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At least 307 records · Page 17Linked to original sources
PubMed2004

Calcification on the ventricle wall associated with a shunt tube--case report.

A 53-year-old man with renal failure presented with symptoms of shunt malfunction 11 years after placement of a ventriculoperitoneal shunt. Computed tomography showed high-density lesions on the lateral ventricle wall around the shunt tube. The shunt tube was replaced under monitoring with a neuroendoscope. The resected specimen from the ventricle wall lesion showed calcification and fibrosis. Disturbed calcium and phosphate metabolisms associated with renal failure may have been involved in this abnormal calcification on the ventricle wall.

Brain Diseases↗
PubMed1998

Endoscopic anatomy of the cerebellopontine angle: a study in cadaver brains.

The increasing trend toward performing minimally invasive neurosurgery may benefit from recent progress in using neuroendoscopic techniques to reduce trauma in patients who have undergone operations. Arterial and venous vessels, especially loops, may compress the central segment and cause hyperactive dysfunction of the nerves. Relationships of the anterior inferior cerebellar artery to the facial and vestibulocochlear nerves and the anterior inferior, and superior cerebellar arteries to the trigeminal nerve were studied. The authors report findings from an endoscopic study performed in cadaver heads via the retrosigmoid and retrolabyrinthine approaches. Arteries and veins were colored by injection of red and blue silicon rubber. The cerebellopontine angle (CPA) was examined using 2.7-mm and 4-mm-diameter rigid endoscopes at viewing angles of 0s degrees , 30s degrees , and 70s degrees . Well-known structures could be identified endoscopically without prior dissection, and the entire CPA could be explored. However, with a retrosigmoid or a retrolabyrinthine approach, the cerebellum had to be retracted to some extent to view the CPA. Moreover, wide dural exposure was required to maneuver the endoscope freely in the CPA. Use of the rigid fiberoptic endoscope is not yet superior to standard surgical techniques for approaching and exploring the CPA.

Journal Article↗
PubMed2005

Image-guided endoscopy: description of technique and potential applications.

OBJECT: Neuroendoscopic approaches to lesions of the central nervous system and spine are limited by the loss of stereoscopic vision and high-fidelity image quality inherent in the operating microscope. Image-guided endoscopy (IGE) and image-guided surgery (IGS) have the potential to overcome these limitations. The goal of this study was to evaluate IGE for its potential applications in neurosurgery. METHODS: To determine the feasibility of IGE, a rigid endoscope was tracked using an IGS system that provided navigational data for the endoscope tip and trajectory as well as a computer-generated, three-dimensional, virtual representation of the image provided by the endoscope. The IGE procedure was successfully completed in 14 patients (nine with pituitary adenomas, one with a temporal cavernous malformation, and four with unruptured aneurysms). No complications could be attributed to the procedure. Compared with direct microscopy performed using anatomical landmarks, registration of the endoscope, and virtual image were highly accurate. CONCLUSIONS: This procedure offers many potential advantages for central nervous system and spinal endoscopy. Advances in IGE may enable its application to regions outside the central nervous system as well.

Bone Diseases↗
PubMed2005

Neuroendoscopy: past, present, and future.

Neuroendoscopy began with a desire to visualize the ventricles and deeper structures of the brain. Unfortunately, the technology available to early neuroendoscopists was not sufficient in most cases for these purposes. The unique perspective that neuroendoscopy offered was not fully realized until key technological advances made reliable and accurate visualization of the brain and ventricles possible. After this technology was incorporated into the device, neuroendoscopic procedures were rediscovered by neurosurgeons. Endoscopic third ventriculostomy and other related procedures are now commonly used to treat a wide array of neurosurgically managed conditions. A seemingly limitless number of neurosurgical applications await the endoscope. In the future, endoscopy is expected to become routine in modern neurosurgical practice and training.

Brain Diseases↗
PubMed2006

Cavernoma of the foramen of Monro. Case report and review of the literature.

The authors report on a patient who presented with an intraventricular mass located at the level of the foramen of Monro. The clinical presentation and neuroimaging appearance of the mass led to an initial diagnosis of colloid cyst. A neuroendoscopic approach offered a direct view of the ventricular lesion, which was found to be a cavernous angioma partially occluding the foramen of Monro. The lesion was then removed using microsurgery. In this report the authors highlight possible pitfalls in the diagnosis of some lesions of the third ventricle, and the possible advantages of using a combined endoscopic and microsurgical technique when approaching such lesions.

Adult↗
PubMed1998

Laser-assisted neuroendoscopy using a neodymium-yttrium aluminum garnet or diode contact laser with pretreated fiber tips.

OBJECT: Although lasers have proved to be valuable in neuroendoscopy, surgeons are still not comfortable using high-energy laser endoscopic probes in proximity to vital structures such as the basilar artery in third ventriculostomy. The authors have developed a special laser catheter for use in neuroendoscopy; the object of this paper is to present their experimental and clinical experiences using the catheter. METHODS: This laser catheter is fitted with an atraumatic ball-shaped fiber tip that is pretreated with a layer of carbon particles. These carbon particles absorb approximately 90% of the energy emitted, which is very effectively converted into heat. As the heat is generated in this very thin layer of carbon coating, the temperature at the surface of the ball-shaped tip reaches ablative temperatures instantly at powers of only a few watts per second, which has enabled the authors to limit drastically the amount of laser light used and the length of exposure needed, thereby increasing safety even around critical structures. CONCLUSIONS: The authors present experimental data and their clinical experience using these pretreated fiber tips with a neodymium-yttrium aluminum garnet contact laser or a diode contact laser in 49 patients (22 males and 27 females) and a variety of procedures: third ventriculocistemostomy (33 patients), cyst fenestration (nine patients), colloid cyst resection (six patients), and fenestration of the septum pellucidum (one patient). There was no instance of mortality or increased morbidity. To date, the procedure success rate is 100% and the overall outcome success rate is 86%. The authors conclude that pretreated atraumatic ball-shaped fiber tips now make laser application safe and effective in a variety of neuroendoscopic procedures. Because of their low power range (only several watts), compact diode lasers will be the energy source of first choice.

Adolescent↗
PubMed1999

Application of a rigid endoscope to the microsurgical management of 54 cerebral aneurysms: results in 48 patients.

OBJECT: To enhance visual confirmation of regional anatomy, endoscopy was introduced during microsurgery for cerebral aneurysms. The risks and benefits are analyzed in the present study. METHODS: The endoscopic technique was used during microsurgery for 54 aneurysms in 48 patients. Forty-three aneurysms were located in the anterior circulation and 11 were in the posterior circulation. Thirty-eight aneurysms (70.4%) had not ruptured. All ruptured aneurysms in the present series produced Hunt and Hess Grade I or II subarachnoid hemorrhage. After initial exposure achieved with the aid of a microscope, the rigid endoscope was introduced to confirm the regional anatomy, including the aneurysm neck and adjacent structures. The necks of 43 aneurysms were clipped using microscopic control or simultaneous microscopic/endoscopic control. After clipping, the positions of the clip and nearby structures were inspected using the endoscope. Use of the neuroendoscope provided useful information that further clarified the regional anatomy in 44 cases (81.5%) either before or after neck clipping. In nine cases (16.7%), these details were available only with the use of the endoscope. In five cases (9.3%), the surgeons reapplied the clip on the basis of endoscopic information obtained after the initial clipping. There were two cases in which surgical complications were possibly related to the endoscopic procedures (one patient with asymptomatic cerebral contusion and another with transient oculomotor palsy). CONCLUSIONS: It is the authors' impression that the use of the endoscope in the microsurgical management of cerebral aneurysms enhanced the safety and reliability of the surgery. However, there is a prerequisite for the surgeon to be familiar with this instrumentation and fully prepared for the risks and inconveniences of endoscopic procedures.

Adult↗
PubMed2000

Benign aqueductal cyst causing bilateral internuclear ophthalmoplegia after external ventricular drainage. Case report.

The introduction of magnetic resonance (MR) imaging to the field of neuroimaging has allowed detection of various lesions that cause aqueductal stenosis. The authors report the case of a 3-year-old boy in whom a benign ventricular cyst developed in the aqueduct. The patient became drowsy after having complained of headache and vomiting; MR imaging revealed mild triventricular dilation and a normal-sized fourth ventricle. Repeated MR imaging performed 1 week later revealed an aqueductal cyst that had markedly enlarged during the intervening period. An external ventricular drainage system was installed, but recovery of consciousness in the child was unsatisfactory and a new bilateral internuclear ophthalmoplegia developed. Fenestration of the cyst wall and placement of a ventriculocisternostomy in the third ventricle were performed simultaneously by using a flexible neuroendoscope. By 2 weeks postsurgery, the patient's neurological symptoms had completely resolved. This case illustrates that simple rerouting of ventricular cerebrospinal fluid (CSF) can aggravate the symptoms of this rare lesion by causing severe compression of periaqueductal structures by a cyst that maintains a high intracystic pressure. Endoscopic surgery was an excellent choice of treatment to achieve both cyst fenestration and normalization of intracranial CSF pressure by creating a ventriculocisternostomy.

Cerebral Aqueduct↗
PubMed2000

Pathophysiology of long-standing overt ventriculomegaly in adults.

OBJECT: Long-standing overt ventriculomegaly in adults (LOVA) is a unique form of hydrocephalus that develops during childhood and manifests symptoms during adulthood. The aim of the present study was to analyze the specific pathophysiological characteristics of LOVA. METHODS: The specific diagnostic criteria for LOVA include severe ventriculomegaly in adults that is associated with macrocephalus measuring more than two standard deviations in head circumference and/or neuroradiological evidence of a significantly expanded or destroyed sella turcica. Twenty patients who fulfilled these criteria, 14 males and six females, were retrospectively studied. These patients' ages at diagnosis ranged from 15 to 61 years (mean 39.4 years). All had symptoms and/or signs indicating that hydrocephalus first occurred at birth or during infancy in the absence of any known underlying disease. The authors performed a pathophysiological study that included specific variations of magnetic resonance (MR) imaging, such as fluid-attenuated inversion recovery and cardiac-gated cine-mode imaging; intracranial pressure (ICP) monitoring; three-dimensional computerized tomography (CT) scanning; and other techniques. Hydrocephalus was caused by aqueductal stenosis in all patients. Severe ventriculomegaly involving the lateral and third ventricles was associated with a marked expansion or destruction of the sella turcica in 17 cases. Cardiac-gated cine-MR imaging did not reveal any significant movements of cerebrospinal fluid in the aqueduct. Three-dimensional CT ventriculography confirmed that the expanded third ventricle protruded into the sella and, sometimes, extended a diverticulum. Fourteen patients revealed symptoms and signs that indicated increased ICP with prominent pressure waves. Dementia or mental retardation was seen in 11 patients, gait disturbance in 12, and urinary incontinence in eight; all three of these symptoms were observed in seven patients. Thirteen patients experienced visual disturbance. Nine patients underwent ventriculoperitoneal shunt implantation as the initial treatment, leading to postoperative subdural hematoma in all seven cases in which a differential pressure valve was used. Nine patients, three of whom were initially treated by shunt placement, underwent a neuroendoscopic procedure, mainly for third ventriculostomy. Postoperatively, ICP returned to normal, and marked to-and-fro pulsatile movements at the site of ventriculostomy were recognized on cine-MR imaging in patients treated endoscopically. However, the ventriculomegaly was little improved. Consequently, all patients eventually demonstrated improvement in response to either a shunt equipped with a pressure-programmable valve or an endoscopic procedure; however, depression appeared in six patients, who required psychiatric consultation or medication. CONCLUSIONS: Such remarkably decreased intracranial compliance but relatively high ICP dynamics are the pathophysiological characteristics of LOVA. The therapeutic regimen should be determined based on the individual's specific pathophysiological makeup.

Adolescent↗
PubMed2001

Eyebrow incision for combined orbital osteotomy and supraorbital minicraniotomy: application to aneurysms of the anterior circulation. Technical note.

A modification of the supraorbital keyhole approach, the eyebrow incision-minisupraorbital craniotomy with orbital osteotomy, is described. Unique to this approach is a one-piece supraorbital craniotomy, measuring 2.5 x 3.5 cm, that incorporates the orbital rim and roof and the frontal process of the zygomatic bone through an eyebrow incision. The orbital osteotomy facilitates view of the anterior and middle cranial fossa through the operating microscope, as well as the maneuverability of instruments through a small craniotomy. A pericranial flap is elevated with its base at the orbit and used for closure of the frontal sinus, if necessary. The approach was used successfully in elective surgery of 10 aneurysms of the anterior circulation. The mean aneurysm size was 5.9 mm, with a range of 4 to 10 mm. Advantages of this approach include minimal disruption and exposure of normal brain tissue, reduced frontal lobe retraction, and an excellent postoperative cosmetic result. The approach is performed quickly by virtue of a limited skin incision with minimal temporalis muscle dissection and a small bone flap. The neuroendoscope, although helpful at times, is not essential and no special instruments or intraoperative image guidance is required. Relative contraindications include the presence of a large frontal sinus, severe brain edema, and recent subarachnoid hemorrhage. In addition, this approach has not been used for the treatment of giant intracranial aneurysms.

Aged↗
PubMed2005

Endoscopic options in the management of isolated fourth ventricles. Case report.

Isolation of the fourth ventricle is occasionally observed after shunt treatment of the lateral ventricles for obstructive panventricular hydrocephalus. Of the various surgical options currently available, placement of shunts in the fourth ventricle has remained as the mainstay of treatment. These shunts are difficult to place, however, and have been associated with higher complication rates. With the advent of neuroendoscopic techniques, the treatment of this condition has shifted from shunt therapy to endoscopic third ventriculostomy (ETV) and aqueductal reconstruction. The authors report on four patients (age range 11-28 years old) who had undergone fourth ventricular shunt placement earlier in childhood to treat panventricular hydrocephalus and who presented with an isolated fourth ventricle (IFV) during the follow-up period. All patients underwent magnetic resonance imaging to identify the extent of the stenosed aqueduct. Symptoms improved in all and the size of the fourth ventricle decreased as well, indicating a functioning stent. The ETV failed in two patients, however, and they required placement of a ventriculoperitoneal (VP) shunt. Aqueductal stenting with an ETV or a VP shunt is a promising option in the management of IFVs.

Adult↗
PubMed2006

Endoscopic transoral surgery for craniovertebral junction anomalies. Technical note.

Craniovertebral junction (CVJ) anomalies continue to be challenging for neurosurgeons because of the complex anatomy of this region. To date, microsurgical decompression via a transoral route is the standard treatment for anteriorly located compressive lesions of the cervicomedullary junction (CMJ). The results obtained by minimizing surgical trauma are fewer complications, shorter hospital stays, and reduced overall psychological burden. Endoscopic surgery is becoming a leading modality in minimally invasive neurosurgical treatment. The authors performed surgery in 11 patients with irreducible osseous dislocations resulting from CVJ abnormality during a 2-year period. Anterior CMJ decompression was achieved in all patients by performing neuroendoscopically controlled transoral excision of bone and soft tissues. The surgical technique and results will be discussed. The use of the endoscope offers several advantages in cases requiring a transoral approach to the lower clivus and atlantoaxial region. The use of minimally invasive endoscopic techniques has the potential to reduce the need for a wider cranial base opening and to decrease postoperative complications.

Adolescent↗
PubMedDate not supplied

[Shunting operations in the hypertensive hydrocephalic syndrome in children with developmental defects of the central nervous system].

By analyzing the outcomes of surgical treatment of 105 children with hypertensive syndrome of various genesis, the authors present their data on the detection, diagnosis, and treatment of children with malformations of the central nervous system (CNS). The paper defines the present feasibilities of neurosonography, magnetic resonance imaging, neuroendoscopic verification of CNS malformations and their place in determining the policy and choice of a surgical treatment. The rationale for and the efficiency of cerebrospinal fluid corrective operations in children with these abnormalities are defined. Less good prognosis and a higher risk of surgery for hydrocephalic complications have been revealed and statistically evidenced.

Adolescent↗
PubMed1999

[A case of neurocysticercosis with multiple intraparenchymal and intraventricular cysts].

Neurocysticercosis is a rare disease, and no association with intraventricular cysts has been reported in Japan. We report a case of neurocysticercosis that presented the unique symptom of a fourth ventricular cyst. A 55-year-old man with a 7 year history of neurocysticercosis and hydrocephalus developed a positional headache and vomiting 3 months after an L-P shunt, and was admitted to our hospital. MRI showed multiple intraparenchymal cysts, ventricular enlargement and an intraventricular cyst in the fourth ventricle. The cyst and the cysticercus in the fourth ventricle were totally removed via the suboccipital approach. Histological examination showed characteristics of cysticercus. Two weeks after this surgery, V-P shunt with neuroendoscopical observation of the ventricle was performed. A small cyst was detected in the right lateral ventricle. The symptoms disappeared after surgery. Following surgery, a therapeutic course of albendazole was administered at a daily dose of 600 mg for 30 days. MRI after administration of the anticysticercal drug revealed reduction in the size of the cysts.

Cerebral Ventricles↗
PubMed1999

Unilateral hydrocephalus in paediatric patients, a trial of endoscopic fenestration.

Two uncommon cases of unilateral, asymmetrical hydrocephalus secondary to membranous occlusion of foramen of monro are described. Both the cases presented with clinical features of raised intracranial pressure and their cranial computerized scans (CT) revealed asymmetrical dilatation of lateral ventricles with displacement of septum pellucidum towards the side of smaller ventricle. Neuroendoscopic fenestration of septum pellucidum and foramen of monro was tried in both the cases, which remained successful in first, while the second case required unilateral ventriculoperitoneal shunt, due to failed endoscopic negotiation of narrowed foramen of monro and intraoperative bleeding during endoscopic intervention.

Adolescent↗
PubMedDate not supplied

[The endoscopic diagnosis and differential treatment of the complications of shunting operations in children].

The authors present their experience with endoscopic diagnosis and differential treatment of children with complications after bypass surgery. They show the present-day potentialities, spectrum of surgical interventions and role of video-assisted neuroendoscopic surgery in determining a treatment policy and choosing its method. A principle of multiportality was defined and substantiated, a diagnosis and treatment algorithm for children with this pathology was proposed by using the new minimum invasive technique video-assisted surgery.

Algorithms↗
PubMed2001

[The treatment of cerebral abscesses in children--the clinical experiences of neurosurgical clinic of PMMH in Lodz].

In our study we made attempt to assess which clinical criteria are essential for choosing optimal treatment for children suffering from cerebral abscesses. We observed the clinical results obtained at our Department from treatment of infections of the central nervous system (CNS) in children and analysed them with respect to applied therapy and clinical conditions. Between 1990 to 2000, 45 children aged 3 days to 15 years (mean 1.34 years, standard deviation 3.23 years) with infections of the CNS were treated at our Department. Within this group, 26 patients were diagnosed with cerebral abscesses, 1 with epidural empyema, 3 with subdural empyema and 15 with pyocephalus. 42 patients were operated. In 3 patients a conservative treatment was introduced at the moment when the abscesses were in the initial stage of organisation; in each case after a complete cycle of antibiotic therapy a regression of lesion was noted. The most frequently performed--in 19 patients--surgical procedure was the radical excision of the abscess by craniotomy. In 2 cases a re-operation was necessary. The highest rate of re-operations was noted in the group of children treated by external drainage; within this group of 18 patients only one 3-month-old girl did not require an additional surgical intervention. Neuroendoscopic techniques were used in 7 patients with compound hydrocephalus. Out of 45 treated children, 3 died from encephalitis, the primary reason being the infection of the ventriculo-peritoneal shunt. All children were assessed according to the Glasgow Outcome Scale and the results were significantly worse in those under 3 years in age. We suggest that in children above 3 years of age with mature abscesses of the central nervous system an operative evacuation of the abscesses by craniotomy should be performed.

Adolescent↗
PubMed2002

[Endoscopic third ventriculostomy for management of obstructive hydrocephalus secondary to supratentorial intraventricular hematoma. Case report].

We report two cases of intraventricular hematoma with obstructive hydrocephalus. We perform endoscopic treatment of the hydrocephalus: aspiration of the hematoma associated with a third ventriculostomy. Both patients respectively aged 59 and 74 years had an obstructive hydrocephalus due to intraventricular hemorrage. The patient neurological status worsen at day 6 for patient No. 1 and at day 4 for patient No. 2. Endoscopic ventriculoscopy was performed respectively at day 6 and at day 5. Operatively, immediate vision was poor but was progressively improved by repetitive irrigation with Ringer-lactate (RL). Obstruction of the right Monro foramen by clot was observed. Introduction of the neuroendoscope into the third ventricle was possible after suction of the hematoma. Perforation of the floor of the third ventricle was performed after identification of the mammillary bodies and the infundibulum. Neurological status recovered within 10 days after surgery and the patients were referred to a medical unit. The patients were independent at home. The one-year MRI follow-up study showed a functional acqueduc in case 1 and a non-functional acqueduc in case 2 indicating in this case that the ventriculocisternotomy was useful. Intraventricular hematoma is not a contraindication for endoscopic third ventriculostomy. If possible, waiting for 6 or 5 days to allow the structuring of the blood clot and using large irrigation RL may facilitate the endoscopic procedure. This indication for endoscopic third ventriculostomy constitutes an alternative to external ventricular drainage which is significatively associated with complication (infection and obstruction). We cannot affirm that the removal of the clots and ventriculocisternostomy versus temporary external drainage avoids secondary hydrocephalus.

Aged↗