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PubMed2000

The fate of the cerebrospinal fluid after neuroendoscopic third ventriculostomy.

This paper describes the case of a 9-year-old girl with a posterior thalamic/pineal region lesion and secondary obstructive hydrocephalus. The hydrocephalus was treated by neuroendoscopic third ventriculostomy (NTV), and she underwent simultaneous transendoscopic biopsy. The tumour biopsy was haemorrhagic, but the bleeding settled with constant irrigation. The patient remained neurologically unchanged, but subsequent imaging revealed an asymptomatic thoracolumbar spinal subdural haematoma thought to be due to blood flowing out through the NTV into the subdural space. This demonstrates the subdural location of the cerebrospinal fluid after NTV.

Biopsy↗
PubMed2003

Intraoperative direct neuroendoscopic observation of the aqueduct in Dandy-Walker malformation.

A 3-month-old female infant with Dandy-Walker malformation manifesting as hydrocephalus was treated successfully by only ventriculoperitoneal shunting. A flexible neuroendoscope was used intraoperatively to confirm the patency of the aqueduct, i.e. communication of the ventricular system and the cyst in the posterior fossa. Direct confirmation of the patency of the aqueduct and cyst communication is valuable to select the shunt procedure in the treatment of Dandy-Walker malformation.

Cerebral Aqueduct↗
PubMed2001

Neuroendoscopic third ventriculostomy for hydrocephalus in adults: report of a single unit's experience with 63 cases.

BACKGROUND: Neuroendoscopic third ventriculostomy (NTV) is becoming a first line treatment for hydrocephalus in this center. Its use in a consecutive series of adults is reported. METHOD: Initially a retrospective data collection after 7 months becoming prospective studying all patients who underwent NTV in this center. The adults (17 years or older) have been studied. RESULTS: Sixty-three patients met the criteria for inclusion: 38 male, 25 female. Mean age at first NTV 37.5 years. There was an 80% success rate (i.e., no further therapy for the hydrocephalus required). Follow-up was for a mean of 3.1 years. The largest subgroup were patients with third ventricular tumours (35%), of whom 86% were successfully treated. Mean time to failure for the whole series was 8.5 months (range immediate--30 months). Complications occurred in 17.5%; those deemed serious in 11%. There were three deaths (4.7%) within 30 days of the procedure. There were six other deaths during follow-up, five because of tumour progression and one because of pneumonia. CONCLUSIONS: This procedure lends itself to the treatment of hydrocephalus in adults and appears to be more successful than in young children. It is efficacious in both previously shunted and non shunted patients. It is now the first-line treatment for noncommunicating hydrocephalus in this center and also for patients with shunt failure who are anatomically suitable, having cerebrospinal fluid spaces large enough to admit the endoscope. The complication and mortality rates compare favorably with those for shunts.

Adolescent↗
PubMed2004

Loculated ventricles and isolated compartments in hydrocephalus: their pathophysiology and the efficacy of neuroendoscopic surgery.

The neuroendoscopic procedures applied inpatients with isolated compartments, including IUH, LV, IFV, IRF, and multiloculated ventricles were foramen of Monro reconstruction, septostomy, septal wall removal, cyst wall fenestration, fourth ventriculostomy, and endoscopic shunt placement. It was found that the operative goal, creating a state of arrested hydrocephalus, could be achieved by communicating the trapped space to the rest of the ventricular system, opening the ventricular isolation. The associated hydrocephalus could not always be managed endoscopically, however, and shunting of the ventricular system was frequently required, especially in infants. This may be because of the immaturity of the subarachnoid CSF dynamics in infants. What does seem to be logical is to continue to consider managing these conditions with the assistance of the endoscope.

Cerebral Ventricles↗
PubMed2001

Angled rigid neuroendoscope for continuous intraoperative visual monitoring: technical note.

We developed and tested a new, angled rigid endoscope as a tool for performing continuous visual monitoring during microsurgery. The shaft of the scope is angled 110 degrees at its midportion using a prism. We used the scope continuously in 30 cases including 15 pituitary tumours, 7 brain tumours, 7 cerebral aneurysms, and one hemifacial spasm. For pituitary tumours the tip of the scope was positioned in the sphenoid sinus or in the cavity formed by tumour removal; for cerebral aneurysms it was placed behind the parent artery or the aneurysmal neck. Image quality was acceptable for intraoperative monitoring. In no case did the neuroendoscope have a deleterious impact on th e proper function of the microscope or surgical instruments. This angled rigid scope was more effective for intraoperative monitoring than conventional straight scopes.

Endoscopes↗
PubMed2000

Neuroendoscopic biopsy of tectal glioma: a case report.

OBJECTIVE AND IMPORTANCE: A type of intrinsic dorsal midbrain glioma known as benign tectal glioma can cause obstructive hydrocephalus. Because of its slow progress and relatively good prognosis, initial treatment should be cerebrospinal fluid diversion and biopsy. CLINICAL PRESENTATION: We report a 24-year-old man with obstructive hydrocephalus from a tectal glioma, who was admitted to the hospital for malfunction of a shunt placed 16 years previously. INTERVENTION: Magnetic resonance imaging demonstrated enlargement of the dorsal midbrain associated with increased signal intensity on T2-weighted images and fluid attenuation inversion recovery (FLAIR) images. No enhancement occurred with contrast administration. We performed a neuroendoscopic third ventriculostomy and biopsy of the tumor. Histologic examination of the specimen obtained disclosed a low-grade astrocytoma. No postoperative neurologic complications occurred. CONCLUSION: FLAIR images were superior to T2-weighted images in demonstrating abnormal intensity in the dorsal midbrain. Neuroendoscopy confirmed a yellowish tumor inferior to the posterior commissure occluding the entrance of the aqueduct, an observation useful in planning biopsy of the lesion. As the tumor apparently had existed for a number of years, the case supports the notion that the prognosis associated with these tumors is good.

Adult↗
PubMed2001

Neuroendoscopic treatment of cystic craniopharyngioma in the third ventricle.

The third ventricle is a relatively uncommon location for craniopharyngiomas. Generally, craniotomy has been considered the procedure of choice in such cases. We describe a girl in whom a cystic third ventricular craniopharyngioma was successfully treated by evacuation of the cyst contents via a flexible neuroendoscope and precise placement of an Ommaya reservoir catheter within the tumor.

Child, Preschool↗
PubMed2002

Treatment of Chiari malformation, syringomyelia and hydrocephalus by neuroendoscopic third ventriculostomy.

This short paper illustrates a case with cervical myelomeningocoele, a Chiari malformation (CM), hydrocephalus (HC) and cervical syringomyelia treated by neuroendoscopic third ventriculostomy (NTV) with resolution of both the hydrocephalus and the syrinx. Two similar cases are discussed. The technique is advocated for the treatment of such complex dysraphic conditions.

Arnold-Chiari Malformation↗
PubMed1998

Neuroendoscopic fenestration of arachnoid cysts.

The authors report 6 patients with arachnoid cysts treated endoscopically. The series includes 6 patients with temporobasal arachnoid cysts. The age of the patients at the time of diagnosis ranged from 5 to 71 years. The patients' symptoms included headache, seizures, vomiting, nausea, dizziness, and problems with balance. The authors performed cystocisternostomies via burr holes with the aid of a universal neuroendoscopic system. In 4 cases the endoscopic fenestration was a unique treatment which enabled the avoidance of a definitive cystoperitoneal shunt. In the two cases treated subsequently, cystoperitoneal shunts were performed. The surgical endoscopic technique and the postoperative radiological findings which indirectly confirm the patency of the fenestration are discussed. The authors conclude that endoscopic fenestration of intracranial fluid cysts represents the treatment of preference. In cases where the endoscopic procedure fails a microneurosurgical procedure or cystoperitoneal shunting is recommended to avoid exposing the patient to additional risk.

Adolescent↗
PubMed2000

Microvascular Doppler ultrasound-assisted neuroendoscopic surgery.

To achieve endoscopic procedures more safely and less invasively, an operative strategy with ultrasound-assisted neuroendoscopic surgery is described. The improvement in the endoscope unit is that endoscopic viewing can be stopped on the display, anytime we choose and simultaneously visualize the ongoing view on the same display. The ultrasound unit, using a miniature Doppler probe, is to able to detect even invisible vessels in real-time, easily and non-invasively. The information from both units can be switched intraoperatively, whenever required.

Arachnoid Cysts↗
PubMed1999

Flexible neuroendoscopic treatment of suprasellar arachnoid cysts.

Endoscopic treatment of suprasellar arachnoid cysts is now the treatment of choice. By marsupializing the roof of the cyst the condition can be cured. The perceived necessity to open both the roof and the floor is called into question by this paper. Three cases of suprasellar arachnoid cyst are described all of which have had successful marsupialisation of the cysts by flexible neuroendoscopy Flexible neuroendoscopic marsupialization of the cyst by widely opening the cyst roof only is described. This is compared with the other techniques, and also the endoscopic technique involving opening both the roof and the floor of the cyst, a more difficult and potentially dangerous method. Successful treatment of this condition is achieved by marsupialization of only the roof of the cyst. This is a much safer procedure, and has resulted in a resolution of signs and symptoms in the cases described followed-up between 24 and 28 months from the procedure.

Arachnoid Cysts↗
PubMed2002

Changes in third ventricular size with neuroendoscopic third ventriculostomy: a blinded study.

The objective was to study the relation between changes in cerebral ventricular size and clinical outcome after neuroendoscopic third ventriculostomy (NTV) in both primary (no previous surgery) and secondary (previous CSF diversion for hydrocephalus) NTV. Changes in ventricular size were related to the need for further surgery for CSF diversion. A blinded retrospective study of the pre-NTV and post-NTV sizes of the ventricles in an unselected series of patients undergoing this procedure was done. A decrease in third ventricular size was seen in significantly more patients in the primary group than in the secondary group. Median change in third ventricle width for those who did not require further CSF diversion was significantly greater than those with no clinical benefit (p=0.01). Positive predictive power for successful outcome was highest for measures of the third ventricle; 73% and 68% for third ventricle width and height respectively, 88% for anterior to posterior commissure distance. In conclusion, third ventricular size reduces after NTV. The use of such a change as an arbiter of success in this procedure is questionable as clinically successful cases can have no change in ventricular size. It is considered that clinical outcome is the most important guide to success or failure as reduction in ventricular size is by no means guaranteed. Radiological outcomes alone may be misleading and reliance on them should be avoided.

Adolescent↗
PubMed2005

Neuroendoscopic aspiration of hematocephalus totalis: technical note.

OBJECTIVE AND IMPORTANCE: Massive intraventricular hemorrhage requires aggressive and rapid management to decrease intracranial hypertension. The amount of intraventricular blood is a strong prognostic predictor, and its fast removal is a priority. Neuroendoscopy may offer some advantages over more traditional surgical approaches. We describe here the technical details and clinical outcomes of the neuroendoscopic management of massive tetraventricular hemorrhage in 25 consecutive patients, highlighting the potential pitfalls and the advantages of the technique. CLINICAL PRESENTATION: Twenty-five patients, aged 7 to 80 years, presenting with massive ventricular hemorrhage were admitted between January 1996 and May 2004 to our neurosurgery unit after an emergency computed tomographic scan. Severity of ventricular hemorrhage was graded according to the Graeb scale; the mean Graeb score was 9.8 +/- 2.9. Hemorrhages were secondary to vascular malformation in 12 cases. INTERVENTION: Endoscopy was performed on the first day in 17 cases, with a delay of 1 to 5 days in the remaining 8 cases. A flexible endoscope with "free-hand" technique was always preferred. The ventricular cleaning proceeded in three phases: lateral ventricle, third ventricle, and then aqueduct and fourth ventricle. In selected patients, a catheter, both for intracranial pressure monitoring and for drainage, was positioned. The procedure was successfully completed in all cases. There was no surgery-related mortality. The mean length of intensive care unit stay after the operation was 18 +/- 12 days. Short-term mortality (1 mo) was 12%, whereas long-term (> 6 mo) mortality was 24%. Complete recovery (Glasgow Outcome Scale score, 5) was achieved in 40% of cases. A ventriculoperitoneal shunt was necessary in 12% of patients. CONCLUSION: Intraventricular hemorrhage, analogously to other ventricular diseases, can be treated successfully with flexible endoscopes. Obviously, the limitation of this study lies in its observational nature; however, the encouraging results reported here should prompt a randomized study to evaluate the effectiveness and efficiency of the endoscopic approach in comparison to the more established semiconservative management offered by external derivation with fibrinolytic agents.

Adolescent↗
PubMed2005

Current state and future development of intracranial neuroendoscopic surgery.

Since the introduction of the modern, smaller endoscopes in the 1960s, neuroendoscopy has become an expanding field of neurosurgery. Neuroendoscopy reflects the tendency of modern neurosurgery to aim towards minimalism; that is, access and visualization through the narrowest practical corridor and maximum effective action at the target point with minimal disruption of normal tissue. Transventricular neuroendoscopy allows the treatment of several pathologies inside the ventricular system, such as obstructive hydrocephalus and intra-/paraventricular tumors or cysts, often avoiding the implantation of extracranial shunts or more invasive craniotomic approaches. Endoscopic endonasal transphenoidal surgery allows the treatment of pathologies of the sellar and parasellar region, with the advantage of a wider vision of the surgical field, less traumatism of the nasal structures, greater facility in the treatment of possible recurrences and reduced complications. However, an endoscope may be used to assist microsurgery in virtually any kind of neurosurgical procedures (endoscope-assisted microsurgery), particularly in aneurysm and tumor surgery. Basic principles of optical imaging and the physics of optic fibers are discussed, focusing on the neuroendoscope. The three main chapters of neuroendoscopy (transventricular, endonasal transphenoidal and endoscope-assisted microsurgery) are reviewed, concerning operative instruments, surgical procedures, main indications and results.

Brain↗
PubMed1999

[Intracranial arachnoid cysts. Neuroendoscopic treatment].

The author reports the techniques and results of seven patients with intracranial arachnoid cysts treated surgically, all of them through neuroendoscopic approach. Two carriers of supraselar cysts had undergone several shunt surgeries, and another carrier of a temporal cyst undergone external drainage to treat an associated subdural higroma. Only in this case the endoscopic approach has not resulted in control of the symptoms of the patient. The follow up period extended from one to nine years.

Adolescent↗
PubMed1990

Development and clinical usefulness of a new neuroendoscope system for CT-guided stereotactic brain surgery.

Since computed tomography (CT)-guided stereotactic surgery is essentially blind surgery, it always involves the risk of injuring viable brain tissue and vessels, and it is difficult to obtain a sufficient amount of biopsy specimen from cystic or necrotic lesions. Moreover, the direct observation of the lesion would provide extremely valuable information. The authors have therefore developed a new subminiature rigid endoscope and an ultrasonic aspirator for use in stereotactic surgery, as well as a new micromanipulative system to attach the equipment to the stereotactic frame so that they can be accurately inserted into the optimum position from any direction. The new neuroendoscope includes a graded refractive index glass rod only 1.0 mm in diameter (Selfoc, Nippon Sheet Glass Co., Osaka), which provides a focal depth from 1 mm to infinity, as well as an extremely bright and wide visual field with an angle of 70 degrees. Furthermore, because the outer probe and endoscopic sheath share the outer rigid metal tube 4.5 mm in outer diameter, a large internal channel of 2.1 mm in diameter allows the introduction of various microinstruments such as an ultrasonic aspirator probe, laser probe, and biopsy forceps. When a miniaturized video camera is attached, the surgical procedures can be controlled using the video monitor and photographed. The new probe for the ultrasonic aspirator has been developed in various types suitable for fragmentation and aspiration of hematomas and brain tumors, so under endoscopic control even the harder coagulants and tumors can be removed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

Neuroendoscopic septostomy for isolated lateral ventricle.

The clinical features and endoscopic findings were investigated in 20 patients with isolated lateral ventricle treated by neuroendoscopic septostomy to establish cerebrospinal fluid communication and open an isolated ventricular compartment. The endoscopic procedure was incomplete because of thickened septum pellucidum and insufficient working space in two adults with postmeningitic hydrocephalus. Two children underwent second septostomy. In all other cases, results were good and there were no complications related to endoscopic procedures. Endoscopic septostomy is less invasive and has few complications. Intraoperative navigation and the biportal approach may be required in difficult cases with multiple septum formation and severe postmeningitic hydrocephalus. Adequate stomal size is required in high-risk groups including children under 2 years of age.

Aged↗
PubMed2004

Tension pneumocephalus after a neuroendoscopic procedure--case report.

A 60-year-old female presented with gait disturbance, urinary incontinence, and recent memory disturbance. Computed tomography and magnetic resonance imaging revealed a partially calcified mass lesion without enhancement in the left caudate head and mild ventriculomegaly. She underwent endoscopic tumor biopsy. The histological diagnosis was astrocytoma grade 2. After the endoscopic procedure she presented with prolonged consciousness disturbance caused by tension pneumocephalus. Tension pneumocephalus is one of the potential complications of neuroendoscopic procedures.

Astrocytoma↗