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PubMed2004

Neuroendoscopic transventricular surgery for suprasellar cystic mass lesions such as cystic craniopharyngioma and Rathke cleft cyst.

Cystic mass lesions in the suprasellar cistern are often associated with neurological deficits, cognitive disorders, and endocrinological impairments. Many surgical approaches are available to treat these mass lesions, but are technically difficult and cannot remove the lesion completely without risking damage to neurological and endocrinological functions due to the proximity to the surrounding structures. Neuroendoscopic transventricular surgery was performed using a ventricular fiberscope for three patients with craniopharyngiomas and two patients with Rathke cleft cysts, with gamma knife radiosurgery for craniopharyngiomas. The endoscopic transventricular approach is safe and minimally invasive for congenital benign suprasellar cystic lesions, especially arachnoid cysts.

Aged↗

PubMed1996

Neuroendoscopic approach to arachnoid cysts.

A prospective study of seven consecutive patients with congenital arachnoid cysts treated endoscopically is reported. The ages of the patients at the time of diagnosis ranged from 6 to 47 years with three patients under 15 years. Two cysts were located in the posterior cranial fossa, four in the middle cranial fossa, and one in the suprasellar-prepontine area. The patients' symptoms included headache, seizures, vomiting, nausea, dizziness, balance problems, and precocious puberty. The authors performed cystocisternostomies and ventriculocystostomies via burr holes with the aid of a universal neuroendoscopic system. Minor bleeding was easily controlled by rinsing. In one case, the endoscopic procedure had to be abandoned because of significant bleeding, which obscured a clear operative view, and an open microsurgical cyst fenestration was performed. The follow-up review periods in this group of patients ranged from 15 to 30 months. There was no mortality or morbidity. Symptoms were relieved in five patients and improved in one. Precocious puberty in one case continued. In six cases, follow-up magnetic resonance images or computerized tomography scans revealed a decrease in the size of the cysts. Although the follow-up period is too short to make statements on long-term outcome, the authors recommend the minimally invasive endoscopic approach for treatment of arachnoid cysts as the first therapy of choice. Should the endoscopic procedure fail, established treatment options such as microsurgical fenestration or cystoperitoneal shunting can subsequently be performed without causing additional risk to the patient.

Adolescent↗

PubMed2000

Neuroendoscopic aqueductal stent placement procedure for isolated fourth ventricle after ventricular shunt placement. Case report.

Isolated fourth ventricle (IFV) is a rare complication in patients who undergo shunt placement, and it is not easily corrected by surgical procedures. The authors report a case of IFV that was successfully treated with an aqueductal stent placed under direct visualization by using a neuroendoscope. This 36-year-old suffered meningitis after partial resection of a brainstem pilocytic astrocytoma, and subsequently developed hydrocephalus for which a ventriculoperitoneal shunt was placed. Nine months later, the patient presented with progressive cerebellar ataxia, and magnetic resonance imaging revealed slitlike supratentorial ventricles and a markedly enlarged fourth ventricle, which were compatible with the diagnosis of IFV. The surgical procedure described was performed under visualization through a styletlike slim optic fiberscope inserted into a ventricular catheter. The catheter, with the endoscope inside it, was passed through the foramen of Monro and then through the aqueduct to reach the enlarged fourth ventricle, where membranous occlusion of the foramen of Magendie was clearly visualized. The tip of the catheter was placed in the fastigium of the fourth ventricle. After the procedure, the size of the fourth ventricle was reduced and the patient's symptoms improved. Thus, it is concluded that endoscopic aqueductal stent placement is a simple and safe surgical procedure for treatment of IFV.

Adult↗

PubMed2000

Virtual image navigation: a new method to control intraoperative bleeding in neuroendoscopic surgery. Technical note.

In this neuroendoscopic study the authors tested the newly developed "red-out module" of their visual navigation system that enables the neurosurgeon to achieve hemostasis if total visualization is lost due to hemorrhage ("red out") within the visual field. An optical position measurement system connected to the endoscope guarantees that digitized endoscopic images are coupled with the accurate endoscopic position. Computerized images are simultaneously stored with their respective position data, and this creates a virtual anatomical landscape. The system was tested in in vivo bleeding conditions in a rat model. Artificial endoscopic cavities were created in the inguinal, pelvic, and jugular regions in rats to imitate the conditions of the human ventricular system. Two experimental settings were tested: Technique I, in which a computer landmark has been previously determined at the point where the vessel will be lesioned; and Technique II, in which a landmark has been previously set in the surrounding area of the vessel. Immediately after hemorrhage obscures the visual field (red out), the computer automatically displays the virtual images on a separate monitor. The previously set landmarks and the graphic overlay of the coagulation fiber enable the surgeon to navigate within the operative field based on the virtual images and to perform coagulation at the site of the lesion. A total of 175 vessels were coagulated: 43 arteries and 132 veins. In using Technique I, 130 (90.9%) of 143 vessels and in using Technique II, 26 (81.2%) of 32 arteries were successfully coagulated. The authors' data revealed that virtual image guidance has the potential to be a helpful tool in neuroendoscopy.

Animals↗

PubMed2004

Neuroendoscopic findings in patients with intracranial germinomas correlating with diabetes insipidus.

OBJECT: Intracranial germinomas commonly occur in the pineal region, the floor of the third ventricle (hypothalamus), or both, and they are often associated with diabetes insipidus (DI). The authors conducted a study to correlate preoperative DI with the endoscopic and magnetic resonance (MR) imaging evidence of tumor on the third ventricle floor. METHODS: The authors reviewed hospital records, office charts, and MR imaging studies obtained in patients in whom a biopsy sampling procedure was performed with or without endoscopic third ventriculostomy (ETV) at Children's Hospital, Birmingham, Alabama between May 1998 and July 2002. Ten patients with the pathological diagnosis of pure germinoma were identified. Preoperative MR imaging findings and presenting symptoms were correlated with intraoperative neuroendoscopic findings. Seven patients presented with symptomatic hydrocephalus and underwent concomitant ETV. Six patients presented with DI and MR imaging evidence of involvement of the third ventricle floor. Two patients presented with DI and no initial MR imaging evidence of neoplastic involvement of the third ventricle floor; in both there was endoscopic evidence of neoplastic involvement of the floor of the third ventricle. In two children without DI, neither MR imaging nor endoscopic evidence of involvement of the third ventricle floor was observed. CONCLUSIONS: In the authors' experience with intracranial germinoma, endoscopic tumor biopsy sampling, and ETV provide an effective, safe, and minimally invasive means of obtaining diagnostic tissue and treating any concomitant hydrocephalus. The authors found that preoperative DI is an absolute predictor of neoplastic involvement of the hypothalamus regardless of MR imaging findings. Therefore, in the setting of DI and intracranial germinoma without neuroimaging evidence of hypothalamic involvement, germinomatous involvement of the hypothalamus should be assumed present, if not confirmed endoscopically at the time of biopsy sampling or third ventriculostomy, when devising adjuvant treatment plans for such patients.

Adolescent↗

PubMed2006

Neuroendoscopic management of interhemispheric cysts in children.

OBJECT: Interhemispheric arachnoid cysts are very rare, and they are often associated with complex brain malformations such as corpus callosum agenesis and hydrocephalus. Debate remains concerning the proper management of these lesions. Placement of shunts and microsurgical marsupialization of the cyst are the traditional options. Using endoscopic methods to create areas of communication between the cyst, the ventricular system, and/or the subarachnoid space is an attractive alternative to the use of shunts and microsurgery. METHODS: Between 2000 and 2005, seven consecutive pediatric patients with interhemispheric arachnoid cysts underwent neuroendoscopic treatment involving cystoventriculostomy in two patients, cystocisternostomy in two, and cystoventriculocisternostomy in three. There were three cases of associated hydrocephalus, six cases of corpus callosum agenesis, and one case of corpus callosum hypogenesis. The follow-up period ranged from 12 to 49 months (mean 31.6 months). Endoscopic procedures were completely successful in all but two patients. In one of the remaining two patients, a repeated endoscopic cystocisternostomy was performed with success because of closure of the previous stoma. In the other, a subcutaneous collection of cerebrospinal fluid (CSF) was managed by insertion of an lumboperitoneal shunt. A subdural collection of CSF developed in three patients; it was treated with insertion of a subduroperitoneal shunt in one patient and managed conservatively in the other two patients, resolving spontaneously without further treatment. Neurodevelopmental evaluation performed in six patients showed normal intelligence (total intelligence quotient [IQ] > 80) in three patients, mild developmental delay (total IQ 50-80) in two, and severe developmental delay (total IQ < 50) in one. CONCLUSIONS: Endoscopic treatment of interhemispheric cysts can be considered a useful alternative to traditional treatments, even if some complications are to be expected, such as subdural or subcutaneous CSF collections and CSF leaks due to thinness of cerebral mantle and to the often-associated multifactorial hydrocephalus.

Arachnoid Cysts↗

PubMed1999

[A case of enlarged infundibular dilatation diagnosed by vertebral angiograms with carotid compression and neuroendoscope].

A case of enlarged infundibular dilatation diagnosed by vertebral angiograms with carotid compression was reported. A 57-year-old woman suffered from headache. She underwent MRA which revealed left internal carotid artery aneurysm. Left common carotid angiograms suggested a left saccular internal carotid artery aneurysm (4 mm x 6 mm) without a posterior communicating artery. However, it was confirmed to be an enlarged infundibular dilatation on left vertebral angiograms with carotid compression. It was confirmed at operation microscopically and neuroendoscopically, and the dilatation was treated by coating. When carotid angiograms reveal no posterior communicating artery, it is difficult to differentiate the origin of posterior communicating artery from internal carotid artery-posterior communicating artery junction aneurysms. Vertebral angiograms with carotid compression is useful for the differentiation for the exact diagnosis.

Aneurysm↗

PubMed2000

[Neuroendoscopic removal of a colloid cyst of the third ventricle].

The removal of the benign and only slightly symptomatic but by virtue of their localization potentially fatal lesions is a challenge for the neurosurgeons. Such cases demand a therapy without any postoperative morbidity. The neuroendoscopy meets these requirements and proves to be effective in more and more fields of the art. This article reports a case when colloid cyst was resected entirely by use of a neuroendoscope, firstly in Hungary.

Adolescent↗

PubMed1999

[The development and clinical application of a multipurpose neuroendoscope].

The multipurpose rigid neuroendoscope MGE-4 has been developed with the application of the self-focussing lens technology. We have been using it to examine and treat 10 neurosurgical patients who suffered from tumours, hydrocephalus, intracerebral haematomas of head injury and hypertensive cerebral haemorrhage. The short-term effect was satisfactory and there was no operative complications. It is considered that Model MGE-4 with the accessories can be used safely for the brain functional subcortical lesion or the deep-seated cystic lesions and haematomas.

Adult↗

PubMed2003

Microanatomical and neuroendoscopic studies of the internal auditory meatus and its surrounding structures.

OBJECTIVE: To observe the morphology of the internal auditory meatus in relation with its surrounding structures in Chinese people, for the purpose of providing microanatomical reference for surgeries adopting retro-sigmoid approach. METHODS: The retro-sigmoid surgical approach was simulated on 5 fresh specimens of human head, in which the internal auditory meatus and its surrounding structures were observed through a neuroendoscope and a surgical microscope. The distances from the posterior inferior edge of the internal auditory meatus to the central point of the posterior edge of the sigmoid sinus and to the posterior edge of the posterior semicircular canal were measured. RESULTS: The internal auditory meatus was located at the center of the medial surface of the petrous bone, and the cranial nerve VII ran through its anterior-superior part while the cranial nerve VIII through its posterior-inferior part. After forming an arterial loop at the internal auditory meatus, the anterior-inferior cerebellar artery branched into 1 to 3 internal auditory arteries. The distance from the posterior-inferior edge of the internal auditory meatus to the central point of the posterior edge of the sigmoid sinus was 32.15+/-1.76 mm on the left side, and 33.34+/-1.57 mm on the right, and the distance to the posterior edge of the posterior semicircular canal was 12.51+/-2.15 mm on the left side, and 13.26+/-2.44 mm on the right. CONCLUSION: Thorough knowledge of the microanatomy of the internal auditory meatus and its surrounding structures is of crucial importance to preserve the functions of the cranial nerves VII and VIII in the surgical removal of acoustic neuroma.

Asian People↗

PubMed2003

[Neuroendoscopic treatment for Rathke's cleft cyst: transventricular approach to suprasellar cystic lesion].

We report a case of a Rathke's cleft cyst, which was successfully treated by neuroendoscopy. The endoscopic procedure for the intra-suprasellar cystic lesion used the transventricular approach, similar to that of third ventriculostomy. A 66-year-old woman suffered from headache, nausea and constriction of the visual field. Magnetic resonance imaging (MRI) on admission showed an intra-suprasellar cystic lesion. Biopsy of the cyst wall and fenestration of the floor of the third ventricle was performed using an endoscopic transventricular approach. The cyst content was totally aspirated, using a suction system which was connected to the operation channel of the endoscope. The histological diagnosis was Rathke's cleft cyst. No post-operative complication was observed. The endoscopic transventricular approach is safe and most suitable in terms of minimum invasiveness for the intrasuprasellar cystic lesion. We consider that neuroendoscopic transventricular approach will become the common surgical method of choice for treating a suprasellar cystic mass lesion.

Aged↗

PubMed2005

[Neuroendoscope-assisted endonasal-transsphenoidal surgery for pituitary neoplasms].

OBJECTIVE: To evaluate the effect of curative effect of endonasal transsphenoidal approach for removal of pituitary neoplasms (PNs) assisted by neuroendoscopy. METHODS: Seventy-eight consecutive PNs patients with sellar mass causing compression of optic nerve and optic chiasm shown by MRI or CT underwent tumor removal via the endonasal transsphenoidal approach with the help of neuroendoscope. RESULTS: Total removal of tumor in 71 cases (91.0%) and subtotal removal in 5 cases (6.4%) were achieved. Partial removal was carried out in the remaining 2 cases (2.6%) with fibrous tumor. There was no postoperative death. Follow-up with a median of 3 months in 67 patients revealed that preoperative diminished acuity caused by optic nerve compression was recovered in 64 cases (95.5%), and improved in 3 cases (4.5%). Among the 62 patients with preoperative visual field defects, postoperative recovery was achieved in 60 cases (96.8%), and improvement in 2 cases (3.2%). CONCLUSION: Endonasal transsphenoidal approach assisted by neuroendoscopy is an effective minimally invasive method for removing the PNs. Changing the angle of the endoscope intraoperatively helps removing the tumor safely and completely.

Adult↗

PubMed2005

[A case of the lateral ventricle lesion mimicking arachnoid cyst treated by neuroendoscopic surgery].

A 12-year-old female suffered from intermittent headache with nausea. Neuroradiologic studies demonstrated a cystic lesion in the right trigone with content like cerebrospinal fluid. The right inferior horn was isolated and increased in size. Eodoscopic fenestration was attempted using a flexible fiberscope via the inferior horn. Postoperative magnetic resonance image revealed shrinkage of the cyst and reduced size of the right inferior horn. Intermittent headache dissapeared. Neuroendoscopic treatment is a less invasive and effective therapy for intraventricular arachnoid cyst as well that in the other intracranial lesion.

Arachnoid Cysts↗

PubMed1999

Neuroendoscopic third ventriculostomy.

Neuroendoscopic third ventriculostomy is becoming increasingly popular as the primary mode of therapy for patients with noncommunicating hydrocephalus. In this article the author reviews the procedure and its indications, and highlights its complications. It can, without doubt, be recommended as the first line treatment for hydrocephalus and also in cases in which shunt malfunction or infection occurs.

Journal Article↗

PubMed1994

Neuroendoscopic third ventriculostomy. A practical alternative to extracranial shunts in non-communicating hydrocephalus.

The outcomes in 103 patients who have undergone third ventriculostomy for non-communicating hydrocephalus at our institution form 1978-1994 have been analysed. The group has been sub-divided by age, cause of hydrocephalus and whether the third ventriculostomy was the initial definitive procedure or whether progression of their hydrocephalus had been arrested for a long time (usually years) by an extracranial shunt prior to third ventriculostomy. At the time of shunt malfunction (usually blockage) a third ventriculostomy was performed if the anatomy was, or could be made suitable for the safe performance of the procedure. Third ventriculostomy under the age of 6 months was successful in only 8 of 25 patients. Seventeen patients in whom the onset of hydrocephalus was under the age of six months and the ventriculostomy was performed between 6 months and 18 years, 8 were successful. Sixteen of these had had previous long term shunts. In 40 patients in whom the onset of hydrocephalus was over the age of 6 months and the ventriculostomy performed after the age of 19 years, 32 were successful. In 28 patients over the age of 20 years, 13 had previously been shunted and in 8 of these the procedure was successful. In 15 patients not previously shunted, 9 ventriculostomies were successful. Three failed, 2 died before evaluation could be done and one was lost to follow-up. There were no deaths caused by the procedure. Two patients suffered from a hemiparesis, (1 transient) 1 patient suffered mid-brain damage. There were 2 subdural effusions. Two patients had infections, 1 superficial and 1 a ventriculitis.

Adolescent↗

PubMed2002

Neuroendoscopic intracranial pressure monitoring.

OBJECT: We wished to find a way of monitoring patients' intracranial pressure (ICP) during endoscopic surgery. METHODS: The Codman Microsensor ICP monitor can be inserted through the working channel of an endoscope with an interposed assembly (Check Flo II with male fitting, 9 F, manufactured by Cook, model #CFM-100TM) to provide a water-tight seal and allow simultaneous irrigation. During endoscopic third ventriculostomy surgery with this setup in our hospital, the ICP was continuously monitored. The effects of irrigation on ICP were also followed. The sensor was assumed to be absolutely accurate and not referenced to a column of water. CONCLUSION: The small size of the Microsensor ICP monitor enabled easy placement through the working channel of the endoscope and interposed assembly. The ICP reading was continuously available, even during irrigation. The effect of irrigation on ICP was carefully monitored, and limited when pressure changes were noted.

Brain↗

PubMed2003

Pineal germinoma with intratumoral hemorrhage after neuroendoscopic tumor biopsy.

CASE REPORT: We report an intratumoral hemorrhage immediately after a ventricular endoscopic procedure in an 18-year-old man who had a pineal germinoma with symptomatic hydrocephalus. The patient was successfully treated using long tract external ventricular drainage and urgent radiation therapy. DISCUSSION: The contributing factors for the acute reduction of intracranial pressure to zero during the endoscopic procedure are discussed.

Adolescent↗

PubMed2004

Incidence of complications in neuroendoscopic surgery.

OBJECTIVE: This study was undertaken to determine the complication rate in intracranial endoscopic neurosurgery. RESULTS: The complications in our series of endoscopic intracranial procedures for the treatment of hydrocephalus, colloid and arachnoid cysts, as well as intraventricular tumors, were analyzed. CONCLUSION: Although the complication rate in endoscopic neurosurgery is low, severe, rarely even life-threatening, complications may occur. The complication rate decreases markedly with surgical experience, indicating a steep learning curve.

Brain Diseases↗