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At least 73 records · Page 4Linked to original sources
PubMed1997

Flexible neuroendoscopy for percutaneous treatment of intraventricular lesions in the absence of hydrocephalus.

A procedure with a flexible fiberoptic neuroendoscope was applied to a series of patients with small lesions in the lateral ventricle, not associated with hydrocephalus. The maneuverability of the flexible neuroendoscope allows the surgeon to work in narrow spaces of the lateral ventricle avoiding surgical trauma to surrounding neural structures. The safety and accuracy of this procedure depend upon how available working space is obtained in the undilated ventricles. Both shaft-rotation and tip-flexion of the flexible neuroendoscope are available for adjusting it to the wider axis in each region of the lateral ventricle and for dealing with the intraventricular lesions. Three patients with a small intraventricular lesion, two with arachnoid cysts and one with subependymal hematoma, underwent such a procedure successfully. It is concluded that this neuroendoscopic procedure provides benefits to the treatment of small intraventricular lesions regardless of the size of the cerebral ventricles.

Adult↗
PubMed2000

Neuroendoscopy in microvascular decompression for trigeminal neuralgia and hemifacial spasm: technical note.

Miocrovascular decompression is an effective treatment for trigeminal neuralgia (TN) and hemifacial spasm (HFS). A complete cure cannot be obtained, and additional adjuncts for extended use of endoscopy are needed. The use of an endoscope combined with the operating microscope can enhance the surgeon's ability to view deep structures during operation. We study the application of combined microsurgical and endoscopic techniques in 21 cases of HFS and 12 cases of TN. With these techniques the surgeon can explore the ventral aspect of the brainstem and cranial nerves without further retraction, can see the groove caused by compression of the offending artery, and can confirm the proper position of the prosthesis after attachment to the dura by fibrin glue. In HFS the most common offending vessels in 75% of cases were the posterior inferior cerebellar artery (PICA) and anterior inferior cerebellar artery (AICA) and in 25% of cases the vertebral artery (VA). In trigeminal neuralgia the offending vessel in 60% of cases was the superior cerebellar artery (SCA), and in 40% of cases the AICA. The overall success rate was 97% with minimal morbidity 3% (facial palsy) and no mortality. The aim of this work is to study advantages and disadvantages of using endoscopy during microvascular decompression for TN and HFS.

Brain Stem↗
PubMed2000

Neuroendoscopy combined with frameless neuronavigation.

Minimal invasive neurosurgery is becoming more and more standard in neurosurgical procedures. Several types of lesions are now approached endoscopically. The surgical planning and intraoperative orientation during endoscopic surgical procedures are sometimes difficult. To solve this problem, a combination of the endoscopic procedure with a frameless, armless neuronavigation system is used in our service. The combination of the endoscope and the frameless navigation system was used in tumour surgery, ventriculostomies and arachnoid cyst operations. All procedures were performed successfully. The combination of both systems has proved to be advantageous because of safe surgical planning using the frameless stereotactic technique and the possibility of real time orientation of the endoscope. This technique is very useful in removing intraventricular and large brain mass lesions.

Arachnoid Cysts↗
PubMed2001

Episodic high irrigation pressure during surgical neuroendoscopy may cause intermittent intracranial circulatory insufficiency.

Intermittent high peak pressure values inside the endoscope during neuroendoscopic surgical procedures are associated with postoperative morbidity. Unexpected delay in awakening is the complication most frequently observed by the anesthesiologist as a result of high peak pressure values inside the endoscope. During eight neuroendoscopic procedures the authors continuously monitored cerebral hemodynamic function, using a transcranial doppler (TCD) probe fixed on patients' temporal window. We observed that episodes of high peak pressure values inside the endoscope during neuroendoscopic navigation rinsing periods resulted in changes in the TCD wave profile consistent with "near intracranial circulatory arrestlike" wave. No systemic hemodynamic warning signs accompanied these intermittent episodes of severe decrease in cerebral perfusion pressure. When the rinsing liquid was allowed to escape, the pressure inside the endoscope decreased and the TCD wave immediately returned to its previous value. Neuroendoscopic procedures, although classified as minimally invasive surgery, warrant special monitoring that could alert us to a decrease in cerebral perfusion pressure. Middle cerebral artery TCD recording is a reliable and accurate tool for this purpose.

Adult↗
PubMed2006

Orbital head pain elicited by neuroendoscopy of the third ventricle performed under local anesthesia.

Endoscopic third ventriculostomy (ETVS) is considered a minimally invasive procedure for blocked hydrocephalus. In 24 cases, this procedure was carried out in awake patients under local anesthesia. All patients reported abrupt orbital pain when the third ventricle floor was manipulated. Although recent advancements in knowledge of some forms of migraine and cluster headache could be regarded as a good basis for interpreting the pain triggered by ETVS, other hypotheses should also be taken into consideration.

Adult↗
PubMed1996

Introduction of a second working portal for neuroendoscopy. A technical note.

The introduction of a second portal during endoscopic procedures in presented. This second portal allows passage of larger instruments while the surgical field is viewed with an endoscope placed through the first portal. This dual portal technique provides an angled view of the operative site, thus avoiding optical obstruction by tissue being pulled toward the endoscope. We report the use of this technique in 6 endoscopic cases.

Adolescent↗
PubMed2004

Isolated third and fourth ventricles associated with neurosarcoidosis successfully treated by neuroendoscopy--case report.

A 48-year-old woman presented with a unique case of isolated third and fourth ventricles associated with neurosarcoidosis, manifesting as upward gaze palsy. She had a past history of surgery for intracranial sarcoid granuloma 10 years previously and placement of a ventriculoperitoneal shunt 3 years later. Magnetic resonance imaging revealed isolated third and fourth ventricles. Endoscopic plasty of the right foramen of Monro, fenestration of the septum pellucidum, and revision of the ventriculoperitoneal shunt were performed. Postoperatively the size of the third and fourth ventricles was reduced, and the upward gaze palsy resolved. Endoscopic treatment is less invasive and effective for the treatment of multiple septum formation in the ventricular system.

Female↗
PubMed2003

Intracranial hypertrophic calcification complicating neuroendoscopy. Report of three cases.

Three cases are presented in which progressive hypertrophic calcification formed following ventricular endoscopy. After a ventricular endoscopy has been performed, it has been the authors' practice to seal the burr hole with bone dust. They believe that the calcifications formed from bone dust that fell into the track left by the endoscope. This is the first time this complication has been described.

Adult↗
PubMed1997

[Primary clinical experience of neuroendoscopy: report of 19 cases].

10 cases of basal ganglion and 6 of subcortical hematoma were evacuated. One case of temporal and 2 cases of para- and intra-ventricle arachnoid cyst were fenestrated towards the cistern or lateral ventricle. Burred holes were near the lesion, through which endoscope should run. We guided the endoscope to the target by stereotatic equipment in 10 cases of basal ganglion hematoma and 1 case of ventricle arachnoid cyst, and introduced endoscope by free-hand in other cases. Hematoma group: CT reexamination within 48 hours showed that the residual hematoma was less than 20%-30% in 9 of 11 cases. Cyst group: symptoms of all cases of arachnoid cysts were alleviated after intervention. CT after a month showed that fenestration entrance could be seen clearly in 2 cases. The cyst reduced 20%-30% in 1 case. There were no direct complications in the group. It was shown that operation by endoscope is minimal invasive and little complicated.

Adolescent↗
PubMedDate not supplied

[Advantages of neuroendoscopy in the management of non-communicating hydrocephalus].

INTRODUCTION: Non-communicating hydrocephalus is defined as a blockade of the physiological cerebrospinal fluid (CSF) flow from the choroid plexus to the subarachnoid space. Usually, a ventricle peritoneal shunt with a valve is employed as treatment but this does not provide a physiological restoration on the CSF flow. OBJECTIVE: The aim of the study is to introduce a more physiological solution by means of endoscopic technique. We also pretend to find out some prognostical factors related to successful treatment. PATIENTS AND METHODS: We present a prospective non-randomized series of 32 endoscopic III ventriculostomies performed in patients with non-communicating hydrocephalus. When the blockade was due to a tumor, an endoscopic biopsy was performed at the same surgical time. In the same way, if the cause was a ventricular hematoma, an endoscopic aspiration was performed. The patients follow-up was two years. RESULTS: The procedure was considered successful (83.8% of the cases) when the clinical symptoms resolved without ventricle-peritoneal shunt. We study the relationship of the blockade level and the highest value of intracranial pressure during endoscopy with the results of the procedure in terms of success and morbidity. We have found significant relation between high pressure during endoscopy and the practice of a complementary biopsy or hematoma evacuation. CONCLUSIONS: Endoscopic third ventriculostomy provides an effective and physiological solution to non communicating hydrocephalus. Complementary endoscopic procedures can be associated at the same surgical time, however this association can be related to increased values of intracranial pressure during surgical performance.

Adolescent↗
PubMedDate not supplied

[Neuroendoscopy in the treatment of third ventricular hydrocephalus accompanying tumors of the posterior part of the third ventricle in children].

OBJECTIVE: The aim of the study was to evaluate the effectiveness of endoscopic third ventriculostomy (ETV) in non-communicating hydrocephalus secondary to tumour of the posterior part of the third ventricle tumours in children. MATERIAL AND METHODS: The study group consisted of 32 patients (13 girls and 19 boys) treated at the Department of Neurosurgery Children's Memorial Health Institute in Warsaw in the years 1996-2000. In 22 cases benign tectal mass (BTM) and 10 malignant neoplasms (including 9 germ cell tumours and 1 ependymoma) were diagnosed. The follow-up period after ETV ranged from 5 months to 4 years (mean 21 months). The retrospective analysis of medical reports and control CTs, MRs, and PC MR-cine studies was performed. RESULTS: In all the patients the early (up to 3 months postop) outcomes were good. 8 patients with malignant neoplasms after initial chemotherapy underwent residual tumor excision (more than 3 months after ETVs) and in two of them the CFS meningeal tumor spreads were detected. In 26 (81%) of the patients permanent control of hydrocephalus was achieved. The recurrence of active hydrocephalus was observed in 6 cases (19%). 3 of them were children with benign tectal masses and 3 with malignant tumours. The reason of failure in 2 cases was associated with meningeal tumor dissemination, and in one with postoperative bleeding after surgical tumor excision (communicating hydrocephalus). In 2 cases with benign tumours reasons of failures were not clear (patent stomies on PC MR-cine) and in 1 case late stomy occlusion on PC-MR flow study was diagnosed. Five out of 6 patients underwent shunt placements and in 1 case with late ventriculostomy occlusion another endoscopic procedure (after 26 months) was successfully performed. CONCLUSIONS: The endoscopic third ventriculostomy was an efficient method to control non-communicating hydrocephalus in children with posterior part of the third ventricle brain tumours. The PC MR flow study was a useful diagnostic tool in the stomy patency evaluation and in further treatment planning in cases of failures. It seems that recurrence of active hydrocephalus can be successfully treated with repeated ETV when the stomy occlusion is detected on MR flow studies. Other cases of failures ought to be treated by shunt implantations.

Adolescent↗
PubMedDate not supplied

[Neuroendoscopy in the treatment of obstructive hydrocephaly].

OBJECTIVE: The purpose of this study was to determine the safety and efficacy in the first sixteen patients operated by endoscopic third ventriculostomy for triventricular obstructive hydrocephalus in the Hospital of S. João-Porto. METHODS: Operated from December 1998 to December 1999, there were one adult, one teenager and 14 children, with a average age of 18 months in the paediatric group. The three major causes for the changed CSF dynamics in this 16 patients were: three had aqueductal congenital stenosis; nine had aqueductal acquired obstruction (three with post-infectious occlusion, three with tumours, two with intraventricular cysts and one with a pineal arteriovenous malformation), and four with obstruction of the basal arachnoidal cisterns associated with myelomeningocele. RESULTS: The endoscopic third ventriculostomy (ETV) was concluded in 15 of the selected cases (it was not possible in a new-born with hydrocephalus after bacterial meningitis), and it was repeated in two patients. The success rate (clinical efficacy of the procedure) was 9/15 (60%), and the mean follow-up was 9.1 months (range from three to 15 months). CONCLUSION: ETV is a efficient method in the treatment of non-communicant hydrocephalus. The safety and low-time consuming of this technique, avoiding the shunt disease, makes it desirable specially in paediatrics patients, or even in the case of different cases of hydrocephalus were some obstructive factor could be identified. So, some patients with a previous shunt or with a diagnosis of myelomeningocele, can benefit with this procedure.

Adolescent↗
PubMed2003

[Biportal neuroendoscopy of the prepontine cisterns].

INTRODUCTION: While bi- or multiportal approaches have been adopted in different fields of surgery including abdominal and spine surgery, the uniportal access into the skull is a traditional principle in neurosurgery. In this preclinical cadaver study the authors developed combinations of biportal endoneurosurgical dissections in the prepontine subarachnoid space to test the safety of this technique. METHODS: In 34 fresh post-mortem adult human cadavers and 14 formaldehyde-fixed adult human head specimen a total of 48 biportal endoscopical dissections were carried out. 0 degree, 30 degrees, and 70 degrees lens scopes with a diameter of 1.7 and 4.2 mm and trochars with a diameter of 5.0 to 6.5 mm were used. RESULTS: Six different endoscopic routes to the prepontine region and a total of 10 different combinations of this approaches could be described. Useful and safe biportal combinations were: 1. supraorbital on both sides, 2. supraorbital combined with ipsilateral anterior subtemporal, 3. supraorbital combined with contralateral anterior subtemporal, 4. supraorbital combined with ipsilateral posterior subtemporal, 5. supraorbital combined with ipsilateral frontal interhemispheric, 6. supraorbital combined with contralateral frontal interhemispheric, 7. anterior subtemporal combined with ipsilateral frontal interhemispheric, 8. anterior subtemporal combined with contralateral frontal interhemispheric. CONCLUSION: The biportal endomicrosurgical strategy offered effective and safe dissections within the prepontine subarachnoid space.

Adult↗
PubMed1996

Neuroendoscopy.

There is currently a great deal of interest in endoscopy in the field of neurosurgery. Given that the central nervous system is bathed in a clear fluid, the brain and spine have always seemed perfect environments "inwhich to use endoscopes, and attempts have been made to do so since the early years of the century. The delicacy of the maneuvers required, the size of the endoscopes, and the rapid advances in other forms of neurosurgical technology all served to hamper the development of this field, until recently. Endoscopes with diameters ofless than 1mm are now available, as are endoscopes with irrigation and working channels in ad- dition to a degree of controlled flexibility as small as 2.3 mm.The only limits to the greater use of endoscopes in the brain are human ingenuity and human expertise-arguably infinite resources.

Journal Article↗
PubMed1997

Neuroendoscopy: current applications and future directions.

Endoscopy is ideally suited to any organ that is hollow and fluid filled. The ventricular system, although only 10% of the total intracranial volume, is the site of many pathological processes. It is filled with crystal clear cerebrospinal fluid and lined thoughout by ependyma. Unfortunately access to it is invariably through normal brain tissue, but morbidity can be limited by choosing areas that are not as eloquent as others. The size of the ventricles limits the type of scope and instrumentation that can be used, but as technology advances these limitations are diminishing.

Journal Article↗