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At least 217 records · Page 12Linked to original sources

PubMed2004

Neuroendoscopic surgery of intracranial cysts in adults.

OBJECTS: The purpose of this study was to describe the indications, surgical techniques and postoperative outcome of neuroendoscopic interventions in a heterogeneous group of intracranial cystic pathologies. PATIENTS AND METHODS: Between 1992 and 2003, 127 patients with symptomatic intracranial cysts and cystic tumours underwent neuroendoscopic treatment in our department. In 22 patients indication for surgery was colloid cysts, in 9 patients pineal cysts and in 3 patients cavum vergae cysts. Twelve arachnoid cysts, 10 cystic craniopharyngiomas, 2 Rathke's cleft cysts and 69 malignant cystic tumours were operated on. The patients' mean age was 45 years and their clinical presentations varied from typical signs of increased intracranial pressure to focal neurological deficits. RESULTS: One hundred and twenty-seven patients with intracerebral cystic space-occupying lesions were operated on using stereotactic frameless or frame-based endoscopic techniques. There was no operative mortality. The operative morbidity was 3.1% including 1 memory deficit due to fornix injury, 1 hemiparesis due to postoperative haematoma after lesion biopsy, 1 aseptic meningitis and 1 subdural fluid collection. CONCLUSIONS: Endoscopic interventions enable neurosurgeons to manage intracranial cystic lesions. Via the same approach, the obstructed CSF pathways may be restored and consequently the increased intracranial pressure diminishes. With the aid of stereotactic guidance or a neuronavigation system, access to the lesion can be gained rapidly and with high accuracy.

Adult↗

PubMed2004

Long-term complications and definition of failure of neuroendoscopic procedures.

OBJECTS: A lot has been published about neuroendoscopic procedures over the last decade. Most of these publications are about the effectiveness of endoscopic third ventriculostomy, the most frequently performed neuroendoscopic procedure. Little is published about the effectiveness of other, less frequently performed neuroendoscopic procedures. Over the years more reports about the complications of endoscopic procedures are published, but again most of these publications are about endoscopic third ventriculostomy and only a little is presented about the complications of all other neuroendoscopic procedures. Furthermore, most reports are about intraoperative and immediate postoperative complications; only a few reports evaluated the long-term complications of neuroendoscopic procedures. There are also a few publications that analyse the failures of neuroendoscopic procedures but a good definition of failure is not given. The reports mention, again, mainly endoscopic third ventriculostomy procedures, and are mostly directed at the short-term failure rates, defined as the need for a shunt to be placed. Less attention is paid to the effects of the endoscopic procedures in the longer term. Looking at longer terms emphasises the need for a better definition of failure. METHODS: To get more insight into the long-term complications and failures of neuroendoscopic procedures, we reviewed the literature and evaluated our own series of 485 different cranial endoscopic procedures. With the information gathered we tried to answer the questions mentioned above. CONCLUSIONS: Most of the complications of neuroendoscopic procedures are transient, either spontaneously or by medical intervention. Only a few permanent complications are known, in our series 1.6%, and most of them are not typically related to the endoscopic procedure itself but are due to the ventricular approach necessary for and the management of the endoscopy. Mortality rates are less than 1%. A uniform definition of failure cannot be given for all neuroendoscopic procedures, because the procedures are too heterogeneous and the indications are widespread. Failures are mainly diagnosed within a few months of the procedure but neurosurgeons must be aware of failure in the longer term, because if not diagnosed they can give rise to increased morbidity and probably mortality.

Brain Diseases↗

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↗

PubMed2005

Rapidly growing giant suprasellar tumor in a high-risk child: treatment strategy and role of neuroendoscopic surgery in slit-like ventricles.

RATIONALE: Suprasellar tumors are common in the pediatric population and exhibit a wide range of pathological appearance and behavior. Although rare, pure suprasellar germinomas carry worse prognosis than other locations. METHODS: We present a case of a 10-year-old girl treated with therapeutic anticoagulation for previous cardiac valvular replacement, who presented with rapidly growing giant (>4 cm) suprasellar germinoma. Neoadjuvant chemotheraphy was effective and the dilated ventricles became slit-like. The fine free-hand maneuver using a fine rigid-rod neuroendoscope. "Oi-Samii Handy Pro" made it possible to obtain the tissue diagnosis. RESULTS: Complete remission was achieved using neoadjuvant chemotherapy, minimally invasive neuroendoscopic surgery, then followed by specific chemoradiotherapy. CONCLUSION: The role of neuroendoscopic procedure, performed in a difficult situation with normalized size of the ventricles, was emphasized.

Brain Neoplasms↗

PubMed2005

Endoscopic assisted excision of a retroclival arachnoid cyst presenting as hysterical breathlessness.

BACKGROUND: Arachnoid cysts are benign developmental cysts occurring most commonly in the middle fossa. Posterior fossa arachnoid cysts are less common, with retroclival arachnoid cysts especially in the pediatric age group being rare. PATIENTS AND METHODS: We present a case of a retroclival interpeduncular farachnoid cyst in a 10-year-old boy who presented with left-sided ptosis and episodes of hysterical breathlessness. RESULTS: The surgical treatment involved endoscopic assisted microsurgical excision of the cyst and the child made an uneventful and complete recovery with complete cessation of breathlessness. The clinical presentation, etiopathogenesis, imaging characteristics and treatment modalities are discussed and the relevant literature reviewed.

Arachnoid Cysts↗

PubMed2005

Huge arachnoid cyst incorporating choroid plexus.

BACKGROUND: We report a rare case of arachnoid cyst incorporating choroid plexus. This 7-month-old girl presented with macrocrania. Magnetic resonance (MR) imaging disclosed a cystic lesion arising from the left prepontine cistern extending to the left middle cranial fossa. METHODS: First, we performed resection of the membrane microscopically and obtained an adequate reduction of the cystic size. However, 4 months after the first operation, the cyst was enlarged again, and bulging of the portion of the craniotomy was noted. Thus, we performed neuroendoscopic transcortical ventriculo-cyst-cysternostomy and confirmed the choroid plexus inside of the arachnoid cyst. DISCUSSION: Postoperative course was uneventful. This is the first reported case of choroid plexus within an arachnoid cyst, determined neuroendoscopically.

Arachnoid Cysts↗

PubMed2005

Hemodynamic and electrolyte changes in patients undergoing neuroendoscopic procedures.

OBJECTS: Intraoperative hemodynamic alterations and postoperative electrolyte disturbances related to endoscopic third ventriculostomy (E3V) have been reported. We aimed to evaluate prospectively those changes in patients undergoing neuroendoscopic procedures. METHODS: This study was carried out in 24 patients who underwent neuroendoscopic intervention. Sevoflurane was used for the induction and maintenance of anesthesia. Heart rate (HR), mean arterial pressure (MAP), peripheral oxygen saturation, end-tidal CO2, and body temperature values were recorded according to the stages of the operation. Blood gas and blood chemistry analyses were performed before and after endoscopic procedure and were repeated on the third postoperative day. CONCLUSIONS: There were no significant differences in intraoperative HR and MAP. Bradycardia occurred only in 1 of the 24 patients during the dilatation. In conclusion, we suggest the use of 0.9% NaCl for intravenous fluid replacement and a warm lactated ringer solution for ventricular irrigation during E3V to prevent intraoperative hemodynamic changes and postoperative electrolyte disturbances.

Adolescent↗

PubMed2006

Neuroendoscopic techniques in the treatment of arachnoid cysts in children and comparison with other operative methods.

OBJECTIVE: The authors intended to evaluate the application of neuroendoscopic techniques for the treatment of arachnoid cysts in children and compare it with other operative methods. METHODS: The analysis covered the results of treatment of 44 children with arachnoid cysts who were subjected to neuroendoscopic procedures and 62 patients who underwent other operations. RESULTS: The neuroendoscopic treatment of arachnoid cysts was very effective because of low rate of reoperative treatment (six out of 44 patients), no need to change the operative method (40 effective out of total 44 operative procedures), and low rate of persistent worsening (none of 44 patients worsened). CONCLUSIONS: Summing up all the mentioned aspects of neuroendoscopic techniques, the neuroendoscopic techniques were the most suitable operative procedures in the treatment of arachnoid cysts in the presented group of patients, providing that the connection between the lumen of the arachnoid cyst and the cerebrospinal fluid cisterns was of good quality.

Adolescent↗

PubMed2006

Assessment of the influence of operative factors in the success of endoscopic third ventriculostomy in children.

OBJECTIVE: To determine if operative factors correlate with success of endoscopic third ventriculostomy (ETV) in the treatment of hydrocephalus. MATERIALS AND METHODS: The ETV procedure video of 33 hydrocephalic children was reviewed. Mean age at operation was 76 months (range: 1-196). Success was defined as no need for shunt in the long term. We calculated the relative size of stoma as the percentage of stoma diameter to the distance between posterior clinoid-basilar artery. Factors analysed were: intra-operative haemorrhage, stoma size, thick/double third ventricular floor, pre-pontine adhesions presence, brisk cerebro-spinal fluid (CSF) flow through the stoma as well as hydrocephalus cause, previous shunt presence, CSF infection or haemorrhage and previous ETV. Analysis was performed using chi-square, linear regression, and one-way ANOVA. RESULTS: Overall ETV success rate was 42%. Mean stoma size was 37%. For the entire group, none of the operative factors correlated statistically with success. Previous shunt presence adversely correlated with success (p=0.008). The highest success rate was in the aqueduct stenosis group. In patients without previous shunt (n=17), stoma size over 30% tended towards significance (p=0.094), CSF leak was adversely associated with ETV success (p=0.041) and mean stoma size was 41.3% in successful ETV and 27.8% in unsuccessful ETV (p=0.072). In patients with previous shunt (n=16), thin third ventricular floor was a negative predisposing factor (p=0.057). CONCLUSION: This study did not demonstrate a correlation between the presence of pre-pontine adhesions, double or thickened floor of third ventricle and ETV success. In patients without previous shunt, stoma size may correlate with success. CSF leak was strongly associated with failure.

Adolescent↗

PubMed2006

Endoscopic aqueductoplasty.

OBJECTIVE: Endoscopic aqueductoplasty (EA) was considered as a good alternative to endoscopic third ventriculostomy (ETV) in selected patients. A personal experience on EA is presented in this paper. MATERIALS AND METHODS: Forty-five patients with primary or secondary aqueductal stenosis underwent EA with or without a stent between June 2000 and June 2005. Age, gender, diagnosis, endoscopic procedures, complications, and outcome were reviewed. EA was considered successful when patients with noncommunicating hydrocephalus became shunt-free. When the patient did not need a fourth ventricular shunt after the EA with or without a stent, it was considered to be successful in patients with isolated fourth ventricle. RESULTS: Fifteen patients were older than 18 years of age. EA, EA with stent, EA with ETV, and EA with stent in addition to ETV were performed in 11, 6, 11, and 17 patients, respectively. Out of 45 patients who had undergone EA with or without stent and ETV, 31 (69%) benefited from the endoscopic procedures. The type of the endoscopic procedure, diagnosis, and the age of the patients did not significantly affect the outcome. CONCLUSION: EA with a stent can be performed in patients with isolated fourth ventricle and in patients with aqueduct stenosis in which ETV is not feasible. EA can be dangerous and useless in aqueduct stenosis (AS), and EA with ETV is even more useless. Those patients who have undergone EA should be closely followed up for a long period of time because restenosis of the aqueduct and stent migration may happen years after endoscopic surgery.

Adolescent↗

PubMed2007

The role of Ommaya reservoir and endoscopic third ventriculostomy in the management of post-hemorrhagic hydrocephalus of prematurity.

OBJECTIVE: The aim of this study is to retrospectively evaluate a series of consecutive patients affected by post-hemorrhagic hydrocephalus in prematurity, treated with an implant of an Ommaya reservoir followed by ventriculo-peritoneal (VP) shunt and/or endoscopic third ventriculostomy (ETV) to evaluate the safety and efficacy of these treatment options in the management of the condition. METHODS: Between 2002 and 2005, 18 consecutive premature patients affected by intra-ventricular haemorrhage (IVH) grades II to IV, presenting with progressive ventricular dilatation, were operated for implant of an intra-ventricular catheter connected to a sub-cutaneous Ommaya reservoir. Cerebrospinal fluid was intermittently aspirated percutaneously by the reservoir according with the clinical requirements and the echographic follow-up. The patients who presented a progression of the ventricular dilatation were finally operated for VP shunt implant or ETV according with the MRI findings. RESULTS: One patient had grade II, 5 had grade III, and 12 had grade IV IVH. The mean age at IVH diagnosis was 5.2 days; the mean age at reservoir implant was 17.3 days. The Ommaya reservoir was punctured on an average basis of 11.4 times per patient (range 2-25), and the mean interval between aspirations was 2.7 days. The mean CSF volume per tap was 20 ml. One patient died for pulmonary complications during the study period. Out of the 17 survivors, 3 did not develop progressive ventricular dilatation, and their reservoir was removed; 14 developed progressive hydrocephalus, 5 of whom were implanted with a VP shunt and 9 received an ETV. Amongst the five shunted patients, two were re-admitted for shunt malfunction and had their shunt removed after ETV after 6.1 and 20.5 months, respectively. Amongst the nine patients who received an ETV, five had to be re-operated for VP shunt implant at an average interval of 2.17 months (range 9-172 days) because of increasing ventricular dilatation. Two of them had a redo third ventriculostomy with shunt removal at 11 and 25.1 months, respectively, after insertion. The first was reimplanted with a VP shunt 4 days later; the second remains shunt free. Therefore, at the end of the follow-up period, 10 out of 17 children affected by post-hemorrhagic hydrocephalus in prematurity were shunt free (59%). CONCLUSIONS: The combination of Ommaya reservoir, VP shunt, and the aggressive use of ETV as a primary treatment or as an alternative to shunt revision allowed for a significant reduction of shunt dependency in a traditionally shunt-dependent population. Further studies are warranted to optimise the algorithm of treatment in these patients.

Age Factors↗

PubMed2004

Chronic subdural collection after endoscopic third ventriculostomy.

Endoscopic third ventriculostomy (ETV) is considered a safe technique for the treatment of obstructive hydrocephalus. We describe a case of chronic subdural haematoma (CSDH) after ETV, revealed by MRI four weeks after the procedure, and requiring surgical evacuation, in a 69 y.o. asymptomatic male patient. In our opinion, overdrainage may evolve also in endoscopic treatment of obstructive hydrocephalus. This complication could be the starting point of the subdural collection. We review the literature and discuss the causes that may lead to CSDH after ETV procedure.

Aged↗

PubMed2004

Robot-assisted navigated endoscopic ventriculostomy: implementation of a new technology and first clinical results.

BACKGROUND: Important landmarks in the evolution of advanced neurosurgical techniques during the past decades include microneurosurgery, neuro-endoscopy and its minimally invasive nature, as well as neuronavigation and advanced intra-operative imaging. With conventional neuroendoscopic techniques, e.g. free-hand endoscopy or the use of mechanical or pneumatic holding devices, a definitive and controlled movement of the endoscope within the brain does depend on the experience and manual skill of the individual neurosurgeon. Therefore, the development of robotic systems to assist surgeons in performing complex neurosurgical procedures is a growing field of interest. METHOD: With the precision robot "Evolution 1" (U.R.S. Universal Robot Systems, Schwerin, Germany) a new neurosurgical tool has just become available for the precise steering of instruments within the cranium. After preclinical anatomical as well as precision studies the system was used for robot-assisted navigated endoscopic third ventriculostomies in six patients with hydrocephalus related to aqueductal stenosis. FINDINGS: All robot-assisted navigated endoscopic procedures were successfully completed. The time for the registration procedure and setup of the robot decreased from 60 min. for the first procedure down to 30 min. The time for the surgical part of the neuro-endoscopic procedure itself ranged from 17 to 35 min. During all procedures no system-related complications occurred. INTERPRETATION: The use of robotic technology for neuro-endoscopic third ventriculostomies is a major step towards the controlled movement of the neuro-endoscope within the cranium. The start up procedure and calibration of the robot is still time consuming, but the real operation time is comparable to free hand neuro-endoscopy. The steering of the endoscope is facilitated and the precision of the endoscopic movements is noteworthy.

Adolescent↗

PubMed2004

Intracranial pressure patterns after endoscopic third ventriculostomy. Preliminary experience.

BACKGROUND: Endoscopic Third Ventriculostomy (ETV) has become the treatment of choice for non-communicating hydrocephalus as it is able to couple high success rate (60-80%) with rare complications (about 5%). Nevertheless, which is the best postoperative care standard and whether or not it is possible to predict the success of the procedure is still discussed. Traditional neuro-imaging techniques show several limitations in the early postoperative period. Indeed, a decrease of the ventricular size is often minimal and not visible before three weeks, while, MRI visualization of a flow void signal through the third ventricle floor, seems to have a significant incidence of false positives. The use of postoperative ICP measurement after ETV has been suggested as a valid monitoring method, mostly in the early postoperative period. In previously unpublished data the authors observed the existence of different ICP patterns following ETV. This finding prompted the authors to search for a relationship among ICP patterns, stoma functioning and prediction of success. METHOD: At our institution 26 consecutive patients affected by obstructive triventricular hydrocephalus underwent ETV. Among them there were 11 primitive aqueductal stenosis (AS), 5 shunt malfunctions, 2 third ventricle mass, 3 intraventricular cysts, and 5 patients with different lesions (1 quadrigeminal cistern arachnoidal cyst, 1 pineal region mass, 2 tectal tumours, and 1 supracerebellar abscess) compressing the aqueduct of Sylvius from outside named " ab estrinseco" aqueductal stenosis. All patients underwent postoperative Intra Cranial Pressure (ICP) monitoring by means of a ventricular catheter. FINDINGS: Transient ICP rises of any grade, mostly responsive to periodical liquoral subtractions, occurred shortly after ETV in as many as 50% of our patients. No major complications occurred. The effect of ETV on ICP trend was found to be variable among groups of patients thus identifying different ICP patterns. Patients with ab estrinseco Sylvian aqueduct compression showed the best effect on ICP, whilst, patients with intraventricular mass lesions causing triventricular hydrocephalus and shunt-dependent patients, revealed a clear trend to develop a more severe intracranial hypertension after ETV. CONCLUSIONS: Patients with shunt malfunction and patients with intraventricular mass lesions, showing a more pronounced trend to develop severe intracranial hypertension after ETV, should always be considered for postoperative ICP monitoring in order to detect and, eventually, treat any ICP rises which may occur. Unfortunately, it is still difficult to assign a predictive value to the different postoperative ICP patterns. The authors encourage postoperative ICP monitoring in all patients in order to define all the possible ICP patterns following ETV.

Adolescent↗

PubMed2005

Outcome of endoscopic third ventriculostomy. Results from an unselected series with noncommunicating hydrocephalus.

BACKGROUND: Endoscopic third ventriculostomy (ETV) has gained acceptance as the treatment of choice for noncommunicating hydrocephalus despite a relatively high failure rate and a higher surgical risk than the placement of a shunt. The benefits of shunt independence overcome both drawbacks. This argument also serves to consider candidates for ETV patients with a poor chance of success, a fact which may to a certain degree explain failure rates higher than 20% in most unselected series of patients with noncommunicating hydrocephalus. METHOD: From 1997 to 2003 sixty-six patients with suspected noncommunicating hydrocephalus were treated with ETV. Male and female patients were equally distributed. It is an adult-based series (median age 53 years). The etiology of hydrocephalus was a space-occupying lesion in 39 patients (59%) and primary aqueductal stenosis in 27 (41%). Forty-seven patients presented an acute form of hydrocephalus (71%), the remainder presented a chronic form of hydrocephalus. The morbidity and outcome of the procedure were reviewed. Criteria for success was shunt independence and failure was considered when any surgical manoeuvre was further required for the treatment of hydrocephalus. The outcome was evaluated using the Kaplan-Meier survival method. FINDINGS: The probability of remaining with a functioning ETV at 5.7 years (mean follow-up period) is 71.6% (95% confidence interval: 60.5-82.8). Failure occurred in 18 patients (27.3%). If failure occurs, there is a cumulative probability of 90% (95% confidence interval: 84-97) that the failure declares itself during the first 16 days after surgery. There were transient complications in five patients (7.5%), permanent in one (1.5%) and no mortality related to the procedure. CONCLUSIONS: ETV had a 5-year success rate of 71.6% with a low rate of permanent complications. When ETV is successful, the result tends to hold up over time. Delayed failure is a rare event.

Adult↗

PubMed2003

Ventriculostomy in a tumor involving the third ventricular floor.

Recently, endoscopic management has gotten preference over open surgical treatment in selected cases of intraventricular tumors. Endoscopic third ventriculostomy (ETV) appears unfeasible when tumors extend to the third ventricular floor region due to the risk of perforators and injury to the basilar artery. We report the case of a 12-year-old male with symptoms of acute, chronic, raised intracranial pressure. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a posterior third ventricular tumor involving the aqueductal and floor regions. The ETV was done after clearing the floor by partial tumor resection, keeping the dorsum sellae as the major anatomical landmark. The patient improved satisfactorily and was given adjuvant radiotherapy, and the need for an external shunt was completely eliminated. We conclude that ETV appears worth trying, even in third ventricular tumors involving the floor region if they can be cleared from the tumor keeping the dorsum sellae as the major anatomical landmark.

Cerebral Aqueduct↗

PubMed2004

Endoscope-assisted microsurgery for tumors of the septum pellucidum: surgical considerations and benefits of the method in the treatment of four serial cases.

Neoplasms that primarily originate from the septum pellucidum are extremely rare. Generally the septum pellucidum is involved in direct extension of tumors that arise from the neighboring structures, principally the corpus callosum. Endoscope-assisted techniques form a useful adjunct to common microsurgical procedures to completely remove intraventricular lesions. There are two main advantages of endoscope-assisted surgery over common microsurgical techniques: reduction of superficial brain retraction with less iatrogenic trauma to the neighboring structures and inspection of hidden corners depict simultaneously anatomical details which are not precisely visible in the zoomed and thus light-reduced beam of the microscope. Four patients with septum pellucidum tumors underwent surgery by a transcallosal approach. In all four patients the endoscope-assisted microsurgery technique was used to remove the tumor. In one of the four patients neuronavigation was additionally used for guidance. Complete tumor excision was achieved in all patients. The histological findings showed pilocytic astrocytoma in two cases, one subependymoma and one neurocytoma, respectively. There were no postoperative complications. Endoscope-assisted microsurgery provides maximum efficiency to remove the septum pellucidum tumors with minimum invasiveness.

Adult↗

PubMed2005

Endoscope-assisted removal of colloid cysts of the third ventricle.

Colloid cysts are benign space-occupying lesions, which arise from the velum interpositum or the choroid plexus of the third ventricle and are able to produce symptomatic obstruction of the foramina of Monro with resultant hydrocephalus. In our department, we have operated on colloid cysts routinely in an endoscope-assisted microsurgical manner via a key-hole approach. During a period of 10 years, 28 microsurgical resections of colloid cysts of the third ventricle were performed. Seven patients demonstrated colloid cysts inside the third ventricle with obstruction of the right foramen Monro, two patients demonstrated cysts with obstruction of the left foramen Monro. Twelve patients suffered from cysts inside the third ventricle with obstruction of both foramina Monro and five patients demonstrated cysts lying into the third ventricle without obstruction of the foramina. In 21 patients no preoperative therapy was performed outside. Three patients had received shunt systems before in other hospitals, two patients received aspiration of the cysts under stereotactic conditions and two patients received external ventricular drains. Total removal of the cyst was achieved in all patients (100%). No patient received a second operation, because none had a recurrent cyst. All cysts were removed with the cyst wall. Overall clinical improvement was achieved in a long-standing period between 6 and 83 months in 27 (96%) patients. In one patient (4%) the psychomotor disturbance was unchanged and no patient deteriorated. From the microsurgical point of view, the combination of keyhole surgery under endoscopic visual control using preexisting anatomical windows offers an effective minimally invasive approach.

Adolescent↗