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At least 343 records · Page 19Linked to original sources

PubMed2005

Endoscopic third ventriculostomy: an outcome analysis of primary cases and procedures performed after ventriculoperitoneal shunt malfunction.

OBJECT: The authors analyzed the role of endoscopic third ventriculostomy (ETV) as a primary treatment for hydrocephalus and also as an alternative to shunt revision for malfunctioning and infected ventriculoperitoneal (VP) shunts. METHODS: A retrospective analysis of clinical notes, operation records, and magnetic resonance imaging procedures before and after ventriculostomy was performed to determine the success or failure of ETVs in 170 patients who underwent a primary ETV and in 63 patients who underwent an ETV for shunt malfunction (secondary ETV). The patients' data were derived from an endoscopy database inaugurated in 1998. Of the 63 patients with shunt malfunctions, 49 patients (78%) had mechanical malfunction only and 14 patients (22%) had both infection and malfunction. Seventy-four percent (126 of 170) of patients in the primary ETV group and 70% (44 of 63) of patients in the secondary ETV had a successful outcome at the time of analysis. The success rate for ETVs in cases involving a mechanical shunt malfunction alone was 67% (33 of 49) compared with 79% (11 of 14) in those cases involving an infected shunt. The origin of the hydrocephalus in the primary and shunt malfunction groups was evaluated as a factor contributing to the success of the ETV. In the primary group, patients with a history of intraventricular hemorrhage (IVH) and meningitis as a cause for hydrocephalus had a poor rate of success after the ETV--27% (four of 15) and 0% (none of two), respectively. This pattern was not seen in the series involving shunt malfunction after the ETV, with 71% (five of seven) and 75% (three of four) of cases having a hydrocephalus origin of IVH and meningitis, respectively, in which a successful outcome was attained. A two-way mixed-model analysis of variance yielded a significant effect for origin (p = 0.011), a significant interaction between group and origin (p = 0.028), and a marginally nonsignificant effect of group (p = 0.0686). More than 95% of failures were evident within 1 month of the ETV in both groups. Complications were minimal in both groups, and there were no procedure-related deaths. CONCLUSIONS: An ETV is a safe procedure with few complications and a high success rate in both primary and secondary groups. An ETV to address shunt malfunction, unlike a primary ETV, is not particularly origin specific. A bonus is its success in dealing with infected shunts. Most failures will be evident early, but long-term follow up is vital.

Adolescent↗

PubMed2006

Late closure of the stoma by spreading of a periaqueductal glioma: an unusual failure of endoscopic third ventriculostomy. Case report.

The late failure of endoscopic third ventriculostomies (ETVs) has been described as a consequence of scarring phenomena involving the third ventricular floor. Although the possibility of closure of the stoma by intraventricular tumor seeding has been hypothesized, no case of ETV failure caused by tumor diffusion has been reported in the literature. The authors report on a 19-year-old patient, affected by obstructive hydrocephalus associated with a periaqueductal pilocytic astrocytoma, who underwent late secondary lesional obstruction of an ETV performed at diagnosis. The authors suggest tumor extension along the diencephalic neural pathways as the possible cause of ETV failure in this patient.

Adult↗

PubMed2006

Frameless, pinless stereotactic neurosurgery in children.

OBJECT: Frameless neuronavigation has been established as a useful adjunct to intracranial surgery; however, the procedure is limited in young children by the need for rigid skull fixation with pins. Pin fixation is difficult and hazardous for patients younger than 2 years of age. Minor risks have been associated with pin fixation in older patients also, including scalp laceration, skull fracture, and epidural hematoma. METHODS: The authors adapted a pinless head fixation system, consisting of a beanbag device, for use with frameless neuronavigation. This system was used to perform intracranial neurosurgical procedures in nine patients. CONCLUSIONS: This pinless, frameless method provides a new option for children who are unable to sustain rigid head fixation. It is also an alternative to rigid pin fixation for patients of any age.

Adolescent↗

PubMed2006

Endoscope-assisted infratentorial-supracerebellar approach to the third ventricle: an anatomical study.

OBJECT: The authors studied the microsurgical anatomy and endoscopic features of the pineal region and third ventricle to describe a combined microsurgical-endoscopic infratentorial-supracerebellar approach to the posterior third ventricle. Such an approach exposes the pineal gland and its complex neurovascular structures so that the third ventricle can be reached through a minimally invasive parapineal incision. METHODS: The approach was studied in 10 adult cadaveric heads, six fresh and four formalin fixed, by using an operative microscope with a magnification level of 6 to 40 and the assistance of an endoscope. The endoscope-assisted infratentorial-supracerebellar approach affords a complete view of the third ventricle from a posterior perspective. The third ventricle is entered through a parapineal incision using the natural space between the internal cerebral vein and the vein of Rosenthal located above the superior colliculi. CONCLUSIONS: The infratentorial-supracerebellar approach to the third ventricle follows a natural corridor and requires minimal retraction and resection of critical neural structures. With the use of the endoscope, an unsurpassed view into the third ventricle from a posterior perspective is obtained.

Adult↗

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↗

PubMed2006

Outcomes in patients undergoing single-trajectory endoscopic third ventriculostomy and endoscopic biopsy for midline tumors presenting with obstructive hydrocephalus.

OBJECT: The primary aim of this study was to evaluate the success of endoscopic third ventriculostomy (ETV) as a treatment for obstructive hydrocephalus secondary to midline tumors (midbrain, pontine, pineal, tectal plate, thalamic, and third ventricular regions). In addition, the study examined the role and value of endoscopic tumor biopsy (ETB) in the management of such cases. All surgical procedures were performed through a single-trajectory approach. METHODS: A retrospective analysis of clinical notes, operation records, and pre- and postventriculostomy neuroimaging data was performed to determine the success or failure and complications of ETV and ETB in 42 patients presenting with tumor-induced obstructive hydrocephalus. Patient data were derived from an endoscopy database initiated in 1998. The study population included 21 female and 21 male patients (mean age 37 years, range 5-77 years). All 42 patients underwent an ETV; 33 of the 42 underwent an ETV and an ETB (single-trajectory). One patient was excluded from the follow-up analysis due to rapid deterioration of his condition from tumor progression. The duration of follow up ranged from 3 to 84 months (mean 32 months). At the last follow up, 11 patients with ETVs had undergone shunt placement and two patients had undergone repeated ETVs, giving a long-term success rate of 68% (28 of 41 cases) for single ETV as a treatment for hydrocephalus at presentation. Statistical analysis revealed no significant relationship (p > 0.92) between tumor location and ETV success or failure. The mean time to ETV failure was 32 weeks. Histological examination of biopsy specimens was non-diagnostic in eight (24%) of the 33 cases in which ETB was performed. Seven of these cases involved pineal region tumors and one involved a tectal plate tumor. There was no death or major morbidity associated with ETV and ETB in this series. CONCLUSIONS: Endoscopic third ventriculostomy is a safe and durable means of controlling hydrocephalus in tumor cases. Its success rate is high--comparable to that reported in aqueduct stenosis cases. Although ETB is probably not as accurate for diagnosis as biopsy with frame-based stereotactic guidance, it is associated with a lower mortality rate and, in the correct clinical setting, may be justifiably attempted as an initial biopsy procedure at the same time as ETV via a single-trajectory approach.

Adolescent↗

PubMed2026

Craniotomy versus Endoscopic Membranectomy in the Treatment of Non-Homogeneous Chronic Subdural Hematoma: A Pilot Randomized Parallel-Group Active-Controlled Trial (EMiT CSDH 2).

BACKGROUND: Chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition with persistent challenges related to recurrence. Endoscopic membranectomy (EM) has shown promising results in managing symptomatic non-homogenous (SNH)-CSDH, but comparative evidence against craniotomy with membranectomy (CM) is lacking. OBJECTIVES: To compare the safety and efficacy of EM versus CM in managing SNH-CSDH. MATERIALS AND METHODS: A pilot randomized parallel-group active-controlled open- labeled superiority trial from September 2023 to November 2024 at Government Kilpauk Medical College, Chennai, India. Sixty patients with SNH-CSDH were randomized into EM and CM groups. Recurrence was the primary outcome. Secondary outcomes included operative time, complications, radiological indices, pain, hospital stay, and functional recovery. All patients were followed for six months. RESULTS: No recurrence was observed in either group at six months. Two CM patients required reoperation on postoperative day one ( P = 0.15). EM was associated with shorter operative time ( P = 0.02), lower incidence of post-operative subdural residual fluid ( P = 0.015), better early hematoma reduction/subdural space reduction index ( P = 0.008), midline shift/symmetry improvement index ( P = 0.001), and lesser surgical site swelling ( P < 0.001). All patients were ambulant and had a Glasgow coma scale (GCS) 15 at discharge and at six months (including reoperated patients). Pain scores and functional recovery were comparable. EM patients had shorter hospital stays ( P = 0.004) and no significant complications. CONCLUSION: EM demonstrated favorable early radiological outcomes, fewer complications, and comparable functional recovery and recurrence versus CM in SNH-CSDH. Independent reproduction and larger multicentric trials are needed for validity and generalizability.

Humans↗

PubMed2000

[Endoscopy-assisted neurosurgery for intracranial operation].

OBJECTIVE: To investigate the value of endoscope-assisted neurosurgery for intracranial operation. METHODS: 37 patients with intracranial lesions including tumors, aneurysms, cysts, hematomas, hydrocephalus and nerve-vessel compression syndrome were treated with this method. Their results were compared to those of microsurgery and macrosurgery. The items analyzed included exposure and protection of brain tissue and cranial nerves, views of operation field, length of procedure etc. RESULTS: 15 patients with tumors, showed a high rate of complete removal but less complications. The 6th nerves of CPA tumors operation were preserved. Six cases of nerve-vessel compression syndrome showed excellent therapeutic effects. In 8 cases of intraventricle lesions, using endoscope easily found tumor location and the cause of hydrocephalus. As to saccular diseases, endoscope was used to deal with the major location. In 4 cases of hematomas, less blot remained and the procedure shortened. Moreover the operation field was more clear and adequate on the expenses of no more complexity of the procedure. CONCLUSIONS: Endoscope-assisted microsurgery is helpful in intracranial operation. It might become a standard neuro-operation in near future.

Adolescent↗

PubMed2003

[Evaluation of an animal model in endoscopic surgery of the cerebello-pontine angle].

In the last few years one can observe a dynamic evolution of the minimal invasive surgery, particularly in the field of the skull base surgery. We are now in a front of a big problem with human specimen for dissection. They become rare. Those circumstances force us to look for an animal model to perform dissections. The swine is a very well known model for general and thoracic surgery but we can hear also some attempt of using it in the field of the skull base surgery. Authors tried to deal with the endoscopic anatomy of the cerebello-pontine angle through the retrosigmoid approach. During this study they found that we could find structures which are analogical to human's one. Animal models will not take place of human specimens in surgical training but they can considerably reduce their number. Difficult technique and unusual tools demands a lot of hours of training, and a big part of it can be easily performed on animal models. Authors present their own experience.

Animals↗

PubMed2003

[Trigeminal neuralgia: results of microsurgical and endoscopic-assisted vascular decompression].

INTRODUCTION: Vascular compression of the Vth cranial nerve is the leading cause of trigeminal neuralgia. Microvascular decompression has been promoted by Jannetta since 1970. We used the minimally invasive retrosigmoid approach, with the complementary help of endoscopic procedure. OBJECTIVES: MRI results, surgical findings and pain relief were studied after endoscopic assisted microvascular decompression. MATERIAL AND METHODS: Between 1991 and 2000, 98 surgeries were performed on 79 patients unresponsive to medical treatment, after an average of 6 years from the onset of the disorder. The mean follow-up period after operation was 28 months. RESULTS: MRI predicted neurovascular conflict with sensitivity of 93.6% and specificity of 100%. Pain relief after surgery was complete in 69% of the cases, partial in 21%. Surgery was a failure in 6% of the cases and 4% of patients were lost. Complications were limited to 10% of CSF disorders but only 1% (1 patient) needed a surgical revision. CONCLUSION: Microvascular decompression, performed through a key-hole approach, without cerebellum retraction and with endoscopic assisted surgery, yields a low risk of morbidity, even in elderly patients, and could be considered acceptable causal treatment of trigeminal neuralgia.

Decompression, Surgical↗

PubMed2004

Interventional MR imaging with an endospinal imaging coil: preliminary results with anatomic imaging of the canine and cadaver spinal cord.

Percutaneous intraspinal navigation (PIN) is a new minimally invasive approach to the subarachnoid space. Using conventional radiographic fluoroscopy, entrance is gained to the lumbar subarachnoid space, allowing navigation throughout the spinal canal. Using an antenna/guidewire introduced via PIN, we performed endospinal MR imaging of the thoracic spinal cord in a cadaver and canine subject. Comparison images were obtained with an optimal surface coil. PIN allows endospinal MR imaging of the spinal cord, providing significant signal-to-noise ratio gains over conventional imaging.

Animals↗

PubMed2004

[Endoscopic third ventriculostomy: complications and failures].

Endoscopic third-ventriculostomy (ETV) became the treatment of choice for non-communicating hydrocephalus and its effectiveness is largely reported. On the contrary, specific articles on complications and failures of this technique are very rare and this review aims at supplying further information about it. Therefore, an analysis of the main and up-to-date series is made and exhaustive data about complications and failures of ETV and about their incidence are obtained. The overall frequency rate of complications is 6-20%. Their severity may vary either because of the length of the damage (transient or permanent) or the value of the involved structures (basilar artery, areas of the CNS, hypothalamus) or the importance of the injury (from subclinical sequelae to fatal complications). Moreover, this study showed both the risk that the endoscopic procedure must be suspended (intra-operative failure) and the risk of an early (before 1 month) or delayed (even some years after the intervention) narrowing of the ventriculostomy. The rate of and the reasons for failure have been analysed and the success of a second ETV has been estimated. The results of this analysis suggest that the children proposed for ETV are carefully selected and meticulously studied during the follow-up.

Blood Loss, Surgical↗

PubMed2004

[Supraorbital keyhole approach for microsurgical treatment of aneurysms in the anterior circulation].

OBJECTIVE: To study the method with endoscope-assisted microsurgical technique through the supraorbital keyhole approach to treat aneurysms in the anterior circulation. METHODS: According to preoperative diagnostic imagings, to work out of the individual operation planning. Skin incision was made in the eyebrow, and the diameter of supraorbital craniotomy was about 2 cm, endoscope-assisted microsurgical technique was used to clip aneurysm. The technique was used in the most recent 12 consecutive patients. RESULTS: Five different kinds of aneurysms in the anterior circulation were clipped through this method and 12 patients were cured. One patient, intraoperative accidental aneurysm rupture occurred. There were no approach-related complications. CONCLUSIONS: This endoscope-assisted microsurgical technique via supraorbital keyhole approach is a safe, minimal invasive and effective way for the treatment of aneurysms in the anterior circulation, and there is more sufficient operating space.

Adult↗

PubMed2003

Realistic Virtual Endoscopy of the ventricle system and haptic-based surgical simulator of hydrocefalus treatment.

New methods and software tools for automatic extraction of the ventricle system from magnetic resonance imagery (MRI) data, ventricle part classification, and realistic texturing are proposed to support Virtual Endoscopy (VE). Volume- and surface-based medical atlases are intensively used as templates in the methods. The processed ventricle-related surfaces are then utilized in a haptic-based system, which provides a surgeon with several basic functions simulating "virtual treatment" of hydrocephalus.

Cerebral Ventricles↗

PubMedDate not supplied

[Endoscopic transsphenoidal treatment of pituitary adenomas].

BACKGROUND AND PURPOSE: The aim of this study is to present a new endoscopic transnasal transsphenoidal method of surgical treatment of pituitary adenomas and to evaluate the results and complications of the method. MATERIAL AND SURGICAL TECHNIQUE: From October 2001 to June 2003 in the Department of Neurosurgery of the Medical University of Silesia in Katowice 88 operations of pituitary adenomas were performed using the transnasal transsphenoidal endoscopic method. The group of patients consisted of 50 females and 38 males. The youngest patient was 11 years old and the oldest was 79 years old. Patients were operated on using the 4-mm diameter endoscope with 0- and 30-degree angled lenses, using a method of operation according to Jho and Carrau with own modifications. At the time of surgery the operation team included 2 neurosurgeons, an anesthesiologist and a laryngologist. RESULTS: In the group of 51 nonfunctioning adenomas, in 32 cases we obtained the total removal of the tumor, which amounts to 63%. Among 37 of hyperfunctioning adenomas there were 11 prolactinomas, 19 GH secreting adenomas and 7 ACTH secreting adenomas. In all cases of prolactinomas the tumor was removed totally and in the cases of GH secreting adenomas and ACTH secreting adenomas the total removal of the tumor was performed in 58% and 86% of the cases, respectively. One patient within our group died after the operation. It was the patient with a huge nonfunctioning macroadenoma, with hydrocephalus and preoperative disturbances of consciousness. The permanent diabetes insipidus occurred in 2 cases, which amounts to 2.3% of all operated patients. In this group we noticed the intraoperative CSF leakage in 20 cases but we did not observe the postoperative CSF leakage or any rhinological complications. CONCLUSIONS: The endoscopic transnasal transsphenoidal approach is an efficient method of surgical treatment of pituitary adenomas. The advantage of this method is low invasiveness and a small number of serious complications.

Adenoma↗

PubMed2005

[Clinical application of minimally invasive neuroendoscopic techniques].

OBJECTIVE: To summarize and analyze the application of neuroendoscopic techniques in neurosurgery, and to discuss the role and significance of neuroendoscopic techniques in the diagnosis and treatment of neurosurgical diseases. METHODS: We treated 1300 patients with different neurosurgical diseases by performing endoscopic neurosurgery (EN) and endoscopy-assisted microneurosurgery (EAM). Among 1300 paitents, 522 were treated with pure endoscopic neurosurgery, 260 with endoscopy-assisted microneurosurgery, 79 with endoscope-controlled bur hole trephination neurosurgery, 434 with endoscope transsphenoidial surgery, and 5 with other techniques through which an endoscope was used in conjunction with stereotactic guidance. RESULTS: Totally 362 hydrocephalus patients were treated using EN. Among them, 190 were treated by third ventriculostomy, 30 by V-P shunt, and 142 patients with complicated hydrocephalus and unsymmetry hydrocephalus by endoscopy-controlled pathologic septum fenestration, septum pellucidum fenestration, and treatment of inventricula inflammation. Clinical symptomatic improvement was achieved in 341 of 362 patients (94.2%). Also 160 intracranial cyst patients were treated using EN for resection and partial resection. Eighty-two patients were performed through cyst-ventricula fenestration. Clinical symptomatic improvement was achieved in 76 of 82 patients (92.7%). Seventy patients treated with endoscopy-controlled bur hole neurosurgery and 8 cases with endoscopy-assisted microneurosurgery got better recovery after operation. Among 260 patients with brain tumors, 252 patients were operated with EAM (190 patients with epidermoid cyst), 8 patients with EN (all brain tumors with diameters < 2.5 cm in inventricular). Clinical symptomatic improvement was achieved in 228 of 260 patients (87.7%). Among 49 patients with inventricular and cistern cyst, 40 patients who were treated by EN and 9 patients by endoscopy-controlled bur hole neurosurgery were resected and their clinical symptoms were improved after operation. Among 434 patients with sellar region lesions, 387 patients with pituitary adenomas, 19 patients with repair for CSF leaks, 9 patients with chordoma, and 19 patients with other neurosurgical diseases were performed with endoscopy-controlled transsphenoidial surgery. Clinical symptoms in 88.9% (386/434) of these patients were improved. Another 5 patients were treated with endoscopy combined with navigation and stereotatic guidance with good results. The complications related to operation were found in only 2% of all the patients including hemorrhage, infection, and damage of important structure. CONCLUSIONS: Clinical application of neuroendoscopic techniques can decrease the damage caused by pure open surgery operation. It is possible to resect lesions at the utmost and protect normal tissue from lesions for using EN and EAM or endoscopy-controlled microneurosurgery (ECM). It is also helpful to enhance surgical quality and, reduce the complications.

Adolescent↗

PubMedDate not supplied

[Transsphenoidal surgery for large and giant pituitary adenomas by intraoperative video endomonitoring].

The paper analyzes the outcomes of surgical treatment of patients with pituitary adenomas on the basis of 614 performed transsphenoidal surgical appliances, of which there were 209 large and giant pituitary adenomas. The use of intraoperative video endomonitoring during these interventions could substantially reduced the number of complications, enhance the radicalism and selectivity of a surgical appliance. By using such advantages as endoscopy as powerful lighting, an endomicroscopic phenomenon, and a lateral view, at surgery we could precisely determine the borders of an adenoma, the site and sizes of non-removed tumors fragments. The lateral view of an endoscope permits removal of a tumor via the optimal access, prevention of traumatization of cerebral structures and the contents of cavernous sinuses. If there is intraoperative liquorrhea, the latter can be verified and eliminated. Thus, the accumulated experience allows the authors to recommend using intraoperative video endomonitoring during transsphenoidal surgery for pituitary adenomas.

Adenoma↗

PubMed2005

[Resection of extensive pituitary adenoma via supraorbital keyhole with endoscope-assisted microneurosurgery].

OBJECTIVE: To study the methods and techniques of the treatment for extensive suprasellar pituitary adenoma and repairing hole. METHODS: From Feb. 2001 to Mar. 2003, 9 patients with extensive suprasellar pituitary adenoma underwent resection via supraorbital keyhole with endoscope-assisted microneurosurgery. Then the remaining tumor was removed with neuro-endoscopy via I and II space of optic chiasma. The small bone flap was fixed with Ti clamp. RESULTS: After the tumor was removed with microneurosurgery, the remaining tumor was still found with endoscope in 7 cases. Remaining tumor was totally removed in 6 cases, almost removed in 3 cases. The vision improvement was found in 7 cases one week after surgery. In the other 2 cases, the vision remained unchanged. Follow-up was conducted in 6 cases for 6 to 22 months. Neuroradiological recovery of MRI with no recurrence of tumor was observed. No complication of incision was present. CONCLUSION: Enough intra and extra-cranial space can be provided to operate via orbital roof approach to sellar tumors. Endoscope-assisted microneurosurgery can increase the total-resection and successful rate treatment for extensive suprasellar pituitary adenoma, reduce the possibility of complication, and protect the function of brain from being injured. Fixation of small bone flap with Ti clamp is safe, easy and reliable.

Adult↗