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At least 271 records · Page 15Linked to original sources
PubMed2004

The supraorbital keyhole approach via an eyebrow incision for resection of tumors around the sella and the anterior skull base.

OBJECTIVE: This study evaluates the technique, indications, advantages and limitations of the minimal invasive supraorbital keyhole approach via an eyebrow skin incision for resection of tumors around the sella and the anterior skull base. METHODS AND RESULTS: In 9 patients (5 males, 4 females) different tumors (6 meningiomas, 1 craniopharyngioma, 1 Rathke's cleft cyst and 1 hypophysitis) with a maximum diameter of 30 millimeters were resected via a small eyebrow incision and a supraorbital keyhole craniotomy. Details of the operative procedure include the use of a high-speed drill, a microsaw, bayonet-shaped instruments, careful microsurgical dissection, the use of a neuroendoscope and miniplates for closure. In all patients complete tumor removal was achieved. Mean duration of surgery was 01 h 51 min and mean hospital stay was 8.9 days. There were no significant postoperative complications. Clinical examination and MR imaging after a mean follow-up of 313 days revealed no tumor recurrence and a very satisfying overall functional and cosmetic result in all patients. CONCLUSION: The eyebrow incision supraorbital keyhole approach proved to be safe, effective and time-sparing. The authors recommend this approach for resection of small tumors around the sella and the anterior skull base in selected cases as a valuable alternative to standard skull base approaches.

Adult↗
PubMed2004

Failure of endoscopic third ventriculostomy in the treatment of idiopathic normal pressure hydrocephalus.

Even though the main indication for neuroendoscopic management of normal pressure hydrocephalus (NPH) is the presence of an aqueductal block, recent reports suggest the possible efficacy of endoscopic third ventriculostomy (ETVS) in idiopathic NPH. We present 14 cases with apparently idiopathic NPH treated by ETVS, and report on the low rate of success (21 %). A closer analysis of the successful cases reveals possible elements which may explain the good outcome, and should be taken into consideration when defining the best strategy to address NPH.

Aged↗
PubMed2005

Minimally invasive management of ependymoma of the aqueduct of Sylvius: therapeutic considerations and management.

A major concern in the neuroendoscopic approach to an intraventricular tumor is the histological confirmation from a limited biopsy. However, the effort to excise the whole bulk of the tumor should be made for the minimally invasive management of selected intraventricular tumors. The case of an adult male with focal aqueductal ependymoma who presented with the clinical syndrome of hydrocephalus is reported. This may be of particular interest because it represents the first case of aqueductal ependymoma that has been successfully treated with endoscopic surgery.

Brain Neoplasms↗
PubMed2006

Endoscopic transsphenoidal treatment in recurrent and residual pituitary adenomas--first experience.

AIM OF THE STUDY: The aim of the study has been the assessment of the endoscopic method in the surgical management of recurrent and residual pituitary adenomas, as concerns treatment efficiency, substantial complications, and its possible advantages for the operating surgeon and patient. MATERIAL AND METHODS: In Department of Neurosurgery, Silesian University School of Medicine in Katowice, between October 2001 and June 2004, 125 patients underwent endoscopic surgery due to pituitary adenoma. The analysis comprised 20 patients, who were operated on due to recurrent adenomas or residual tumour not completely removed during the first surgical procedure. The group of patients was composed of 9 women and 11 men. The youngest patient was 32 years of age, the oldest 79. The average age was 53.9 years. The analysed group had 14 non-functioning adenomas, 4 GH-secreting adenomas, 1 PRL-secreting adenoma and 1 ACTH-secreting adenoma. 19 of them were macroadenomas while 1 was a microadenoma. 11 of the 20 adenomas infiltrated the cavernous sinuses. The surgical procedures were performed by a stable team, composed of 2 neurosurgeons, a laryngologist and an anaesthesiologist. The surgery method was based upon the technique developed by Jho and Carrau, with own modifications of the operators. A rigid neuroendoscope having the diameter of 4 mm with 0 degrees and 30 degrees optics by Storz was used. The follow-up period after surgery was between 12 and 42 months, 24.2 months on average. RESULTS: Of the 20 cases, complete recovery was achieved in 40% of patients undergoing secondary surgical procedures. In the group of 11 patients with adenomas not infiltrating the cavernous sinuses, recovery was reported for 8 of them, that is 73%. No fatalities occurred. 7 cases of liquorrhoea occurred during operation, requiring reconstruction and sealing of the sella by means of tissue glue and artificial dura or freeze-dried human dura. In 1 case, despite the application of post-operative lumbar drainage, rhinorrhoea occurred one month after the procedure, which required endoscopic reconstructive treatment. In the same patient, a pneumoencephalocele was observed. The average time of the repeat surgical procedure using endoscopic techniques was shorter by 18 minutes than the repeat procedure using microscopic techniques. CONCLUSIONS: The endoscopic method is a safe, hardly invasive and efficient surgical technique in the treatment of recurrent and residual pituitary adenomas. Advantages which add to its attractiveness are also reduction of the procedure duration, very good visualisation of the operative field, absence of serious complications, less pain experienced after the surgery.

Adenoma↗
PubMed2006

Optical coherence tomography for experimental neuroendoscopy.

Optical coherence tomography (OCT) is a non-invasive and non-contact imaging technology that has been applied to several biomedical applications. We have recently demonstrated that OCT allows discrimination of tumor adjacent brain, diffuse and solid tumor tissue and that this technology may be used to detect residual tumor within the resection cavity during resection of intrinsic brain tumors. Here we show that an OCT integrated endoscope can image the endoventricular anatomy and other endoscopically accessible structures in a human brain specimen. A Sirius 713 optical coherence tomography device was mounted to a modified rigid endoscope. A formalin-fixed human brain specimen was used to simulate endoscopic visualization of brain anatomy and two specimens of fixed malignant tumors with endoventricular growth patterns. Simultaneous OCT imaging and endoscopic video imaging of the visible spectrum was possible using a graded index rod endoscope. OCT imaging of a human brain specimen in water allowed an in-depth view into structures like the walls of the ventricular system, the choroid plexus or the thalamostriatal vein. OCT further allowed imaging of structures beyond tissue barriers or opaque media. In this fixed specimen OCT allowed discrimination of vascular structures down to a diameter of 50 mum. In vessels larger that 100 mum the lumen could be discriminated and within larger blood vessels a layered structure of the vascular wall as well as endovascular plaques could be visualized. This in vitro pilot study has demonstrated that OCT integrated into neuroendoscopes may add information that cannot be obtained by the video imaging alone. This technology may provide an extra margin of safety by providing cross-sectional images of tissue barriers within optically opaque conditions.

Brain↗
PubMed1996

Endoscopic ventricular fenestration of intracranial fluid cysts.

The authors report 5 patients with paraventricular or intraventricular fluid cysts, successfully treated by fenestration into the ventricular system using a neuroendoscopic technique. The series includes three paraventricular malformative CSF cysts, a cyst of the velum interpositum and a cystic astrocytoma with small, deeply located and unresectable mural nodule. In all cases the endoscopic fenestration was the unique treatment and allowed to avoid the definitive ventriculoperitoneal shunt. The surgical endoscopic technique and the postoperative radiological findings which indirectly confirm the patency of the fenestration are discussed. The authors conclude that endoscopic ventricular fenestration represents the treatment of choice for most paraventricular and intraventricular CSF collections.

Adolescent↗
PubMed1996

Endoscopic exploration of the IVth ventricle.

Regarding to the upcoming techniques in neuroendoscopy the IVth ventricle was examined. First in a series of 30 fresh and fixed anatomical specimens-the vessels injected with LATEX-the fourth ventricle was investigated endoscopically. There are three possibilities to reach the IVth ventricle: coming from the IIIrd ventricle via the aqueductus cerebri, using the basal cisterns through the apertura lateralis Luschkae and coming via the cerebellomedullar cistern through the foramen of Magendi. Using different kinds of endoscopes (rigid, flexible and steerable flexible)-diameter ranging from 5 to 9 french-with different optical systems (0 degree, 5 degrees, 30 degrees, 75 degrees) and different light sources (Halogen, Xenon) the anatomical details seen under the endoscope and the topographical landmarks of the approaches were investigated, presented and discussed. Based on the experience at the end of the cadaver work a short comment on which kind of equipment seems the best was given. A series of 14 clinical cases was presented as the second part of the study (7 cases with a tumor in the IVth ventricle-2 metastasis, 3 gliotic tumors, 1 ependymoma, 1 medulloblastoma, 3 patients with an occluded aqueduct because of meningo-ventriculitis and 4 patients with cystic malformations). The neuroendoscopic approaches, the neuroanatomical details relevant for surgery and the clinical data will be given and discussed. In general no intraoperative or postoperative complications were seen. In conclusion our experience from the theoretical neuroanatomical and the clinical part as well as the advantages and disadvantages from the different kind of endoscopes and approaches are discussed.

Adult↗
PubMed1999

Endoscopic neurosurgery "around the corner" with a rigid endoscope. Technical note.

Endoscopically "working around the corner" is presently restricted to the use of flexible endoscopes or an endoscope-assisted microneurosurgical (EAM) technique. In order to overcome the limitations of these solutions, endoscopic equipment and techniques were developed for "working around the corner" with rigid endoscopes. A steering insert with a 5 French working channel is capable of steering instruments around the corner by actively bending the guiding track and consecutively the instrument. A special fixation device enables strict axial rotation of the endoscope in the operating field. Endoscopic procedures "around the corner", including aqueductal stenting, pellucidotomy, third ventriculostomy and biopsy were performed in human cadavers. Special features of the used pediatric neuroendoscope system, i.e., reliable fixation, axial rotation, and controlled steering of instruments, increase the safety and reduce the surgical traumatization in selected cases, such as obstructive hydrocephalus due to a mass lesion in the posterior third ventricle, since endoscopic third ventriculostomy and biopsy can be performed through the same burr hole trephination. Limitations of this technique are given by the size of the foramen of Monro and the height of the third ventricle as well as by the bending angle of the instruments (40-50 degrees).

Biopsy↗
PubMed1999

Experience with an ultrasonic aspirator in neuroendoscopy.

This report describes the clinical application of an ultrasonic aspirator for endoscopic neurosurgery. Eight patients with intraventricular hematoma with complete tamponade of the ventricular system and marked hydrocephalus were treated with the ultrasonic aspirator for endoscopic neurosurgery. Clinical evaluation and neuroimaging studies were obtained for one month. Removal of hematoma was confirmed on follow-up imaging. The ultrasonic aspirator is operated by electrostriction transducer on low generating power (15-30 watts). Its tube has an outer diameter of 1.8 mm. This aspirator is designed to fragment and aspirate the cattle-liver. On observing the adjacent neural and vascular structures with the neuroendoscope, the massive hematoma within the ventricles is removed with the use of this aspirator. Subtotal removal (> 90% of hematoma volume) was achieved in all patients. All patients tolerated the procedure well. However, postoperative re-rupture occurred in two patients prior to aneurysm clipping following an immediate interval. Three patients with hypertension, two patients with head trauma, and one patient after aneurysm clipping were discharged home within one month after treatment. Preliminary experience with this aspirator has demonstrated its feasibility and safety. Clinical application of this technique is expected in other fields of neurosurgery.

Adult↗
PubMed1999

Role of preoperative midsagittal magnetic resonance imaging in endoscopic third ventriculostomy.

We measured the distance between the infundibular recess and the tip of the basilar artery (BA) on midsagittal magnetic resonance (MR) images in 217 subjects (mean age, 54.7 years) without intracranial disorders and 8 patients with hydrocephalus treated neuroendoscopically. The mean distance measured in the 217 subjects without intracranial disorders was 10.5 +/- 2.3 mm. There were no significant differences in this distance among age groups. In 28 of these 217 subjects (12.9%), the tip of the BA had shifted anterior to the mamillary bodies on MR images. Twenty-six of these 28 subjects (93%) were 60 years of age or older. The mean distance between the infundibular recess and the tip of the BA was 12 +/- 3.7 mm in 8 patients with hydrocephalus. There was no significant difference between the subjects without intracranial disorders and the patients with hydrocephalus in this distance. In an elderly patient with aqueductal stenosis for whom the distance between the infundibular recess and the tip of the BA was 6 mm, the tip of the BA had shifted anterior to the mamillary bodies and indented the floor of the third ventricle on preoperative midsagittal MR images, and perforation of the floor of the third ventricle therefore had to be carefully performed in order to avoid injury of the BA. Preoperative midsagittal MR images can clearly reveal neurovascular structures beneath the floor of the third ventricle and increase the safety of endoscopic third ventriculostomy.

Adolescent↗
PubMed1999

Virtual neuroendoscopy, a comparative magnetic resonance and anatomical study.

We evaluated the usefulness and reliability of intraventricular virtual neuroendoscopy based on a comparative anatomical study. Virtual intraventricular endoscopic images were calculated from 3D magnetic resonance images in five anatomic specimens. Contiguous 1.2 mm slices of the specimen heads were acquired at a 1.5 T MR scanner using a 3D-gradient echo sequence. The images were then transferred to an independent 3D-workstation (Sun Spark 20). After scanning the specimen heads, real endoscopy within the cerebral ventricles of these brains was performed with a standard rod lens system. Comparison between real and virtual endoscopic views of the intraventricular topography was based on the same anatomical reference and landmarks. Acquisition of MR data and virtual image post-processing have been possible in all specimens. The virtual endoscopic images of the ventricles were comparable to the intraventricular views obtained by a standard rod lens system. Virtual intraventricular neuroendoscopy can be employed for planning and simulating neuroendoscopic procedures. It enables the neurosurgeon to simulate the endoscopic procedure within the cerebral ventricles on the basis of the patient's individual anatomy prior to surgery.

Cerebral Ventricles↗
PubMed1997

An economic argument in favour of endoscopic third ventriculostomy as a treatment for obstructive hydrocephalus.

This project was undertaken to examine the health resource implications of performing endoscopic third ventriculostomy as an alternative to CSF shunting in appropriate patients. We carried out a retrospective study of case records and X-rays of patients shunted de novo at the INS, Glasgow for the two year period 1990-1991. We identified all those patients who would have been suitable for endoscopic third ventriculostomy and examined the shunt complications and extra days in hospital required by these patients. A total of 150 new shunts was inserted during the two year period. Of these, 23 patients (15%)were judged suitable for endoscopic third ventriculostomy as an alternative to CSF shunting. Eight out of 23 patients required a total of 29 repeat operations and an extra 230 days in hospital due to shunt complications. Assuming an 80% success (shunt free) rate for endoscopic third ventriculostomy, we calculate that 9 operations and 74 bed days per year could be saved by using this technique. We conclude that in units undertaking a large number of CSF shunt insertions, investment in neuroendoscopic equipment, training, and expertise has the potential to release significant resources for other uses.

Adolescent↗
PubMed1997

Endoscopic treatment of brain abscess in children.

Three children with intracerebral abscesses were treated endoscopically. Two of the treated abscesses were located in the left temporal lobe and one in the right parietal lobe. The presenting symptoms included headaches, seizures, hemiparesis and signs of infection. Burr hole craniotomy, insertion of a peelaway sheath, obtaining of a specimen, introduction of endoscope, and complete irrigation under view was performed. After this a draining catheter was positioned in the abscess. All three abscesses grew multiple organisms. The patients received longstanding intravenous treatment with antibiotics. The follow-up period in this group ranges between 5 and 32 months. The initial neurological deficits were relieved in all three patients. The follow-up MRI studies revealed minor residual changes without evidence of significant sequelae. Neuroendoscopic treatment of brain abscesses has additional advantages compared to stereotactic aspiration or more complete drainage and lavage.

Brain Abscess↗
PubMed1995

The radiographic restoration of the ventricular system after third ventriculostomy.

Ten adult patients were treated by third ventriculostomy for idiopathic aqueductal stenosis. Idiopathic aqueductal stenosis was diagnosed according to MR imaging; aqueductal stenosis secondary to tumor, hemorrhage, and/or infection was excluded. Following a third ventriculostomy under a flexible neuroendoscope, all patients were reviewed at 1, 3, 6, 12, and 24 months, and MR images with ventricular measurements were repeated for evaluation of the radiographic restoration of the ventricular system. The ventricular structures arranged in order of restoration were the size of the III ventricle, the upward deviation of the brain stem, and the size of the lateral ventricle in response to third ventriculostomy. The restoration of the whole ventricle steadied within two years. Our results contribute new information regarding restoration of the ventricular system under aqueductal stenosis and produce evidence that third ventriculostomy is a reasonable treatment based upon the patient's physiological condition.

Adult↗
PubMed1998

Third ventriculostomy, phase-contrast cine MRI and endoscopic techniques.

Endoscopic third ventriculostomy has become an increasingly popular procedure. This is mainly due to the improvement of the endoscopes. The progress in imaging techniques and Phase-Contrast Cine MRI in particular offers a reliable method of pre-and post-operative assessment of the patients. Two endoscopes, NeuroPEN and Channel Neuroendoscope (Medtronic PS Medical, CA, USA) have been evaluated in our center for third ventriculostomy. These instruments are light, have a good maneuverability and are disposable. The illumination and the quality of the image are excellent. We have performed Phase-Contrast Cine MRI pre-operatively and post-operatively for our patients. It offers a good assessment of the patency of the ventriculostomy and the fluid dynamics of the CSF pathways. Endoscopic third ventriculostomy is the technique of choice for the treatment of obstructive hydrocephalus. This is mainly due to two points: The progress in the endoscopic instrumentation (namely the reduction in size of endoscopes and introduction of disposable models), and the establishment of Phase-Contrast Cine MRI as the gold standard method for the pre- and post-operative evaluation of the CSF dynamics. However, to date, no technique can show the patency of the subarachnoid space, which is the most important predictive factor of surgical outcome.

Endoscopy↗
PubMed1995

Laser-assisted flexible endoscopic fenestration of giant cyst of the septum pellucidum.

The use of the flexible neuroendoscope and laser fenestration in the surgical management of a symptomatic cyst of cavum septum pellucidum is reported. Successful communication was established between the cyst cavity and the lateral ventricles using this technique. Satisfactory clinical and radiological improvement as seen on MRI confirmed the operative success.

Brain Diseases↗
PubMed2003

Risk factors for pediatric ventriculoperitoneal shunt infection and predictors of infectious pathogens.

Identification of risk factors for shunt infection and predictors of infectious pathogens may improve current methods to prevent and treat shunt infections. We reviewed data on 820 consecutive ventriculoperitoneal (VP) shunt placement procedures in 442 pediatric patients at our institution during 1992-1998. Ninety-two shunts (11%) developed infection a median of 19 days (interquartile range, 11-35 days) after insertion. Premature birth (relative risk [RR], 4.81; 95% confidence interval [CI], 2.19-10.87), previous shunt infection (RR, 3.83; 95% CI, 2.40-6.13), and intraoperative use of the neuroendoscope (RR, 1.58; 95% CI, 1.01-2.50) were independent risk factors for shunt infection. The bacterial organisms early after shunt surgery (<14 days) were the same as those late after shunt surgery (>14 days). As determined by an analysis of the 92 infected shunts, hospital stay of >3 days at the time of shunt insertion (odds ratio [OR], 5.27; 95% CI, 1.15-25.3) and prior Staphylococcus aureus shunt infection (OR, 5.91; 95% CI, 1.35-25.9) independently increased the odds that S. aureus was the causal pathogen.

Adolescent↗