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Results for “Neuroendoscopy”

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At least 145 records · Page 8Linked to original sources

PubMed2001

Endoscopic treatment of suprasellar and third ventricle-related arachnoid cysts.

OBJECTIVE: To evaluate the role of neuroendoscopy in the treatment of rare suprasellar and other third ventricle-related arachnoid cysts. METHODS: A review of supratentorial midline arachnoid cysts treated by endoscopic fenestration. RESULTS: Ten cases were identified. The median age of these ten patients was 7.5 years. In three a cysto- or ventriculoperitoneal shunt had previously been inserted. Six cysts were located in the suprasellar/prepontine area, one was a combined suprasellar/middle fossa cyst, and three were complex cysts arising mainly in the quadrigeminal cistern and extending into the third ventricle. Successful endoscopic fenestration to both the ventricular system and the basal cisterns ("bipolar" fenestration) was achieved in all cases. In seven cases a cystoventriculostomy and cystocisternostomy was performed, while in three a cystoventriculostomy was combined with a third ventriculostomy, achieving additional communication to the subarachnoid space. The previously inserted shunts were removed at the end of the procedure. The median follow-up period was 17 (range 1-30) months. The clinical outcome was excellent in all cases, despite only marginal reduction in the cyst size and persistence of ventriculomegaly in some cases. No further treatment to the cyst was required during the period of follow-up. CONCLUSION: Third ventricle-related arachnoid cysts can be satisfactorily and safely treated by endoscopy. This approach leaves the patient shunt independent.

Adolescent↗

PubMed1995

Video-assisted thoracoscopic resection of intercostal neurofibroma.

BACKGROUND Video-assisted thoracoscopy (VAT) is being increasingly utilized by thoracic surgeons as an alternative to thoracotomy for several thoracic disorders. Neuroendoscopy is an exciting addition to the neurosurgical armamentarium. These procedures are attractive alternatives in the era of minimally invasive surgery and cost containment, while providing the highest quality medical care to patients. METHODS We report the application of this technology in a patient presenting with intractable thoracic radicular pain secondary to an intercostal neurofibroma. Complete excision of the intercostal neurofibroma was performed utilizing VAT. RESULTS The patient reported good relief of her preoperative thoracic radicular pain. She was ready for discharge from the hospital within 72 hours of surgery. CONCLUSIONS With the advent of improved instrumentation, video-assisted thoracoscopy offers a safe alternative to thoracotomy and the potential benefits of less postoperative discomfort and shorter hospital stays. The potential neurosurgical applications of VAT should not be overlooked.

Adult↗

PubMed1995

Evaluation of endoscopy in the treatment of rare meningoceles: preliminary results.

BACKGROUND: Endoscopy is used on different occasions-for instance, to open the floor of the third ventricule in triventricular hydrocephalus, to open a cyst into the cerebrospinal fluid circulation, for biopsy or for partial resection of some tumors, or to insert a shunt in hydrocephalus or syringohydromyelia. However, the use of endoscopes for evaluating and treating meningoceles remains to be assessed. METHODS: Five different kinds of rare meningoceles are presented. In each, neuroendoscopy was used as the main tool for exploration and treatment. RESULTS: Two sacral meningoceles and one oral cephalocele were cured through a keyhole opening under endoscopic control. One posterior sacral meningocele was explored and no communication with normal subarachnoid spaces was observed, allowing a simple suture of the posterior to the anterior walls. And, last, a complex case with three intrasacral meningocles was explored and partially treated. CONCLUSIONS: Meningocles with very small communication within the normal subarachnoid spaces appeared the most suitable to be cured by an endoscopic procedure. In case of a larger communication, the meningocele could be treated, or at least the morphology can be better understood, by using a keyhole procedure under endoscopic control. In all cases the surgery was of short duration (less than 1 hour) and very well tolerated.

Adolescent↗

PubMed1996

Endoscopic treatment of septated chronic subdural hematoma.

BACKGROUND: Chronic subdural hematomas are well delineated collections of fluid (blood) between the dura mater and the arachnoid space. Two types of encapsulated chronic subdural hematoma can be distinguished: the nonseptated and the septated form. The nonseptated form can be treated easily using the burrhole-drainage method, whereas treatment of septated chronic subdural hematoma remains a therapeutical problem. The main problem is the division of the hematoma by neomembranes into compartments, which hinder the efflux of the hematoma fluid through one or two burrholes. METHODS: Since 1991 we have operated on 14 patients with septated subdural hematoma using flexible steerable endoscopes through a burrhole approach. The flexible endoscopes are fixed and guided with the help of the Marburg Neuroendoscopy Fixation and Guiding System. For resection of neomembranes small microscissors or microforceps were used. This technique avoids blunt rupture of the membranes which may cause bleeding. A closed drainage system is applied temporarily to guarantee the efflux of the remaining hematoma. RESULTS: From January 1991 to May 1994, 14 patients with the septated variant of chronic subdural hematoma were operated on using the endoscopic technique. After the neuroendoscopic intervention 12 patients had a sufficient or complete hematoma evacuation. One patient had to be operated on a second time, and there was one postoperative subdural infection. Long term follow up of all patients shows no recurrence of the subdural hematoma. CONCLUSION: Treatment of membraneous septated CSH using an endoscopic operative technique combined with the application of a closed drainage system is a minimally invasive method and a therapeutic alternative to the craniostomy-membranectomy technique.

Adult↗

PubMed1998

Advances in endoscopic neurosurgery.

This article describes the authors' experience using neuroendoscopes to perform a variety of intracranial procedures with minimal invasiveness to neural tissue. The article also presents the history of neuroendoscopy and provides information about current practice. Surgical technique and intraoperative and postoperative nursing considerations are reviewed.

Endoscopy↗

PubMed2003

Comparison of revision rates following endoscopically versus nonendoscopically placed ventricular shunt catheters.

BACKGROUND: Endoscopic placement of ventriculoperitoneal (VP) shunt catheters in pediatric patients has been increasingly used in an attempt to minimize the unacceptably high rates of revision. Although this procedure carries an increased expense, there is currently no evidence to support an improved long-term outcome. This paper compares the rates of revision following ventricular catheter placement for shunted hydrocephalus with and without the use of endoscopy. METHODS: We retrospectively reviewed the records of all pediatric patients who had undergone shunt placement for hydrocephalus between April 1992 and February 1998. All shunts placed before March 1995 were performed without the endoscope; all subsequent shunts were placed endoscopically. The independent effect of endoscopic versus nonendoscopic shunt placement on subsequent shunt failure was analyzed via multivariate proportional hazards regression model. Multiple logistic regression analyses were used to determine the independent effect of endoscopic placement on subsequent etiology of failure (infection, proximal obstruction, distal malfunction) in the 511 failing shunts. RESULTS: There were 447 pediatric patients who underwent a total of 965 shunt placements or revisions. Six hundred and five (63%) catheters were placed with the use of the endoscope. Three hundred and sixty (37.3%) were placed without the use of the endoscope. Neuroendoscopy did not independently affect the risk of subsequent shunt failure [Hazard Ratio (95% Confidence Interval) = 1.08 (0.84-1.41)]. Endoscopic placement independently decreased the odds [Odds Ratio (95% Confidence Interval) = 0.56 (0.32-0.93)] of proximal obstruction, increased the odds of distal malfunction [1.52 (1.02-2.72)], and was not associated with infection [1.42 (0.78-2.61)]. CONCLUSIONS: Endoscopic assisted ventricular catheter placement decreased the odds of proximal obstruction but failed to improve overall shunt survival in this 6 year experience.

Cerebral Ventricles↗

PubMed1998

The supraorbital keyhole approach to supratentorial aneurysms: concept and technique.

BACKGROUND: Anterior surgical approaches to the base of the brain have always required relatively large craniotomies, most larger than the lesion itself. Especially in aneurysm surgery, the size of the lesion is not always proportionate to the extent of brain exposure. The improvement of surgical techniques and diagnostic imaging, as well as the introduction of neuroendoscopy and new surgical instruments, enable us now to treat various intracranial lesions through small keyholes. In particular, cerebral aneurysms, because of their anatomic characteristics, are apt to be treated by the keyhole approach. The supraorbital keyhole approach has the broadest field of indications, although its technical aspects have not yet been evaluated. METHODS: The concept and technique of the supraorbital keyhole approach are presented in detail. We conducted a retrospective study in which we evaluated the technical aspects of the supraorbital keyhole approach considering the indications, limitations, and complications of this approach as well as new instrumentation in surgery of supratentorial aneurysms. RESULTS: The use of 139 supraorbital keyhole approaches for 197 aneurysms is described. Multiple aneurysms have been treated by one approach in 38 patients. Clipping of the aneurysm was performed in 94% and wrapping in 6% of patients. Eighteen aneurysms were contralateral to the approach. In four patients, intraoperative accidental aneurysm rupture occurred. There were no approach-related complications. CONCLUSIONS: The supraorbital keyhole approach offers equal surgical possibilities with less intraoperative accidental rupture and less approach-related morbidity as conventional approaches in the treatment of supratentorial aneurysms.

Adolescent↗

PubMed2003

Virtual endoscopy of the cerebral ventricles based on 3-D ultrasonography.

Virtual endoscopy enables preoperative surgical planning based on "surgeons' view" information in the individual patient. In neurosurgery, magnetic resonance (MR) images are mainly used for planning of virtual neuroendoscopy (VNE). We studied the feasibility of three-dimensional (3-D) ultrasonography as the imaging modality for VNE in pediatric patients with hydrocephalus. 3-D ultrasonography data sets were obtained through the open anterior fontanelle and analyzed using perspective volume rendering, with delineation of the ventricular system for anatomical details in relation to standard ultrasonography and intraoperative anatomy, during endoscopy in two infants with hydrocephalus. VNE clarified anatomical variants seen on standard ultrasonography images, anticipated ventricular dysmorphia seen during neuroendosopy and enabled a realistic impression of an endoscopic inspection into the ventricular system of the two infants studied. Based on 3-D ultrasonography, VE enables detailed information on ventricular anatomy in pediatric patients for planning of endoscopic interventions.

Cerebral Ventricles↗

PubMed2003

Cyst of the third ventricle as an unusual cause of acquired hydrocephalus.

Cysts of the third ventricle are rare congenital suprasellar malformations of arachnoidal, endodermal, or neuroepithelial origin. Depending on their size and location, they can cause space-occupying intracranial lesions and hydrocephalus occlusus by obstruction of the aqueduct or foramen of Monro. They can be missed on routine computer tomography and magnetic resonance imaging. A 2-year-old boy presented signs of intracranial pressure. Initial magnetic resonance imaging revealed a triventricular internal hydrocephalus with no visible etiologic lesion. An extended investigation with the constructive interference in steady state-technique showed a mobile cystic cerebrospinal fluid-intense lesion within the third ventricle, causing transient occlusion of the foramen of Monro. A suprasellar cyst of the third ventricle is an important differential diagnosis in apparently "idiopathic" internal hydrocephalus. In such cases, magnetic resonance imaging using the constructive interference in steady state-technique with a slice thickness of 1 mm is the method of choice for detecting intraventricular cysts. Neurosurgical fenestration and/or resection of the cyst by neuroendoscopy can resolve cerebrospinal fluid circulation disturbances and seems to be superior to a shunt.

Child, Preschool↗

PubMed2003

Endoscopic assisted microneurosurgery for cerebral aneurysms.

While there have been many advances in the field of microneurosurgery, the clipping of aneurysms remains an intricate procedure. Technical complications include residual aneurysm, perforator injuries, parent artery occlusion and cranial nerve injuries. The neuroendoscope is a useful tool and adjunct to the microsurgical clipping of these aneurysms. We study the usefulness of the neuroendoscope in enhancing visualisation during surgery. Twenty-four cases of ruptured cerebral aneurysms were operated on over a duration of 6 months in which a 1mm diameter rigid endoscope was used. We discuss our preliminary results and examine the advantages of the neuroendoscope. These include the ability to look around corners and behind obstructions. While this provides an additional view to the surgeon, the high magnification gives good definition of the surrounding structures. With less brain retraction, smaller operative exposures and yet better visualisation offered, neuroendoscopy may reduce operative morbidity.

Adolescent↗

PubMed1997

Recent advances in the understanding and treatment of hydrocephalus.

Advances in the management of patients with hydrocephalus and other abnormalities of cerebrospinal fluid dynamics and intracranial pressure have come from a variety of sources including an improved understanding of the pathophysiology of the various subtypes of the problem, development of alternative methods of treating the condition without reliance on implantable shunting devices, use of neuroendoscopy, and the development of newer types of shunt valves. The purpose of this review is to put into perspective the relative importance of each of these advances to the overall management of our patients.

Adult↗

PubMedDate not supplied

Endoscopic and minimally invasive microsurgical approaches for treating brain tumor patients.

Recent developments in neuroendoscopy and minimally invasive procedures have greatly impacted the diagnosis and treatment of brain tumors. In this paper, we will review these innovations and discuss how they have influenced our approach to the treatment of intraventricular and pituitary tumors. Finally, the concept of keyhole neurosurgery is illustrated by discussing 'eyebrow orbitotomy' approach as an example. As noninvasive therapeutic alternative become available, future neurosurgeons will be challenged to develop effective and less invasive surgical approaches for the diagnosis and treatment of patients will brain tumors.

Brain Neoplasms↗

PubMed2002

Anaesthesia for minimally invasive neurosurgery.

Technological advances in imaging, computing and surgical instrumentation have encouraged the application of minimally invasive surgical techniques to various neurosurgical disorders. This chapter discusses the wide application of neurosurgery and the implications for anaesthesia, focusing on the specific anaesthetic considerations for neuroendoscopy, stereotactic procedures and radiosurgery.

Anesthesia↗

PubMed2000

Traumatic subependymal hematoma during endoscopic third ventriculostomy in a patient with a third ventricle tumor: case report.

Endoscopic third ventriculostomy has become a routine intervention for the treatment of non-communicating hydrocephalus. This technique is largely considered safe and a very low incidence of complications is reported. However, hemorrhage in the course of neuroendoscopy is still a problem difficult to manage. The authors present a case in which endoscopic third ventriculostomy and tumor biopsy were performed in a young patient with a huge tumor growing in the posterior part of the third ventricle. The surgical approach to realize the stoma was difficult because the tumor size reduced the third ventricle diameter. Surgical manipulation produced a traumatic subependymal hematoma. This hematoma drained spontaneously after few minutes into the ventricle and the blood was washed away. The postoperative neurological course was uneventful and the ventriculostomy showed to work well by reducing the size of the lateral ventricles and the intracranial pressure in three days. This complication during endoscopic third ventriculostomy has never been reported before. We emphasize the difficulty of endoscopic procedures in patients with huge tumors in the third ventricle. Where reduction in size of the third ventricle and of the foramen of Monro ist present we suggest a careful approach to the third ventricle.

Adolescent↗

PubMed2000

Endoscopic third ventriculostomy with ultrasonic contact microprobe.

The authors describe their first clinical experiences in endoscopic third ventriculostomy (ETV) with the original ultrasonic contact microprobe (UCM) designed at the Department of Neurosurgery in Zagreb. The analysis includes the clinical course of disease in eight patients submitted to surgery from May to September 1999 (3 men and 5 women, from 14 to 61 years of age). Surgery was performed in patients with neurological symptoms of elevated intracranial pressure and neuroradiological evidence of non-communicating hydrocephalus caused by mesencephalic aqueduct stenosis. The perforation in the base of the third brain ventricle made by the ultrasonic contact microprobe was widened by a balloon catheter. The authors have come to conclusion that the ETV when performed by contact ultrasonic microprobe is a small risk procedure in case of non-communicating hydrocephalus. For its small diameter (1.6 mm) and simple handling the newly designed contact ultrasonic microprobe is very suitable for use in neuroendoscopy as it enables fenestration of the third brain ventricle with minimal thermal and ultrastructural damage to the adjacent neurovascular structures. Further research will be focused on defining indications for the use of the device in other neuroendoscopic procedures as well.

Adolescent↗

PubMed2000

Neuroendoscopic biopsy of tectal glioma: a case report.

OBJECTIVE AND IMPORTANCE: A type of intrinsic dorsal midbrain glioma known as benign tectal glioma can cause obstructive hydrocephalus. Because of its slow progress and relatively good prognosis, initial treatment should be cerebrospinal fluid diversion and biopsy. CLINICAL PRESENTATION: We report a 24-year-old man with obstructive hydrocephalus from a tectal glioma, who was admitted to the hospital for malfunction of a shunt placed 16 years previously. INTERVENTION: Magnetic resonance imaging demonstrated enlargement of the dorsal midbrain associated with increased signal intensity on T2-weighted images and fluid attenuation inversion recovery (FLAIR) images. No enhancement occurred with contrast administration. We performed a neuroendoscopic third ventriculostomy and biopsy of the tumor. Histologic examination of the specimen obtained disclosed a low-grade astrocytoma. No postoperative neurologic complications occurred. CONCLUSION: FLAIR images were superior to T2-weighted images in demonstrating abnormal intensity in the dorsal midbrain. Neuroendoscopy confirmed a yellowish tumor inferior to the posterior commissure occluding the entrance of the aqueduct, an observation useful in planning biopsy of the lesion. As the tumor apparently had existed for a number of years, the case supports the notion that the prognosis associated with these tumors is good.

Adult↗

PubMed2001

Operative management of third ventriculostomy in cases of thickened, non-translucent third ventricular floor: technical note.

Today, endoscopic third ventriculostomy is an established operative modality in occlusive hydrocephalus. The elemental step in third ventriculostomy is the perforation of the floor of the third ventricle. Especially with a thickened third ventricular floor, anatomical orientation can be disturbed and perforation of third ventricular floor technically difficult. The combination of a neuronavigation system with an endoscope provides interactive image-guided neuroendoscopy. Exact planning of the approach is thus possible and the ideal trajectory to the target area can be determined. We have combined interactive neuronavigation and intraoperative fluoroscopy for incorporating real-time feedback to optimize endoscopy in patients with a thickened third ventricular floor selected for third ventriculostomy.

Endoscopy↗

PubMed2001

Application of flexible neuroendoscopes to intracerebroventricular arachnoid cysts in children: use of videoscopes.

Videoscopes used in other parts of the human body are potential tools for neuroendoscopy as long as they are slim enough, because they provide exceptionally high resolution images. We describe the application of flexible videoscopes and neuroendoscopes developed in Japan to intraventricular arachnoid cysts in children. Thirty-eight children with middle fossa arachnoid cysts were treated either by conventional cystoperitoneal shunting operations (n = 28) or by neuroendoscopes (n = 10). Neuroendoscopic operations such as cyst fenestration were highly useful, eliminating the need for open surgery for cyst excision/fenestration or cystoperitoneal shunting operations in all of the patients during a mean follow-up period of 17.7 months. Statistically highly significant reductions were observed in the major complications (p < 0.0001 by chi(2)-test) because shunting operations were inevitably accompanied by shunt malfunction, infection, or dependence. Compared to the traditional neuroendoscopes, our slim videoscopes provided outstanding image quality, allowing for more comprehensive examination and treatment while minimizing operative trauma.

Arachnoid Cysts↗