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At least 325 records · Page 18Linked to original sources
PubMed1992

[Surgical treatment of cerebral hematoma using an endoscopic method].

In the period from January 1990 to March 1991 in the Neurosurgery Department, Mining Industry Health Service Hospital in Sosnowiec 21 operations of evacuation of supratentorial intracranial haematomas were carried out by the endoscopic method using a neuroendoscope produced by K. Storz. The indication to this operation was a serious condition of the patients up to 10 points of the Glasgow scale, strictly limited extent of haematoma and ventricular system shifting over 5 mm in computed tomography. The mass of the haematoma could be evacuated in 70-90% and the patients were spared extensive craniotomy. Two patients had reoperations due to renewed haematoma formation. 48% of the patients left the hospital in good condition without neurological deficits and 42.5% had focal neurological signs.

Adult↗
PubMed2003

[A case of severe parkinsonism induced by failure of ventriculo-peritoneal shunt for aqueductal stenosis].

A 26-year-old man, who had received a ventriculo-peritoneal shunt for obstructive hydrocephalus after possible encephalitis, complained of disturbance of upward gaze and difficulty in movement seven months after the shunt implantation. One month later, neurological examination revealed upward gaze paresis and rigidity of all four limbs, but the neuroimaging studies revealed no ventricular dilatation. His symptoms deteriorated, and tremor of the extremities appeared. He was admitted to our hospital 10 months after the shunt implantation. He developed akinetic mutism soon after admission. Cerebrospinal fluid protein was elevated (62 mg/dl). At that time, the shunt reservoir was found to be insufficiently filled, and neuroimaging showed dilatation of the lateral and third ventricles with no dilatation of the fourth ventricle. A neuroendoscopic third ventriculostomy with removal of the previous shunt system gradually resolved the parkinsonism within two months, and the patient became capable of walking. The dilatation of the ventricles improved on neuroimaging. The present report suggests that shunt malfunction should be suspected when parkinsonism occurs in patients who have undergone a shunt placement, even though hydrocephalus on neuroimaging is not observed.

Adult↗
PubMedDate not supplied

[Endoscopic treatment of the spontaneous intracerebral hematomas].

BACKGROUND AND PURPOSE: Surgical evacuation of spontaneous intracerebral hematomas (ICH) performed in a traditional way usually increases primary brain tissue damage due to the hemorrhage. On the other hand, symptoms of the intracerebral pressure and secondary brain tissue destruction close to the hematoma are the basis for making a decision about surgical treatment. In order to limit surgical trauma we started research to evaluate the usefulness of endoscopic surgery in the treatment of ICH. MATERIAL AND METHODS: Twenty three cases were included in the study. Patients with consciousness disorders and/or focal neurological deficit and different systemic diseases were qualified for endoscopic evacuation. The diagnosis of hematoma was based on computed tomography (CT). ICHs were lobar and in certain cases they extended to the basal ganglia. All patients were operated on within one week from the onset of symptoms. Neuroendoscope was introduced to the hematoma cavity through the burr hole and the puncture of the cerebral surface over the hematoma. The hematoma was evacuated by fractionated rinsing. Bigger clots were fragmentized but those which were adjacent to the cavity wall were left. Postoperative assessment of the hematoma evacuation was based on CT performed immediately and in the second week after surgery. RESULTS: Total evacuation of the ICH was achieved in 6 patients, and its volume was reduced in 17 cases. Symptoms of brain edema resolved in all patients. A significant trend to reduce focal neurological deficits was observed: 16 patients improved and 3 remained unchanged. Four patients died. CONCLUSIONS: Endoscopic surgery allows a complete hematoma evacuation or reduction of its volume, reduces symptoms of brain edema and accelerates the improvement of focal neurological deficits.

Aged↗
PubMed2004

[Usefulness of the "P.N." frame in biopsies and stereotactic operations on the brain].

BACKGROUND: Stereotactic biopsy represents the gold standard for tissue diagnosis surgically inaccessible gliomas, tumors and cystic lesions. Tissue samples can be obtained by minimally invasive technique. Moreover, the combination of the neuro-endoscope with stereotactic method is possible. MATERIAL AND METHOD: 23 patients underwent 43 stereotactic biopsy procedures for diagnosis diffuse, deep-seated and eloquent site tumors at Neurosurgery Department Jagiellonian University in Krakow since February 2003. Stereotactic frame "P.N." type (TatraMed S.r.o.) was used. In one case the combined method was used for third ventriculostomy. The specimen was obtained from the target point of CT scan by the aspiration method under local anesthesia in 17 patients and under general anesthesia in 6 patients. The lesion was located in 9 cases of cerebral hemisphere and basal ganglia, in 8 cases of spreading site, in 5 cases of eloquent area and in 1 case of corpus callosum and third-ventricle. RESULTS: Material from the stereotactic biopsy has been examined neuropathologically. Astrocytoma II(o) WHO were diagnosed in 6 cases, Astrocytoma III(o) WHO in 11 cases, Astrocytoma IV(o) WHO in 3 cases, Metastatic adenocarcinoma in 1 case and in 2 cases the neoplasm was not found. The diagnosis was histologically confirmed in 91.3%. Emergency craniotomy was performed in one patient. In 3 cases the increased intracranial pressure produced by tumor cysts was reduced by the use of biopsy. CONCLUSIONS: Our data confirm that the "P.N." frame is useful in stereotactic biopsies and operations even with the use of neuroendoscope. The procedure is safe, easy to follow as a tool for patients with various tumors.

Adult↗
PubMedDate not supplied

[The use of neuroendoscopy in the treatment of intraventricular and paraventricular brain tumors].

BACKGROUND AND PURPOSE: Because of their deep location, intra- and para- ventricular brain tumors pose an important therapeutic issue. Technical difficulties during the operation often result from the alteration of anatomy produced by the tumor, which brings about the risk of injury to functionally important structures. The authors assess clinical usefulness of neuroendoscopy in the treatment of discussed tumors. MATERIAL AND METHODS: Medical records of 16 adult patients treated between 2000 and 2003 were analyzed. The diagnosis was based on CT with 3D reconstruction and MRI. In 7 cases the tumor was located in the third ventricle, in 4--in lateral ventricles, in 5--paraventricularly. Surgery was performed using a rigid neuroendoscope and/or neurofiberscope equipped with the basic set of endoscopic instruments. The efficacy of the procedure was evaluated by clinical, CT and MRI follow-up examinations. The intended and achieved aim of the operation as well as the remote outcome were analyzed. RESULTS: The planned aim of the procedure was achieved in 12 (75%) patients. In 3 cases the tumor was removed totally, in 5--tumor mass was reduced restoring the cerebro-spinal fluid passage, in 4--tumor biopsy was performed. In 4 patients different obstacles made it impossible to achieve the intended aim of the procedure. 1 patient died in the direct postoperative course. In the long-term postoperative follow-up ranging from 8 to 44 months (median: 23 months), the clinical condition improved or was stable in 10 patients, 2 patients were reoperated, 2 became dependent and 1 was lost for follow-up. CONCLUSIONS: Neuroendoscopy offers new options in the treatment of intraventricular and paraventricular brain tumors allowing for their removal, reduction, histopathological verification and restoration of the cerebrospinal fluid passage. The outcome is good with a low complication rate.

Adult↗
PubMed2005

[Syndromes of overdrainage of ventricular shunting in childhood hydrocephalus].

Overdrainage in ventricular shunting constitutes a difficult to prevent and to treat complication. The authors reviewed a retrospective series of 512 children submitted to a ventricular shunting procedure aimed at analysing factors influencing this type of complication. The causes for the hydrocephalus were congenital (n=172), post-myelomeningocele (n=123), posthemorrhagic (n=103), tumoral (n=64), postmeningitis (n=40) and posttraumatic (n=10). Eighty-eight children (17.8%) evolved with a complication related to the excessive function of the valve. The authors investigated the relationship between hydrocephalus' etiology and type of overdrainage syndromes. The most frequent complication was ventricular catheter block (n=50), followed by symptomatic slit ventricle syndrome (SVS) (n=19), subdural hematoma (n=10) and trapped fourth ventricle (n=9). There were no statistical differences regarding complications for each etiologic subset of hydrocephalus. SVS occurred in 19 children (3.71%), a low rate according to the current literature. Posthemorrhagic and postinfectious hydrocephalus grouped together showed a higher rate of SVS (p=0.005), a feature that we attributed to the cerebral destruction caused by these two conditions. Treatment of SVS was complex and required diverse procedures, applied in an escalated way, which included five decompressive craniectomies. The authors suggest avoiding, as much as possible, the use of ventricular shunts, and recommend the alternative use of new technology valves and neuroendoscopic procedures.

Cerebrospinal Fluid Shunts↗
PubMed2006

[Direct surgery for paraclinoid aneurysm arising from the anterolateral wall of the internal carotid artery].

The internal carotid aneurysm (ICA) arising from the paraclinoid region is associated with the origins of the superior hypophyseal artery and the ophthalmic artery. Recently, other aneurysms which can arise in this region without imvolvement of the arterial branches has been reported. Among those aneurysms, there are very rare type of aneurysms located on the anterolateral aspect of the internal carotid artery. In this report, we described our experience with direct surgery for five cases of the unruptuted paraclinoid aneurysm arising from the anterolateral aspect of the ICA. Firstly, the common carotid artery was exposed to carry out proximal flow control. We used the pterional approach. The anterior clinoid process was deleted after having confirmed aneurysm and the dural ring was incised. Extreme care had to be taken during this step. All patients underwent successful neck clipping. In recent two cases we employed the neuroendoscope (EndoArm) to observe the unrecognized area of surgical microscope and untrasonic bone curette (SONOPET) to perform the safe removal of the anterior clinoid process. This procedure is very useful for carrying out the neck clipping for aneurysms which are located on the anterolateral aspect of the internal carotid artery.

Adult↗
PubMedDate not supplied

[Tactics of surgical intervention in multileveled obstructive hydrocephalus in children].

Ninety-three obstruction areas were revealed in 23 operated children aged 1.5 to 16 years who had multileveled obstructive hydrocephalus. Fifty-four endoscopic manipulations were performed. These included perforation of the bottom of the third ventricle in 9 children, resection of the cystic wall in 33, that of membranous commissures in 2, and interventriculostomy in 10. Open cystectomy was made in 1 case. Compensation of hydrocephalus was achieved in 16 (64%) children; there was no need for revision of the preinserted and nonfunctioning shunt in 5 cases. Internal drainage operations were ineffective in 7 cases (remaining liquor hyporesorption in 3 cases and uncoupling of ventricles and subarachnoidal spaces in 4), in this connection, VP shunts were implanted or the preinserted ones were preserved. In 3 (13%) children, complications (moderate ventricular hemorrhages (n=2) and an exacerbation of aseptic ventriculitis (n=1)) were successfully abolished. Four children underwent resurgery due to closure of the preapplied cystic stoma. There were no fatal outcomes. Thus, neuroendoscopic interventions are the most effective treatment for multileveled obstructive hydrocephalus. Of priority is the creation of liquor outflow from a larger cavity that induces severe compression of cerebral structures or dislocation occlusion and from the ventricular system cavities located more orally. The need for implantation of intra- and extracranial drainages emerges only when occlusion cannot be endoscopically eliminated.

Adolescent↗
PubMed2006

Endoscopic treatment of midline cerebral cysts.

Axial cerebral cysts of various location and origin are relatively rare lesions. Endoscopic neurosurgery has made them amenable for safe intervention even in vital brain regions. Neuroendoscopic treatment was used by the author in 35 patients during the last 7 years without permanent morbidity or mortality. The aim of the surgery was to fenestrate the cyst or to perform cyst exstirpation to relieve the pressure effect on the surrounding functioning neural tissue and to reestablish the patency of cerebrospinal fluid pathways, as well as histological verification of the cyst origin. Contemporary imaging modalities are capable of diagnostic evaluation, but the detailed anatomical relationship to the surrounding structures can be visually analysed completely together with understanding of their functional effects only during endoscopic surgeries, supported by the results of imaging. Therefore the precision of endoscopic surgeries was substantially enhanced and during the surgery a large amount of knowledge enriching the contemporary information about the cerebrospinal fluid flow through the cerebral ventricular system and blood circulation in the deep cerebral venous system and the relationship of these veins to hydrocephalus was obtained (Tab. 1, Fig. 9, Ref. 11).

Adolescent↗
PubMed2004

[Endoscopic method in etiological diagnosis of spontaneous intracerebral hemorrhage. Case report].

The etiology of cerebral hemorrhage is not always easy to diagnose and modern neuroimaging methods may be deceptive. The authors report on a 48-year-old previously healthy male admitted to hospital with a first-time severe generalized epileptic seizure. The patient presented with aphasia, confusion, headaches, nausea, right hemianopia and early papilledema. CT revealed an intracerebral hematoma in the left occipital lobe but MRI and MRA failed to provide any further insight into the etiology of the hemorrhage. Due to persisting intracranial hypertension, the patient underwent neuroendoscopic removal of the hematoma. After blood clots were evacuated, pathologic vascularity was found. Tissue samples were collected from the walls of the hematoma cavity. Neoplastic cells adjacent to the blood vessels were identified in one of the samples. The patient was reoperated and a glioma-like tumor was removed. The diagnosis of cerebral intratumoral hemorrhage is difficult especially when there are no previous clinical signs of a tumor. Neuroendoscopy may speed up the diagnostic process which usually extends past resorption of the haematoma and the technique may be an alternative to stereotactic surgery.

Brain Neoplasms↗
PubMed1993

Ventriculostomy for treatment of hydrocephalus.

Ventriculostomy for hydrocephalus can either obviate completely or reduce considerably the complications of cerebrospinal fluid (CSF) shunts. Renewed interest in this procedure has followed the development of flexible and steerable neuroendoscopes, high-quality video cameras, endoscopic surgical instruments, including lasers, and methods of providing computer-guided stereotactic assistance. Ventriculostomy is the preferred treatment for patients with congenital aqueduct stenosis that requires CSF diversion. It is less successful in patients with acquired aqueduct stenosis but is still a treatment option. Interventriculostomy for treatment of intracranial cysts or loculated regions of the ventricles also can obviate or reduce the need for CSF shunts.

Humans↗
PubMed1993

Endoscopy of the internal auditory canal during hearing conservation acoustic tumor surgery.

Hearing conservation acoustic neuroma surgery is technically demanding. This is attributable primarily to the formidable anatomic obstacles. The axis of the internal auditory canal (IAC) is oriented at an obtuse angle relative to the posterior petrous ridge. In addition, the labyrinth blocks the view of the lateral 2 to 3 mm of the IAC. These two factors prohibit an unobstructed view of the fundus of the IAC with a standard operating binocular microscope. However, angled rigid endoscopes (30 and 70 degrees) offer excellent views of the lateral portion of IAC. The facial nerve, cochleovestibular nerve, transverse crest, and vertical crest (Bill's bar) can be seen endoscopically. Neuroendoscopic examination is helpful to ensure complete tumor removal in the lateral IAC during acoustic tumor surgery. It is also helpful in visually verifying the continuity of the facial and cochlear nerves at the end of the operation.

Adult↗
PubMed1997

[Treatment of hydrocephalus without shunt placement: third ventriculostomy].

Hydrocephalus is usually treated by placing an extracranial CSF shunt. Endoscopic third ventriculostomy, however, has been revived recently as a less invasive method for treatment. We intended to avoid shunting or to eliminate the previously placed shunt with this procedure. The authors review their experiences on third ventriculostomy employing a flexible neuroendoscope under video monitoring in 14 cases of pediatric hydrocephalus. The result was that we succeeded in 11 cases (79%) by third ventriculostomy alone; we avoided shunting in 8 cases and eliminated a previously placed shunt in 3 cases. Clinical summary is shown on Table 1, and illustrative cases are presented with the figures and legend. The patients' group consisted of 8 males and 6 females. Their age ranged from 1 month to 17 years (average age, 6 yr) old. Background diseases of hydrocephalus were brain tumor in 6 cases, Chiari type I malformation in 3, intraventricular hemorrhage in 3, neonatal meningitis in 1 and arachnoid cyst in 1 case. In the remaining 3 cases, however, we failed to avoid the necessity of placing shunt because of indirect reasons (recurrence of tumor, infection after another operation, subdural fluid collection). There was no major complication in relation to third ventriculostomy, except for a moderate elevation of temperature of several days' duration following the procedure. Indication and outcome of this operation is also discussed. Endoscopic third ventriculostomy is an efficacious procedure for the treatment of hydrocephalus in selected patients.

Adolescent↗
PubMed1997

[Neuroendoscopy: diagnosis and therapeutic uses].

Minimally invasive neurosurgical techniques permit improved ways of approaching problems which could previously only be solved by open surgery or microsurgery. In this field, neuroendoscopy offers a very efficient, clear means of diagnosis and a less aggressive form of treatment of lesions on the central nervous system. Particularly in paediatric neurosurgery, procedures such as implanting valves for ventriculo-peritonial derivations (DVP) may be carried out knowing the exacts anatomical site of the catheter tip, or allowing catheters adherent to structures such as the choroid to be removed. Ventriculoscopy permits review and biopsy of intraventricular and paraventricular structures. Myeloscopy allows intramedullary and paramedullary visualization together with the possibility of syringoscopy. The new option presented by neuroendoscopy, as a help in microneurosurgery, when studying structures which are not visible using a microscope, is particularly useful in vascular surgery and in surgery of the base of the skull. It also permits rapid, efficient drainage of subdural and intraventricular haematomas. This technique has become a useful tool in neurosurgical departments for solving problems and as a support for the classical techniques. Equally it requires practice and the study of neuroendoscopic anatomy.

Brain↗
PubMed1998

Neonatal applications of neuroendoscopy.

Neuroendoscopy is a minimally invasive technique that has revolutionized the management of multiple intracranial conditions. Neuroendoscopic techniques can be safely applied to the newborn in selected circumstances, but the indications, surgical technique, and the potential pitfalls and complications must be completely understood to ensure a successful outcome in these fragile patients.

Endoscopy↗
PubMed1998

[Treatment and diagnosis of middle fossa arachnoid cyst: ventriculofiberscopy and cine-MRI].

The treatment of intracranial arachnoid cysts in controversial regarding its surgical indication and operative procedures. Conventional surgical approaches such as fenestration, membranectomy, and shunting operation are invasive. Also CT cisternography and/or RI cisternography are invasive, when it has been performed to evaluate the possible CSF communications between the arachnoid cyst and subarachnoid space. Between July 1994 and February 1997, 10 patients with intracranial middle fossa arachnoid cysts were treated with a newly developed ventriculofiberscope which is characterized by splendid mechanical flexibility and high resolution. The cine-MRI, which is a non-invasive diagnostic tool, is used to evaluate the CSF circulation around the cyst fenestration. The patients' ages ranged from 4 months to 10 years, with a mean of 4.46 years. The cyst locations were left middle fossa (9), and right (1). Eight patients presented with macrocrania, 4 with developmental delay, three with seizure, two with headache, and one with subdural hematoma. The patients were preoperatively evaluated by means of MRI and cine-MR images. In all patients ventriculofiberscopic procedures including cyst fenestration, membranous dissection, cyst puncture and shrivelling were successfully performed. Postoperative MR and cine-MR studies have shown reduction of the cyst size and appropriate CSF circulation. Neuroendoscopic procedures seem to be the choice for children with arachnoid cysts and the ventriculofiberscope proved to be very useful not only for cyst fenestration but also for cyst dissection. In addition, the non-invasive cine-MR studies are useful for long follow-up at OPD.

Arachnoid Cysts↗
PubMed1998

[75 years after Dandy, Fay and Mixter--looking back on the history of neuroendoscopy].

The first neuroendoscopic operation was done in the year 1910 by the urologically practicing doctor Victor Darwin Lespinasse (1878-1946). Lespinasse never published this procedure. He only reported the case in front of a local surgical society. Several years later (1922/23) the first endoscopic operations in the brain were published by three neurological surgeons within one year (Dandy, Fay and Mixter). This 75 year anniversary is the background for the following historical overview.

Endoscopes↗
PubMedDate not supplied

[Endoscopic brain surgery of intracranial cysts: report of 2 cases].

Two cases are presented of intracranial cystic lesions, which were treated by the neuroendoscopic method. In the two cases the patients' radiological and clinical conditions improved. Neuroendoscopy is a very effective and safe method to treat intracranial cystic lesions.

Adult↗