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At least 37 records · Page 2Linked to original sources
PubMed2004

The evolution of stereotactic guidance in neuroendoscopy.

OBJECTIVES: To evaluate the advantages and limitations of the utilized system in accordance with the operative indications of stereotactic neuroendoscopy. PATIENTS AND METHODS: We reviewed our collective experience of computer-assisted stereotaxy (frame-based and frameless) and virtual endoscopy in neuroendoscopic surgery from 1982 to 2003. Sterotactic guiding systems (frame-based and frameless) have been used to perform more than 450 neuroendoscopic operations at our institute. RESULTS: Even though image guidance is not essential in all cases, technological developments have definitely been one of the major factors in improving outcomes. Planning endoscopic trajectory and intraoperative orientation within the ventricular system or other cavities are the main indications for its application. CONCLUSIONS: No surgical tool, no matter how accurate, can be a substitute for thoughtful and methodical pre-operative planning. Image-guided technologies are applied in order to make endoscopic surgery safer, faster and more easily reproducible. Despite the high initial cost of the equipment, overall expenses are expected to be reduced because of greater operative efficiency and shorter hospital stay.

Adolescent↗
PubMedDate not supplied

[Binocular and monocular visors for neuroendoscopy and endoscopy-assisted neurosurgery].

This paper reports the testing of a lightweight wearable stereoscopic display during neuroendoscopies and endoscope assisted neurosurgeries. The viewers tested were a binocular (for the surgeon) and a monocular system (for the instrumenting nurse), whose optics are specially designed for wearable, portable applications and comprise a color corrected refractive magnifying system.

Equipment Design↗
PubMedDate not supplied

[Observation of the ventricular system and subarachnoid space in the skull base by flexible neuroendoscopy: normal structures].

Worldwide in the last two decades, in Latin America in the last decade, and Mexico in particular cerebral endoscopy as part of the minimally invasive neurological surgery, has constituted a significant advance for the treatment of neurological diseases such as congenital or acquired hydrocephalus, Chiari malformation, neurocysticercosis, stroke, ventricular and paraventricular tumors and cysts, arachnoidal cyst and hydrocephalus secondary to shunt malfunction. The lateral ventricles, the third ventricle, the cerebral aqueduct, the fourth ventricle, and the subarachnoid basal cisterns are among the most non-accessible regions of the central nervous system. Due to light-rand fiber optic-systems in combination with the experiences of nine consecutive year's and more than 600 endoscopies, most of them flexible neuroendoscopies, we present the neuroendoscopic approach with flexible cerebral endoscope to the anatomy and its normal variants of the whole ventricle system and the subarachnoid basal cisterns including the subarachnoid space of the cervical spine. We also describe their site related structures including veins, arteries, cranial nerves, pituitary gland, choroidal plexus and their normal anatomic variants.

Cerebral Ventricles↗
PubMed2001

Contact laser-assisted neuroendoscopy can be performed safely by using pretreated 'black' fibre tips: experimental data.

BACKGROUND AND OBJECTIVE: Laser-assisted endoscopic neurosurgery by using conventional fibres requires the use of high-power laser light. Because this is potentially hazardous, we developed a pretreated fibre tip and evaluated tissue effects in vitro and in vivo. STUDY DESIGN/MATERIALS AND METHODS: By applying a highly absorbing coating to the front of the ball tip, almost all laser light is transformed into thermal energy, instantly producing ablative temperatures at the tip itself. The temperature distribution was examined by using an in vitro thermal imaging technique. The in vivo effect on rabbit cerebral tissue was examined macroscopically and histologically. RESULTS: By using a conventional fibre tip, ablation was not observed, despite the use of high energy and power (20 W for 10 seconds), whereas histology and thermal imaging demonstrated deleterious effects deeply into the cerebral tissue. By using the coated fibre tip, ablation was observed at low energy and power (1 W for 1 second) with thermal effects restricted to superficial structures. CONCLUSIONS: We show that laser-assisted neuroendoscopy can only be considered to be safe when pretreated "black" fibre tips are used, as laser light damages deep structures.

Animals↗
PubMed1997

[Neuroendoscopy and endoscopic neurosurgery].

The trend in recent neurosurgery is going toward further reduction of invasiveness and avoidance of traumatization of the brain, spinal cord, and peripheral nerves to reduce the risk of neurological and mental deficit. In this way, the duration of hospital-stay and disablement can be shortened. An important "minimally invasive" technique is neuroendoscopy. The ventricular system and the subarachnoid space of the brain give suitable conditions for the use of an endoscope. Non-communicating hydrocephalus is the most frequent indication for an endoscopic approach. However, arachnoid cysts, cystic tumors, and intraventricular lesions may also effectively be treated with an endoscope. Using special instruments, laser devices, and bipolar diathermy, even highly vascularized lesions, such as cavernomas, may be completely resected. Moreover, endoscopes are used in the treatment of various spinal diseases and carpal tunnel syndrome, as well as in endoscopy-assisted microsurgery.

Brain Diseases↗
PubMed1999

Pediatric neuroendoscopy in Chile. Analysis of the first 100 cases.

The personal series of the first 100 cases of neuroendoscopy performed at the Pediatric Neurosurgery Service of the Institute of Neurosurgery Alfonso Asenjo in Santiago-Chile is presented. The patients were the first to undergo endoscopic operations for different types of hydrocephalus and their ages ranged from newborn up to 15 years. Their clinical records, surgical protocols, radiologic results, videos and follow-up are reviewed. A mortality of 2% and a morbidity of 7% were found in this group, hemorrhage, ventriculitis and CSF leakage being the main problems. Success was achieved in more than 75% of cases in the whole series. If we only consider the group of III ventriculostomies performed in noncommunicating hydrocephalus, our success rate rises to 90%. Follow-up ranges from 30 months in the first case to 2 months in the last case considered. All patients were operated on by the author using a rigid Gaab scope with 5.8 mm OD coupled to a Codman light source and a microcamera. Surgical technique was always the same using a right precoronal burr hole. Prophylaxis with vancomycin was indicated in all cases. General, partial and specific results are presented and allow the conclusion that this is an excellent procedure when it is well indicated. It means a great saving in shunts and treatments and has become an alternative to shunts in all neurosurgical units.

Adolescent↗
PubMed2003

Neuroendoscopy: one year of experience--personal results, observations and limits.

After reading reports of successful neuroendoscopic treatment of hydrocephalus, colloid cysts and arachnoid cysts as well as tumor biopsy, we started using endoscopic procedures in our Department, one year ago. One surgeon (E.S.) skilled in the Decq Endoscope, performed a series of sixteen procedures, from January 2001 to March 2002 (in patients aged 28 to 69 years). The most common pathology was obstructive hydrocephalus (14 cases), one was colloid cyst, and the last case was tumor biopsy. The surgical treatment consisted of third ventriculostomy, cyst opening and shrinking and tumor biopsy. In fourteen patients treated for hydrocephalus with third ventriculostomy (ETV), one required a definitive shunt. Complication occurred in one case with chronic subdural collection. We further report one case of aqueductal restoration after third ventriculostomy. Our results, with no neurological deficits or deaths, confirmed our opinion that neuroendoscopy is a safe surgical technique in well-selected patients and we believe it is the ideal treatment in obstructive hydrocephalus.

Aged↗
PubMed2003

Neuroendoscopy based on computer assisted adjustment of the endoscope holder in the laboratory.

OBJECTIVE: We present our initial clinical experience with a novel technique of frameless stereotactic neuroendoscopy using a neuronavigation system, a specially designed aiming device (endoscope holder/targeting device) combined with a vacuum-mouthpiece based head holder. Due to the reproducibility of patient immobilization in the fixation system, the endoscope holder can be adjusted in the laboratory in the absence of the patient. METHODS: An individual vacuum-mouthpiece was fabricated. The patients were scanned with an external reference frame attached to this mouthpiece and the images were transferred to the neuronavigation system. Determination of the path, mouthpiece-based registration and adjustment of the targeting device were performed the day before surgery in the absence of the patient. In the OR the patient was repositioned and the endoscope was introduced through the preadjusted aiming device to the precalculated depth. RESULTS: The novel technique was successfully used for frameless endoscopic navigation in five patients. Three endoscopic third ventriculostomies in adults, one endoscopic septostomy due to unilateral hydrocephalus in an adult female patient and one endoscopic ventriculo-cysto cisternostomy in a 20-month-old girl with a suprasellar arachnoid cyst, were performed with excellent clinical results and without technical complications. CONCLUSION: Our initial experience indicates that frameless stereotaxy, in combination with a relocatable head holder and a special targeting device, allows for precise and preplanned advancement of the neuroendoscope, reducing or even eliminating intraoperative registration and endoscope trajectory adjustments, thus substantially reducing OR time. Due to the non-invasive but rigid immobilization method, neuronavigation can also be performed in children under 2 years of age.

Adult↗
PubMed1998

Usefulness of neuroendoscopy in treating supracollicular arachnoid cysts--case report.

A 12-year-old girl presented with a supracollicular arachnoid cyst manifesting as a compressive headache. Neurological examination on admission revealed no deficit except bilateral papilledema. Stereotactic cyst puncture failed to perforate the cyst wall. The wall was then punctured using microforceps under neuroendoscopic guidance, followed by cystoperitoneal shunting. Her headache disappeared immediately after surgery. Neuroendoscopy is useful in treating a deep-seated arachnoid cyst.

Arachnoid Cysts↗
PubMed1999

Concurrent three dimensional neuroendoscopy: initial descriptions of application to clinical practice.

Applications of endoscopic technique neurosurgery are becoming increasingly popular as greater evidence of the safety and efficacy of these techniques is reported. Nevertheless, significant technical limitations need to be solved before neuroendoscopy can achieve widespread popularity. One limitation is the surgeon's difficulties in becoming anatomically oriented in a two-dimensional (2-D) environment. The lack of appropriate visual cues to orient oneself in three-dimensional (3-D) space makes relatively simple anatomical regions difficult to navigate. The authors describe an endoscopy system that allows for stereoscopic visualization during minimally invasive procedures and that acts as an adjunct to conventional open craniotomies. Four cases are described in which stereoendoscopy was used as either a primary means of visualization or as an adjunct to the operating microscope in conventional open neurosurgical procedures. The authors believe that stereoendoscopic vision is a significant advance in endoscope technology and will play a large role in the popularization of minimally invasive techniques in neurosurgery.

Journal Article↗
PubMed2002

Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma.

OBJECT: Nonfunctioning pituitary adenomas comprise approximately 30% of all pituitary tumors. The purpose of this retrospective study is to evaluate the efficacy and role of gamma knife radiosurgery (GKS) in the management of residual or recurrent nonfunctioning pituitary adenomas. METHODS: A review was conducted of the data obtained in 42 patients who underwent adjuvant GKS at the University of Pittsburgh between 1987 and 2001. Prior treatments included transsphenoidal resection, craniotomy and resection, or conventional radiotherapy. Endocrinological, ophthalmological, and radiological responses were evaluated. The duration of follow-up review varied from 6 to 102 months (mean 31.2 months). Fifteen patients were observed for more than 40 months. The mean radiation dose to the tumor margin was 16 Gy. Conformal radiosurgery planning was used to restrict the dose to the optic nerve and chiasm. Tumor control after GKS was achieved in 100% of patients with microadenomas and 97% of patients with macroadenomas. Gamma knife radiosurgery was equally effective in controlling adenomas with cavernous sinus invasion and suprasellar extension. No patient developed a new endocrinological deficiency following GKS. One patient's tumor enlarged with an associated decline in visual function. Another patient experienced a deterioration of visual fields despite a decrease in tumor size. CONCLUSIONS: Gamma knife radiosurgery can achieve tumor control in virtually all residual or recurrent nonfunctioning pituitary adenomas. Dose sparing facilitates tumor management even when the adenoma is close to the optic apparatus or invades the cavernous sinus.

Adenoma↗
PubMed1999

A voice-controlled robotic assistant for neuroendoscopy.

This paper describes experiments with a voice-controlled robot system to be used in endoscopic neurosurgery. The robot was a modified version of the robot described in previous publications of the group at Fraunhofer IPA and HSK. To control the robot a voice-controlled user interface was developed. The experiments were conducted on cadavers for three standard approaches in neuroendoscopy. The goal was to gain experience with a voice-controlled user interface and also with the set-up and use of the robotic system under clinical conditions. The results indicate that modifications to the robot and user interface are necessary. However the overall feasibility of the application was demonstrated.

Endoscopy↗
PubMed2002

[Application of neuroendoscopy in brain surgery].

OBJECTIVE: To investigate the effect of neuroendoscope on surgery. METHODS: 315 patients were treated with neuroendoscope. Endoscopic neurosurgery (EN) was used in 219 patients, endoscope-assisted microneurosurgery (EAM) in 72, and endoscope-controlled microneurosurgery (ECM) in 24. RESULTS: 201 (91.8%) of the 219 patients underwent EN effectively. In 72 patients who underwent EAM there was less retraction during tumor removal and visual control was improved. 21 (87.5%) of the 24 patients underwent ECM effectively. No severe complications were observed. CONCLUSION: Neuroendoscopy can reduce tissue trauma, improve visualization during tumor removal, and reduce complications.

Brain Neoplasms↗
PubMed2002

Robot-assisted navigated neuroendoscopy.

OBJECTIVE: Major steps in the evolution of advanced neurosurgical techniques include microneurosurgery, neuroendoscopy and its minimally invasive variations, neuronavigation, and advanced intraoperative imaging. With traditional neuroendoscopic techniques (e.g., freehand endoscopy or the use of mechanical arms), definitive controlled movement of the endoscope within the brain depends on the experience and skill of the individual neurosurgeon. METHODS: With the Evolution 1 precision robot (Universal Robot Systems, Schwerin, Germany), a new neurosurgical tool has become available for the precise steering of instruments within the cranium. After preclinical anatomic and precision studies, the system was used for neuronavigated endoscopic procedures for three patients. RESULTS: All robot-assisted, navigated, endoscopic procedures were successfully completed. The time for the registration procedure and setup of the robot decreased from 60 minutes for the first patient to 30 minutes for the third patient. The time for the surgical part of the endoscopic procedure ranged from 17 to 65 minutes. No complications occurred during any procedure. CONCLUSION: The use of robotic technology for neuroendoscopic procedures is a major advance for controlled movement of the endoscope within the cranium. The start-up procedure and calibration of the robot are still time-consuming, but the actual operation time is comparable to that of freehand neuroendoscopic procedures. Steering of the endoscope is facilitated, and the precision of the endoscopic movements is noteworthy.

Adolescent↗
PubMed1998

Neonatal applications of neuroendoscopy.

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

Endoscopy↗
PubMed2006

Cooperative study by the Italian neuroendoscopy group on the treatment of 61 colloid cysts.

OBJECTS: Microsurgical resection, stereotactic aspiration and VP shunt have for years been the choice options for the treatment of colloid cysts of the third ventricle. Recently, endoscopic approaches have aroused increasing interest and gained acceptance. Although safer, this minimally invasive approach is considered less efficacious than microsurgery. Relatively long-term results are now available and some conclusions might be inferred on the usefulness of this procedure. MATERIALS AND METHODS: Between 1994 and 2005, 61 patients harbouring a colloid cyst of the third ventricle were treated with neuroendoscopic technique in 11 Italian neurosurgical centres. Cyst diameters ranged from 6 to 32 mm. A flexible endoscope was used in 34 cases, a rigid one in 21, both instruments in six. The technique consisted in cyst fenestrations, colloid aspiration, coagulation of the internal cyst wall and, occasionally, capsule excision. Mean postoperative hospital stay was 6.7 days. Early postoperative neuroimaging revealed a cyst residue in 36 cases (mean diameter 4.3 mm). There were two complications (3.2%). Follow-up varied between 1 and 132 months (mean 32 months, more than 5 years in 17 patients). There were seven asymptomatic recurrences, three of them evolving from a previous residue. CONCLUSION: The endoscopic approach to the treatment of colloid cysts is safe, effective and well accepted by patients. Although asymptomatic, recurrences (11.4%) cast a persisting shadow on the long-term results, and, therefore, the controversy with the traditional microsurgical treatment remains open.

Adolescent↗
PubMed2005

Air encephalography for hydrocephalus in the era of neuroendoscopy.

INTRODUCTION: There is often uncertainty regarding the site of the cerebrospinal fluid (CSF) block in individual patients with hydrocephalus, leading to a significant failure rate for endoscopic third ventriculostomy (ETV) when performed for unconventional pathologies such as postmeningitic and posthaemorrhagic hydrocephalus. We describe the use of lumbar air encephalography (AEG) to refine the indications for ETV in such circumstances. METHODS: Data from AEG studies used to guide indications for ETV were collected prospectively. The technique and protocol for AEG have been modified from the historical description of the procedure in the interest of safety and to minimise discomfort. In a separate evaluation, the level of the CSF block was determined by one of the authors, who was blinded to the results of the AEG, based on conventional computerised tomographic criteria. These results are compared with those obtained from the AEG. RESULTS: Forty-five studies were performed over a 2-year period. Thirty-seven were preinterventional, the majority of which demonstrated communicating hydrocephalus. ETV performed in five cases of non-communicating hydrocephalus was successful in each. The prediction of the level of block based on CT criteria was poor. CONCLUSION: It is often difficult to determine whether hydrocephalus is communicating or not with conventional imaging in the absence of a clearly demonstrable lesional obstruction to the CSF pathways. We have found AEG helpful in excluding patients with communicating hydrocephalus from an inappropriate ETV. On the basis of our experience, we consider the modified procedure safe as long as a strict protocol is followed.

Analysis of Variance↗