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Results for “Neuroendoscopy”

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At least 163 records · Page 9Linked to original sources

PubMed2002

Surgical clipping of basilar aneurysms: relationship between the different approaches and the surgical corridors.

BACKGROUND: Surgical clipping for basilar artery aneurysm (BAA) is a technically demanding procedure due to the depth of the surgical field and the presence of vital perforating arteries in the vicinity. The incorporation of various modifications in the conventional approaches has expanded the surgical armamentarium in dealing with these difficult lesions. METHODS AND FINDINGS: 87 patients of BAA were operated at our center, out of which in 48 patients, a pterional transsylvian approach was used. In 12 patients, this approach had to be extended to incorporate the anterior temporal approach in 6 cases, transzygomatic subtemporal approach in 2 cases and transcavernous approach in 4 cases. The surgical indications for the additional approaches and the relationships between the surgical corridors gained by their inclusion were studied. The use of neuroendoscopy facilitated adequate clipping in one case of high BAA without the incorporation of bone drilling, thus opening new surgical corridors. INTERPRETATION: The variable situation of the BAA makes it mandatory for the surgeon to be prepared to simultaneously work through multiple surgical corridors. Neuroendoscopic-assisted microneurosurgery occasionally utilizes a narrow surgical corridor to facilitate BAA clipping using the conventional approaches and eliminates the need to gain access using additional surgical corridors.

Basilar Artery↗

PubMed2003

Giant cyst of the cavum septi pellucidi, cavum Vergae and veli interpositi.

The authors report a case study of a giant cyst of the cavum septi pellucidi, cavum Vergae and veli interpositi spreading to the posterior fossa, and initially treated elsewhere by ventriculoperitoneal shunt, with no resolution of the symptomatology. A few months later the patient was successfully treated by fenestration into the ventricular system through a neuroendoscopic technique, at the Pediatric Neurosurgical Center of the Meyer Children's Hospital in Florence. Symptomatic midline cysts are quite rare and different techniques have been proposed for their treatment, i. e., direct craniotomy, conventional shunting, stereotactic approaches as well as endoscopic fenestration. In such cases neuroendoscopy obtains a good symptom resolution level, avoiding at the same time the risks of damage to endoventricular structures and often eliminates the need for a definitive ventriculoperitoneal shunt. In the present research the authors analyze the anatomy of the midline cavities and the mechanism through which a cyst may become symptomatic. The surgical endoscopic technique and the clinical and radiological assessments which confirmed the patency of the fenestration are also discussed. The authors conclude that endoscopic ventricular fenestration may represent the treatment of choice for this pathology.

Central Nervous System Cysts↗

PubMed2006

Virtual simulation of neuroendoscopic procedures: early clinical experience with ventricular lesions.

BACKGROUND: Virtual endoscopy (VE) is a new and promising imaging technology. Applied to neuroendoscopy it allows preoperative simulation of a procedure and evaluation of the individual intraventricular anatomy in selected cases. Along with neuronavigation and real time intraoperative imaging, VE is expected to improve the safety and efficacy of neuroendoscopic procedures. PATIENTS AND METHODS: Between April 2003 and February 2004 VE simulation was performed in 13 randomly selected patients subjected to endoscopic procedures. Pathological entities included 4 cases with aqueduct stenosis, 4 with suprasellar arachnoid cysts, 2 tumors of the posterior third ventricle, 1 colloid cyst, 1 hyperplasia of the choroid plexus and 1 case with multiloculated hydrocephalus due to intraventricular septations. In 8 patients VE was accomplished preoperatively, in another 5 it was done after the operation, using data sets from neuronavigation imaging planning in 4 patients, and in one case using postoperative imaging studies. T (1)-weighted 3D image sets were acquired on a 1.5 T GE Genesis SIGNA MR scanner and VE reconstruction was performed using the General Electric Navigator software. The VE images were compared with the real images obtained during the endoscopic procedures and evaluated for their impact on the planning of the operative approach. RESULTS: VE implementation succeeded in all 13 patients. Major neuroanatomic reference structures were easily recognizable in all cases. Membranous structures such as the thinned floor of the third ventricle or cyst walls were identifiable in only 46 % of the cases. In 6 cases (46 %) VE showed anatomical variants and details relevant for the endoscopic procedure that were not identified on conventional MR images. CONCLUSIONS: VE has proved to be an important adjunct to the preoperative planning of neuroendoscopic procedures and its routine application is suggested.

Adolescent↗

PubMed2006

Neuroendoscopic management of a solitary pineal region tumor. Case report of an adenocarcinoma metastasis.

The present case describes a two-step endoscopic management of hydrocephalus and diagnosis of a single pineal region metastasis arising from a gastric adenocarcinoma. A 62-year-old man presenting with signs of subacute obstructive hydrocephalus from a pineal region mass had at first been treated with an endoscopic third ventriculostomy. As cerebrospinal fluid tumor markers (alpha-fetoprotein, beta-human chorionic gonadotropin) were negative, an endoscopic biopsy of the pineal region tumor was performed through a more anterior frontal burr hole. Pathology showed an adenocarcinoma and primary tumor work-up revealed an unsuspected gastric tumor, the pathology of which matched with the intracranial metastasis. The present report emphasizes the role of neuroendoscopy in pineal region tumors and reports a rare case of a solitary gastric adenocarcinoma metastasis in this location.

Adenocarcinoma↗

PubMed1996

MRI-guided endoscopy in the brain: a feasability study.

For neuronavigation in neuroendoscopy conventional navigation systems cannot exclude tissue movements caused by loss of cerebrospinal fluid (CSF). Open MRI can serve as a real-time navigation system if special conditions of endoscopic instruments and equipment are followed. We adapted an endoscopic system to the MRI and installed a miniaturized laser guidance system to project the central transaxial and coronal planes onto the phantom. A human cadaveric model was examined with a flexible microendoscope marked with a titanium wire inside the open magnet. The procedures were guided by gradient echo sequences refreshing the image every 4.5 seconds to control position of the endoscope. Endoscopic and corresponding MRI-findings are presented. Results and technical conditions are discussed.

Artifacts↗

PubMed1996

Endoscopic exploration of the IVth ventricle.

Regarding to the upcoming techniques in neuroendoscopy the IVth ventricle was examined. First in a series of 30 fresh and fixed anatomical specimens-the vessels injected with LATEX-the fourth ventricle was investigated endoscopically. There are three possibilities to reach the IVth ventricle: coming from the IIIrd ventricle via the aqueductus cerebri, using the basal cisterns through the apertura lateralis Luschkae and coming via the cerebellomedullar cistern through the foramen of Magendi. Using different kinds of endoscopes (rigid, flexible and steerable flexible)-diameter ranging from 5 to 9 french-with different optical systems (0 degree, 5 degrees, 30 degrees, 75 degrees) and different light sources (Halogen, Xenon) the anatomical details seen under the endoscope and the topographical landmarks of the approaches were investigated, presented and discussed. Based on the experience at the end of the cadaver work a short comment on which kind of equipment seems the best was given. A series of 14 clinical cases was presented as the second part of the study (7 cases with a tumor in the IVth ventricle-2 metastasis, 3 gliotic tumors, 1 ependymoma, 1 medulloblastoma, 3 patients with an occluded aqueduct because of meningo-ventriculitis and 4 patients with cystic malformations). The neuroendoscopic approaches, the neuroanatomical details relevant for surgery and the clinical data will be given and discussed. In general no intraoperative or postoperative complications were seen. In conclusion our experience from the theoretical neuroanatomical and the clinical part as well as the advantages and disadvantages from the different kind of endoscopes and approaches are discussed.

Adult↗

PubMed1997

Supraorbital minicraniotomy.

The recent use of neuroendoscopy combined to microsurgery allows new surgical approaches. We report our early experience with a supraorbital microcraniotomy. This technique is suitable for small lesions situated in the region of the anterior fossa, suprasellar cisterns, and Sylvian cistern. A 50-mm incision in the eyebrow and a supraorbital minicraniotomy are performed. We report on six patients with different lesions and good cosmetic results. We conclude that this approach is safe and useful in selected cases.

Journal Article↗

PubMed2000

Third ventricular cysts and membranes unsuspected on conventional CT and MRI.

Three cases are presented of symptomatic cysts or membranes within the third ventricle interfering with CSF flow and presenting as non-communicating triventricular hydrocephalus. None was visible on conventional CT or MRI, two being discovered at neuroendoscopy and one only with a specific MRI sequence designed to show CSF partitioning.

Adult↗

PubMed1998

Endoscopic removal of a third ventricular cysticercal cyst.

We report the case of a young man who presented with acute obstructive hydrocephalus previously treated with bilateral ventriculo-peritoneal shunts. Previous magnetic resonance imaging studies were consistent with aqueduct stenosis; no intraventricular pathology was identified. Neuroendoscopy was performed in order the third ventricle and perform a third ventriculostomy. This revealed a cysticercal lesion of the third ventricle which was removed endoscopically. In addition, a third ventriculostomy was performed and both shunt systems removed. Following a course of albendazole the patient went on to make a full recovery, and currently remains shunt independent.

Adult↗

PubMed1999

Flexible neuroendoscopic treatment of suprasellar arachnoid cysts.

Endoscopic treatment of suprasellar arachnoid cysts is now the treatment of choice. By marsupializing the roof of the cyst the condition can be cured. The perceived necessity to open both the roof and the floor is called into question by this paper. Three cases of suprasellar arachnoid cyst are described all of which have had successful marsupialisation of the cysts by flexible neuroendoscopy Flexible neuroendoscopic marsupialization of the cyst by widely opening the cyst roof only is described. This is compared with the other techniques, and also the endoscopic technique involving opening both the roof and the floor of the cyst, a more difficult and potentially dangerous method. Successful treatment of this condition is achieved by marsupialization of only the roof of the cyst. This is a much safer procedure, and has resulted in a resolution of signs and symptoms in the cases described followed-up between 24 and 28 months from the procedure.

Arachnoid Cysts↗

PubMed2004

Endoscopic and stereotactic neurosurgery.

PURPOSE OF REVIEW: Review of the anesthetic considerations for neuroendoscopy and stereotactic procedures. RECENT FINDINGS: Minimally invasive procedures are increasingly applied in novel ways in the diagnosis and treatment of neurological pathologies. Endoscopic third ventriculostomy, endoscopic shunt revisions and drainage of intraventricular hematoma using a neuroendoscope have become routine neurosurgical procedures. Stereotaxis has expanded its scope from simple brain biopsy to functional neurosurgery and psychiatry. While these procedures are 'minimally invasive', perioperative critical events may still occur. SUMMARY: Vigilance in preoperative assessment and intraoperative monitoring is essential in minimizing perioperative morbidity and mortality in patients undergoing neuroendoscopic and stereotactic procedures.

Journal Article↗

PubMed1997

Biportal endoscopic management of third ventricle tumors in patients with occlusive hydrocephalus: technical note.

OBJECTIVE: To present the feasibility and advantages of the biportal endoscopic management of posterior third ventricle tumors. As a result of recent developments in neuroendoscopy, classical third ventriculostomy has become a standard single burr hole procedure and a real alternative to shunting in the treatment of occlusive hydrocephalus. In patients with third ventricle tumors occluding the aqueduct, the acute development of hydrocephalus may often precede debilitating focal symptoms and signs. Forty percent of those tumors are radiosensitive, rendering craniotomy unnecessary. The goal of primary management is the alleviation of raised intracranial pressure and determination of the histological nature of the tumor. Cerebrospinal fluid shunting and the performance of a computed tomography- or magnetic resonance imaging-guided biopsy are generally suggested as the methods of choice. METHODS: Three patients with posterior third ventricle tumors and acute hydrocephalus were treated in one session by computed tomography-guided endoscopic third ventriculostomy and endoscopic tumor biopsy was performed by means of two rigid ventriculoscopes. RESULTS: Ventriculostomy was performed in three patients, and tumor biopsy was performed in two patients. The maximum 40-minute operation did not involve mortality or morbidity. Histological findings were established in all patients. In two patients with malignant infiltrative tumors, postoperative radiotherapy was used; in one patient with a small cavernoma, no further measures were taken. At the 6-month follow-up, flow-sensitive magnetic resonance imaging confirmed ventriculostomy patency in all patients. CONCLUSION: The biportal endoscopic approach allowed independent visual control of both procedures, safe passages of the ventriculoscopes via the narrow foramen of Monro, and facile control of the intracranial pressure in the ventricles via the available four irrigation channels during the performance of tumor biopsy and fenestration of the floor of the third ventricle. In selected patients with infiltrating posterior third ventricle tumors, this procedure and postoperative radiotherapy may be an alternative to direct surgery or to shunting and performance of image-guided biopsy.

Aged↗

PubMed1997

Intraoperative dislocation of the distal lens of a neuroendoscope: a very rare complication: technical case report.

OBJECTIVE AND IMPORTANCE: A very unusual complication of neuroendoscopy that was caused by equipment failure is described. CLINICAL PRESENTATION: Intraoperatively, the distal lens of a reusable rigid, lenscope-type neuroendoscope became dislodged. Fortunately, this did not have any adverse consequences for the patient. DISCUSSION: The cause remains obscure but probably relates to the repeated use of the scope. Perhaps the use of a disposable neuroendoscope could have prevented this, but reusable lenscopes are designed to be used many times. CONCLUSION: The risk of such equipment failure should be weighed against the distinct advantage of a much clearer image than is provided by fiberscopes.

Cerebral Ventricles↗

PubMed1998

Endoscopic treatment of mesencephalic ependymal cysts: technical case report.

OBJECTIVE: To evaluate the results of different neuroendoscopic surgical procedures for the treatment of mesencephalic ependymal cysts. METHODS: The clinical records of five patients treated for symptomatic mesencephalic ependymal cysts were retrospectively studied. Two patients had been operated on using an endoscope-assisted microsurgical technique and three patients using a pure endoscopic procedure. RESULTS: Adequate fenestration of the cysts was achieved in all of the patients. Two of the patients were symptom-free, and the other three had improved significantly after a mean follow-up duration of 14 months. There was no surgical morbidity. CONCLUSION: Mesencephalic ependymal cysts can be treated adequately, resulting in a low morbidity rate, using neuroendoscopy or endoscope-assisted microsurgery. This specific surgical technique is presented.

Adult↗

PubMed2002

NeuRobot: telecontrolled micromanipulator system for minimally invasive microneurosurgery-preliminary results.

OBJECTIVE: Microneurosurgery can be performed less invasively with the recent advances in neuronavigation and neuroendoscopy. For even less invasive microneurosurgery, we have developed a telecontrolled micromanipulator system. METHODS: The NeuRobot telecontrolled micromanipulator system was developed. With the use of this system, surgical simulations were performed with a human cadaveric head. RESULTS: The system consists of four main parts, i.e., a micromanipulator (slave manipulator), a manipulator-supporting device, an operation-input device (master manipulator), and a three-dimensional display monitor. Three 1-mm forceps and a three-dimensional endoscope, which could be remotely controlled with three degrees of freedom (rotation, neck swinging, and forward/backward motion), were installed in the slave manipulator. All surgical procedures were accurately performed with this system. CONCLUSION: The use of telecontrolled manipulator systems in neurosurgery is very promising, and we are convinced that this system will facilitate more accurate, less invasive microneurosurgery. The details of the NeuRobot system and preliminary results are presented.

Cadaver↗

PubMed1998

Stereotactically guided endoscopy for the treatment of arachnoid cysts.

Arachnoid cysts are well known to the neurosurgeon, and the evolution of their surgical treatment has followed technological advances in neurosurgical procedures and techniques. With the recent mastering of neuroendoscopy by the neurosurgeons, it is becoming the modality of choice for the treatment of arachnoid cysts. A neonate harboring a middle parasagittal arachnoid cyst benefited from stereotactically guided endoscopy. We report this case because of its peculiarities and introduce technical details about the procedure which are not found in the literature.

Arachnoid Cysts↗

PubMed2002

Endoscopic intraventricular surgery for treatment of hydrocephalus and loculated CSF space in children less than one year of age.

Controversy exists regarding whether children under 1 year of age have a higher risk of treatment failure after neuroendoscopic procedures for the treatment of hydrocephalus than older children. We retrospectively reviewed the surgical management and clinical outcome of 15 infants who underwent neuroendoscopic surgery for the treatment of CSF space loculation and hydrocephalus. We performed 8 third ventriculostomies, 3 endoscopic arachnoid cyst fenestrations, 2 aqueductoplasties, 1 septostomy and in 1 patient, three endoscopic fenestrations for isolated ventricular compartments. Two of the third ventriculostomies, 1 of the aqueductoplasties and the 1 septostomy failed, and these patients underwent placement of a ventriculoperitoneal shunt. In all other patients, symptoms and signs related to hydrocephalus or CSF space loculation were relieved effectively after the endoscopic procedure. We conclude that neuroendoscopy presents an effective alternative for the treatment of hydrocephalus and CSF loculation in infants less than 1 year of age.

Cerebrospinal Fluid Shunts↗

PubMed2002

Cerebrospinal fluid shunt survival and etiology of failures: a seven-year institutional experience.

BACKGROUND: Innovations in shunt technology and neuroendoscopy have been increasingly applied to shunt management. However, the relative life span of shunts and the etiology of shunt failure have not been characterized recently. METHODS: We reviewed the records of all shunting procedures at our institution between January 1992 and December 1998. Independent predictors of shunt failure were analyzed via multivariate Cox regression analysis in 836 shunting procedures. Independent predictors of the etiology of failure (infection, proximal obstruction, distal malfunction) were analyzed via multivariate logistic regression analysis in the 383 shunts which failed. RESULTS: A total of 353 pediatric patients underwent 308 shunt placements and 528 revisions. The risk (hazard ratio; HR) of shunt failure decreased as a function of time in both primary placements and revised shunts. In failed shunts, the odds of infection decreased 4-fold per year of shunt function, while the odds of distal malfunction increased 1.45-fold per year. Increasing number of shunt revisions (HR 1.31, p < 0.05), decreasing patient age in years (HR 1.04, p < 0.001), gestational age <40 weeks (HR 2.15, p < 0.001) but not the etiology of hydrocephalus were associated with an increased risk of shunt failure. Revisions versus primary placements, Dandy-Walker cysts and gestational age <40 weeks were independently associated with proximal, distal and infectious causes of failure, respectively. CONCLUSIONS: The long-term shunt revision rates observed here are similar to those reported over the past 2 decades. Shunt life span remains poorer in shunt revisions and in younger patients. Patient characteristics may suggest a specific risk and mechanism of failure, aiding in the long-term management of shunted hydrocephalus.

Cerebrospinal Fluid Shunts↗