before and after surgery with cardiac-gated T2-weighted and cardiac-gated phase contrast cine sequences. The visibility of anatomic structures and the patency of the ventriculostomy were evaluated. RESULTS: In all 17 patients, the relevant anatomic structures were visible. The cine sequence demonstrated occlusion of the aqueduct and patency of the ventriculostomy in all cases, even in patients with doubtful clinical patterns. CONCLUSIONS: MR imaging with additional cardiac-gated cine sequences allows exact preoperative diagnosis of occlusive hydrocephalus as well as patient selection and planning for endoscopic third ventriculostomy. Non-invasive follow-up, especially in patients with a doubtful clinical pattern, is possible.

Adolescent↗
PubMed2001

Microsurgical anatomy of the Liliequist's membrane and surrounding neurovascular territories.

Since the original description by Liliequist only a few microanatomical studies of the Liliequist membrane have been performed. These studies contain some discrepancies in the description, boundaries, and attachments of the membrane. Using a surgical microscope the authors examined the microsurgical anatomy of Liliequist's membrane and surrounding neurovascular structures in twenty adult brains injected with silicone rubber, with special emphasis given to the analysis of controversial details. This description is intended as an aid for neurosurgeons performing neuroendoscopic procedures.

Cadaver↗
PubMed2001

Incorrect vector after calibration of surgical instruments for image guidance. The problem and the solution: technical note.

Recently, the use of intra-operative image guidance has gained an increasing role in neurosurgery for both spinal and cerebral interventions. Some modern neuronavigation systems are able to register any surgical instrument and create a virtual pointer. A virtual elongation of the digitized instrument is frequently used for neuroendoscopic procedures and spinal instrumentation. The instrument is equipped with a universal instrument adapter clamp and digitized by touching the tip of the instrument into a calibration cone. An algorithm calculates the vector of the instrument using two points: the tip of the instrument, and the geometrical center of the instrument adapter geometry. If a virtual elongation of the calibrated instrument is performed, the neuronavigation software may calculate an incorrect virtual target point. We developed an instrument calibration matrix (ICM) that automatically calibrates the correct vector, tip, and diameter of the instrument used for image-guided surgery. The ICM is easy to handle and does not cause a time delay during surgery. Virtual elongation of the surgical instruments shows correct anatomic data, which are fundamental for planning ventricular tapping and spinal screw placement in particular. The instrument calibration matrix is essential if surgical instruments are digitized and used for neuronavigation. It helps to avoid mis-planning of surgical vectors and mis-placement of the used instruments.

Calibration↗
PubMed2001

Endoscopic approach to intraventricular cysticercal lesions.

Various surgical approaches to treat intraventricular cysticercosis have been practiced over the years. We now present our experience with the use of the endoscope in the removal of intraventricular cysticercal cysts in patients with intraventricular cysticercal lesions associated with hydrocephalus. From 1995 to 1998, we have excised intraventricular cysticercal cysts from 9 patients. They were located in lateral ventricle in 4, in the third ventricle in two and in the fourth ventricle in three patients. A Gaab's rigid neuroendoscope system was used to enter and excise cysts in the lateral and third ventricle. The flexible fiberoptic scope was used for excising cysts in the fourth ventricle, through a transaqueductal route. In all cases a precoronal frontal burr hole was used for entry. All have been treated with albendazole in the postoperative period. All the cysts were removed successfully using endoscopic neurosurgery alone. One patient had a superficial injury to the rigid side of the aqueduct with a postoperative deficit, which improved. Three septal perforations, three third ventriculostomies, and one aqueductoplasty were done in the same sitting after cyst removal for CSF diversion. None of the nine cases required further surgery up to date. The follow-up period varied from 12 to 45 months with a median of 18 months. Endoscopic neurosurgery is a minimally invasive technique enabling removal of intraventricular cyticercal cysts from all locations, avoiding major craniotomies/posterior fossa explorations and shunts.

Adolescent↗
PubMed2002

Surgical clipping of basilar aneurysms: relationship between the different approaches and the surgical corridors.

BACKGROUND: Surgical clipping for basilar artery aneurysm (BAA) is a technically demanding procedure due to the depth of the surgical field and the presence of vital perforating arteries in the vicinity. The incorporation of various modifications in the conventional approaches has expanded the surgical armamentarium in dealing with these difficult lesions. METHODS AND FINDINGS: 87 patients of BAA were operated at our center, out of which in 48 patients, a pterional transsylvian approach was used. In 12 patients, this approach had to be extended to incorporate the anterior temporal approach in 6 cases, transzygomatic subtemporal approach in 2 cases and transcavernous approach in 4 cases. The surgical indications for the additional approaches and the relationships between the surgical corridors gained by their inclusion were studied. The use of neuroendoscopy facilitated adequate clipping in one case of high BAA without the incorporation of bone drilling, thus opening new surgical corridors. INTERPRETATION: The variable situation of the BAA makes it mandatory for the surgeon to be prepared to simultaneously work through multiple surgical corridors. Neuroendoscopic-assisted microneurosurgery occasionally utilizes a narrow surgical corridor to facilitate BAA clipping using the conventional approaches and eliminates the need to gain access using additional surgical corridors.

Basilar Artery↗
PubMed2003

Giant cyst of the cavum septi pellucidi, cavum Vergae and veli interpositi.

The authors report a case study of a giant cyst of the cavum septi pellucidi, cavum Vergae and veli interpositi spreading to the posterior fossa, and initially treated elsewhere by ventriculoperitoneal shunt, with no resolution of the symptomatology. A few months later the patient was successfully treated by fenestration into the ventricular system through a neuroendoscopic technique, at the Pediatric Neurosurgical Center of the Meyer Children's Hospital in Florence. Symptomatic midline cysts are quite rare and different techniques have been proposed for their treatment, i. e., direct craniotomy, conventional shunting, stereotactic approaches as well as endoscopic fenestration. In such cases neuroendoscopy obtains a good symptom resolution level, avoiding at the same time the risks of damage to endoventricular structures and often eliminates the need for a definitive ventriculoperitoneal shunt. In the present research the authors analyze the anatomy of the midline cavities and the mechanism through which a cyst may become symptomatic. The surgical endoscopic technique and the clinical and radiological assessments which confirmed the patency of the fenestration are also discussed. The authors conclude that endoscopic ventricular fenestration may represent the treatment of choice for this pathology.

Central Nervous System Cysts↗
PubMed2003

Minimally invasive pituitary surgery in a hemorrhagic necrosis of adenoma during pregnancy.

A 29-year-old woman with a prolactin microadenoma was under good control with bromocriptine (BCP) therapy until she became pregnant, when the treatment was stopped. During the third trimester of pregnancy the patient presented a unilateral visual loss and intermittent headaches. BCP was restarted and one week later she developed a complete ophthalmoplegia on the other side. The patient was submitted to an endoscopic transnasal transeptal resection of a hematoma and tumoral tissue in the pituitary region. One month after surgery, at 39 weeks of gestation, the patient spontaneously delivered a healthy girl weighing 3 kg, with an Apgar score of 9 and 10 at five minutes. This is the first case in the literature of a pregnant woman with second and third cranial nerve lesions, submitted to minimally invasive neuroendoscopic transnasal transsphenoidal approach in the third trimester of pregnancy.

Adult↗
PubMed2003

Neuroendoscopy: one year of experience--personal results, observations and limits.

After reading reports of successful neuroendoscopic treatment of hydrocephalus, colloid cysts and arachnoid cysts as well as tumor biopsy, we started using endoscopic procedures in our Department, one year ago. One surgeon (E.S.) skilled in the Decq Endoscope, performed a series of sixteen procedures, from January 2001 to March 2002 (in patients aged 28 to 69 years). The most common pathology was obstructive hydrocephalus (14 cases), one was colloid cyst, and the last case was tumor biopsy. The surgical treatment consisted of third ventriculostomy, cyst opening and shrinking and tumor biopsy. In fourteen patients treated for hydrocephalus with third ventriculostomy (ETV), one required a definitive shunt. Complication occurred in one case with chronic subdural collection. We further report one case of aqueductal restoration after third ventriculostomy. Our results, with no neurological deficits or deaths, confirmed our opinion that neuroendoscopy is a safe surgical technique in well-selected patients and we believe it is the ideal treatment in obstructive hydrocephalus.

Aged↗
PubMed2003

Neuroendoscopy based on computer assisted adjustment of the endoscope holder in the laboratory.

OBJECTIVE: We present our initial clinical experience with a novel technique of frameless stereotactic neuroendoscopy using a neuronavigation system, a specially designed aiming device (endoscope holder/targeting device) combined with a vacuum-mouthpiece based head holder. Due to the reproducibility of patient immobilization in the fixation system, the endoscope holder can be adjusted in the laboratory in the absence of the patient. METHODS: An individual vacuum-mouthpiece was fabricated. The patients were scanned with an external reference frame attached to this mouthpiece and the images were transferred to the neuronavigation system. Determination of the path, mouthpiece-based registration and adjustment of the targeting device were performed the day before surgery in the absence of the patient. In the OR the patient was repositioned and the endoscope was introduced through the preadjusted aiming device to the precalculated depth. RESULTS: The novel technique was successfully used for frameless endoscopic navigation in five patients. Three endoscopic third ventriculostomies in adults, one endoscopic septostomy due to unilateral hydrocephalus in an adult female patient and one endoscopic ventriculo-cysto cisternostomy in a 20-month-old girl with a suprasellar arachnoid cyst, were performed with excellent clinical results and without technical complications. CONCLUSION: Our initial experience indicates that frameless stereotaxy, in combination with a relocatable head holder and a special targeting device, allows for precise and preplanned advancement of the neuroendoscope, reducing or even eliminating intraoperative registration and endoscope trajectory adjustments, thus substantially reducing OR time. Due to the non-invasive but rigid immobilization method, neuronavigation can also be performed in children under 2 years of age.

Adult↗
PubMed2003

Unsuccessful third ventriculostomy for occlusive hydrocephalus.

For non-communicating hydrocephalus, neuroendoscopic third ventriculostomy has become a major choice. But sometimes, the procedure results in failure. Typically, impairment of a distal CSF absorption, a preexisting arachnoid membrane just below the fenestrated site and a glial scarring of fenestrated site were pointed out as a factors of failure. On the other side, the intraventricular pressure dynamics of a functioning third ventriculostomy is in the process of study. Recently some reports have noticed the importance of the flow of CSF into the prepontine cistern, mimicking the flow through the aqueduct of Sylvius. We report an unsuccessful trial of third ventriculostomy in a case with huge posterior fossa tumor.

Aged↗
PubMed2003

Pro and cons of different designs of rigid endoscopes.

Experience with more than 200 neuroendoscopic procedures taught us the advantages and disadvantages of the different endoscope designs. Using an endoscope with a sheath with separate channels for the endoscope, the instruments as well as for rinsing and suction we found advantages in rinsing properties, handling, and preciseness of instrument steering. On the other hand an endoscope with a sheath with a singular channel for the endoscope itself, the instruments, rinsing, and suction the advantages were better in visualization of the instruments, more available instruments, and easier extraction of larger specimen. The knowledge of these advantages makes it possible to select the adequate endoscope regarding its design, especially in more complicated cases.

Brain Diseases↗
PubMed2004

A simplified endoscopic third ventriculostomy under local anesthesia.

The aim of this study is the analysis of our experience with awake endoscopic third ventriculostomy (ETVS) in hydrocephalic patients. From September 1994 to December 2001, 24 neuroendoscopic procedures were performed under local anesthesia. Local infiltration was administered using a bupivacaine and lidocaine mixture. Analgesics were titrated to the effect. A free-hand technique with a flexible endoscope was adopted in 24 patients with primitive and secondary (neoplastic) hydrocephalus. ETVS was performed successfully in all cases. No procedure needed to be discontinued due to seizures, bleeding or agitation. Dural incision/coagulation and Fogarty dilatation proved to be the most painful maneuvers requiring, sometimes, supplemental analgesic administration. No intraoperative complications were observed; however, two asymptomatic trajectory hematomas were incidentally discovered two and three days after the operation, respectively. Awake ETVS is a valuable alternative procedure that can be adopted in adult cooperative patients, provided that the procedure is done in an essential and fast way with the free-hand technique, by means of a flexible endoscope, and with the assistance of an anesthesiologist.

Adult↗
PubMed2004

Clinical application of neuro-navigation in a series of single burr-hole procedures.

With recent developments in computer technology and the improvement of neuroimaging, modern optical neuro-navigation systems are increasingly being used in neurosurgery. In this study, we present our experience with 51 operations using a frameless optical navigation system in a variety of single burr-hole procedures. The procedures include neuroendoscopic surgery, frameless stereotactic biopsy, cyst aspiration and catheter placement. Both the VectorVision and the VectorVision(2) neuro-navigation systems (BrainLab AG, Munich, Germany) were used. The reliability and accuracy of the neuro-navigation system, postoperative complications and the clinical usefulness of image-guidance were analyzed. The navigation system worked properly in all 51 neurosurgical cases. Exact planning of the approach and determination of the ideal trajectory were possible in all cases. The mean registration error of the system, given as a computer-calculated value, was 2.1 mm (0.4-3.1 mm). Postoperative clinical evaluations and imaging were performed on every patient in order to confirm the success of the surgical procedure. All patients recovered well and without any postoperative complications. We conclude that image guidance in single burr-hole procedures provides a high degree of accuracy in lesion targeting, permits good anatomical orientation and minimizes brain trauma. The navigation system has proven to be a helpful tool since it increases the safety of single burr-hole procedures.

Adolescent↗
PubMed2004

Minimally invasive management of the third ventricle glioma in a patient without hydrocephalus: neurofiberscopic biopsy followed by gamma knife radiosurgery.

There is usually concern that ventricular enlargement is necessary for safe neuroendoscopic procedures. However, newly developed models of neurofiberscopes with a small outer diameter can be effectively used even in patients without ventriculomegaly. We present the case of a successful neurofiberscopic biopsy of a third ventricle anaplastic astrocytoma in a previously shunted patient without hydrocephalus. Subsequent gamma knife radiosurgery led to complete disappearance of the tumor. It seems that presence of collapsed ventricles, and even symptoms consistent with the slit ventricle syndrome, should not be considered as contraindications for neurofiberscopic surgery when brain compliance is sufficiently preserved. The latter should be considered as the key point of safe endoscopic manipulations. The combination of the neuroendoscopy and stereotactic radiosurgery provides wide possibilities for minimally invasive management of selected intracranial tumors.

Adolescent↗