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PubMedDate not supplied

[Indications for neuroendoscopy].

INTRODUCTION: In order to reduce intracerebral trauma in the diagnosis and treatment of intracranial lesions in children, neuroendoscopy is an important tool in current neurosurgery. Using this minimally invasive technique intraventricular objectives may be approached with little damage caused to adjacent structures. OBJECTIVES: There are two aspects to current indications for neuroendoscopy. Firstly, diagnosis is achieved by taking intraventricular biopsies of cystic lesions and tumours and for anatominical vigilance in microsurgical operations. Secondly, there is the therapeutic aspect, especially in operations to restore the circulation of cerebrospinal fluid (CSF), correct complex hydrocephaly, insert or remove intraventricular shunts, aspiration of cysts or haematomas, fenestration of cysts, resection of tumours within or near the ventricles. DEVELOPMENT: At the present time in neurosurgical paediatric management, neuroendoscopy is a tool used daily in common lesions such as hydrocephaly and the identification of intraventricular lesions. It may be safely used as a primary method of approach to the lesions or as a complement to open or guided surgery to the patient s advantage. We therefore reviewed the literature in the light of our own experience in neuroendoscopy since 1996. CONCLUSIONS: The formal indications for neuroendoscopy are greater in paediatric neurosurgery. In fact, the management of the CSF circulation, and disorders associated with this, together with the identification of tumours using minimally invasive methods, make this technique directly useful for solving these problems. This is most obvious in lesions such as multiseptate complex hydrocephaly, and intraventricular tumours and cysts where it is the first surgical option. In the short term, thanks to improvements in neuro navigation and frameless stereotaxis, its use will be wider and more precise

Brain Neoplasms↗

PubMed1998

Interactive image-guided neuroendoscopy: development and early clinical experience.

Technical advances and pioneering surgeons have established neuroendoscopy as an accepted diagnostic and therapeutic tool. The clinical indications for endoscopy, variety of operative techniques and number of endoscopic surgeons continue to increase steadily. However, there are fundamental limits to the scope of freehand endoscopy principally governed by the need for direct vision of anatomical and pathological structures. In addition, whilst the expert neuroendoscopist is only occasionally disorientated by complex distorted anatomy, the rising number of novices are likely to be mislead relatively often. We report the integration of neuroendoscopy with an optical neuronavigation system to provide interactive image-guided neuroendoscopy. This combination both removes the constraining requirement for direct vision and provides accurate localisation to guide the surgeon during surgery. We describe the clinical application of this method to two cases where image-guided endoscopy was essential to the safe completion of the procedure.

Adult↗

PubMed2002

The role of neuroendoscopy in the management of brain tumours.

Neuroendoscopy is increasingly used in the management of brain tumours and tumour related hydrocephalus and this study reviews the efficacy of neuroendoscopic interventions in this unit in patients with brain tumours. A series of 87 neuroendoscopic operations carried out in 77 patients with brain tumours over a 6-year period is reported. The age range of the patients was from 5 months to 70 years (median 13 years). In 56 cases (64%) presentation was with a newly-diagnosed tumour and hydrocephalus. The majority of the remaining patients had varying degrees of worsening hydrocephalus on the background of a previously diagnosed tumour. Neuroendoscopic third ventriculostomy (NTV) was successful in relieving hydrocephalus in the short term in 63/66 cases (95%) and in the longer term in 55/66 cases (83%). Neuroendoscopic tumour biopsies were successful in providing a tissue diagnosis in 17/28 cases (61%) and four extensive and three partial resections of tumour were carried out. There were two deaths within 30 days of the procedure with only one of these, secondary to intraventricular haemorrhage, directly related to neuroendoscopy. Few significant complications were noted otherwise. For selected intraventricular and paraventricular tumours neuroendoscopy offers the opportunity to combine relief of hydrocephalus with tumour biopsy and sampling of CSF in a single procedure.

Adolescent↗

PubMed2000

Anesthetic management of surgical neuroendoscopies: usefulness of monitoring the pressure inside the neuroendoscope.

Neuroendoscopic procedures are increasing in frequency in neurosurgical practice. We describe the anesthetic technique and the perioperative complications found in 100 neuroendoscopic interventions performed at our institution. Cranial tumor biopsy or retrieval (62%) and cisternostomy for hydrocephalus (33%) were the most frequent indications for neuroendoscopy. The mortality rate was low (1%). Intraoperative complications occurred in 36 patients, with arterial hypertension being the most frequent (53%). Postoperative complications occurred in 52 patients; anisocoria (31%) and delayed arousal (29%) were the most frequent. The pressure inside the endoscope was monitored intraoperatively in the last 47 patients. A saline-filled catheter from a pressure transducer connected to the neuroendoscopy system was used for pressure monitoring. We recorded the highest peak of pressure values measured during each procedure. Twenty-three patients (49%) had peak pressure values >30 mm Hg, 12 patients (25%) >50 mm Hg, and 3 patients >100 mm Hg. Only one patient had hemodynamic changes occurring simultaneously with the pressure changes. We found an association between pressure inside the endoscope >30 mm Hg and postoperative (P = .003) but not intraoperative complications. A relationship was found between surgical duration and postoperative complications (P = .002). Neither the pressure inside the endoscope or the intraoperative morbidity were related to surgical duration. We conclude that there may be a high rate of postoperative complications after neuroendoscopies, namely, new neurologic deficits. High pressure levels inside the endoscope during neuroendoscopic procedures can occur without hemodynamic warning signs. Pressure values >30 mm Hg are associated with postoperative morbidity, especially unexpected delayed recovery. Measuring the pressure inside the endoscope is technically easy and might be beneficial if performed in all neuroendoscopic procedures. Reducing the incidence of episodes of high peak pressure values might decrease the rate of postoperative complications.

Adult↗

PubMed2002

[Image-guided neuroendoscopy].

BACKGROUND AND PURPOSE: By definition, image-guided neuroendoscopy is a connection between a neuroendoscope and a neuronavigational system creating a computer-guided instrument. Our objective was to adapt our rigid endoscope with our neuronavigation system to perform computer-guided endoscopy. METHODS AND RESULTS: The rigid neuroendoscope, equipped with light emitting diodes, was connected to the work station. We report our early results with this device in 17 patients: 8 ventriculocisternostomies, 5 ventriculocisternostomies with biopsies of tumors of the posterior part of the third ventricule, 4 biopsies or tumor removal like colloid cysts. No technical complications were encountered. CONCLUSIONS: The development of image-guided neuroendoscopy has modified our approach to neuroendoscopy because the surgical procedure is facilitated. The use of fluoroscopy becomes unnecessary. The surgeon can choose, independent of the preestablish surgical technique, the entry point, the target and, of course, the optimal trajectory. The technique is adaptable to the individual anatomy of each patient, the location and the nature of the target. It is an undeniably useful teaching tool and represents a real progress in minimally invasive neurosurgery.

Adult↗

PubMed2004

The role of neuroendoscopy in the management of tectal gliomas.

OBJECTIVES: The objective was to determine the role of neuroendoscopy in the management of tectal plate gliomas. METHODS: Clinical and radiological data of children and adults who underwent neuroendoscopy were reviewed. Successful outcome was defined as shunt-freedom and resolution of symptoms and signs of raised intracranial pressure. RESULTS: Between 1 April 1998 and 31 March 2003, 11 patients (6 males and 5 females) underwent endoscopic third ventriculostomy (ETV) for the management of hydrocephalus secondary to a tectal plate glioma. This comprises 4% of 258 patients who have undergone neuroendoscopic procedures in our unit. The median age at the time of surgery was 19 (range 9-59) years. In 4 patients endoscopic biopsy of the tumour was performed at the same time. During a median follow-up period of 31 months (range 2-45), 4 patients underwent a second ETV, of whom 2 subsequently required insertion of ventriculoperitoneal (VP) shunts. Nine patients (82%) remain shunt-independent. Of the 4 tumours that were biopsied, a histological diagnosis of low-grade astrocytoma was made with certainty in only 2 cases. All tumours remained unchanged on follow-up MR imaging. CONCLUSIONS: Endoscopic third ventriculostomy can result in excellent control of hydrocephalus in patients with tectal plate gliomas. Tectal gliomas appear to be very slow growing tumours that can be managed conservatively in adults as well as children. Longer follow-up in larger studies is required.

Adolescent↗

PubMed2005

Neuroendoscopy in Jamaica.

This retrospective, descriptive study reviewed the patient profile, disease spectrum, indications for and results of treatment and complications of all 27 patients who had neuroendoscopy at the University Hospital of the West Indies (UHWI) over the three-year period between November 2000, when the service was first introduced, and November 2003. Nineteen (67.9%) were males and eight were females. Their mean age was 27.5 +/- 21.4 years with a range of four months to 70 years. Of the entire group, 20 had hydrocephalus with raised intracranial pressure, of which 15 had endoscopic third ventriculostomy (ETV) for the treatment of obstructive hydrocephalus, using two different techniques for ventricular floor fenestration. There was no demonstrable difference in outcome between the water jet and blunt forceps techniques. Three procedures failed to relieve the hydrocephalus, requiring subsequent ventriculo-peritoneal shunts. Three patients had successful cyst fenestrations. Six patients had endoscope assisted trans-sphenoidal resection for pituitary tumours. There were five complications and no deaths. Mean hospital stay was 18.4 +/- 16.7 days and mean follow-up was 29 weeks. There were no late failures. Neuroendoscopy is the treatment of choice for obstructive hydrocephalus due to aqueduct stenosis or posterior fossa tumours and has the advantage of avoiding shunt related complications. It is safe and effective for the majority of patients and has a significant role in the management of neurosurgical patients in the Caribbean.

Adult↗

PubMedDate not supplied

[The use of neuroendoscopy in the treatment of intraventricular and paraventricular brain tumors].

BACKGROUND AND PURPOSE: Because of their deep location, intra- and para- ventricular brain tumors pose an important therapeutic issue. Technical difficulties during the operation often result from the alteration of anatomy produced by the tumor, which brings about the risk of injury to functionally important structures. The authors assess clinical usefulness of neuroendoscopy in the treatment of discussed tumors. MATERIAL AND METHODS: Medical records of 16 adult patients treated between 2000 and 2003 were analyzed. The diagnosis was based on CT with 3D reconstruction and MRI. In 7 cases the tumor was located in the third ventricle, in 4--in lateral ventricles, in 5--paraventricularly. Surgery was performed using a rigid neuroendoscope and/or neurofiberscope equipped with the basic set of endoscopic instruments. The efficacy of the procedure was evaluated by clinical, CT and MRI follow-up examinations. The intended and achieved aim of the operation as well as the remote outcome were analyzed. RESULTS: The planned aim of the procedure was achieved in 12 (75%) patients. In 3 cases the tumor was removed totally, in 5--tumor mass was reduced restoring the cerebro-spinal fluid passage, in 4--tumor biopsy was performed. In 4 patients different obstacles made it impossible to achieve the intended aim of the procedure. 1 patient died in the direct postoperative course. In the long-term postoperative follow-up ranging from 8 to 44 months (median: 23 months), the clinical condition improved or was stable in 10 patients, 2 patients were reoperated, 2 became dependent and 1 was lost for follow-up. CONCLUSIONS: Neuroendoscopy offers new options in the treatment of intraventricular and paraventricular brain tumors allowing for their removal, reduction, histopathological verification and restoration of the cerebrospinal fluid passage. The outcome is good with a low complication rate.

Adult↗

PubMed2003

Endoscopic surgical anatomy of the paediatric third ventricle studied using virtual neuroendoscopy based on 3-D ultrasonography.

INTRODUCTION: Endoscopic treatment for occlusive hydrocephalus requires knowledge of individual ventricular and vascular anatomies of the ventricular system. METHODS: We studied the feasibility of virtual neuroendoscopy (VNE) based on 3-D ultrasonography (3-D US) for the identification of parenchymal and vascular anatomical landmarks of the third ventricle and its impact on the surgical planning of endoscopic third ventriculostomy (ETV) in paediatric patients. 3-D US was performed through the anterior fontanel in four infants with hydrocephalus. RESULTS: Virtual neuroendoscopy revealed the size of the foramen of Monro, anatomical landmarks of the floor of the third ventricle crucial for correct fenestration during ETV, but not the premesencephalic cistern. The basilar bifurcation was identified in relation to the floor of the third ventricle by VNE (power-Doppler ultrasonography) and confirmed intraoperatively after ETV. CONCLUSION: 3-D US-based VNE reveals detailed anatomical information on the ventricular system including the foramen of Monro and the floor of the third ventricle. Within the premesencephalic cistern vascular anatomy can be visualized, but not non-vascular structures.

Cerebral Aqueduct↗

PubMed2005

Role of neuroendoscopy in the management of patients with tuberculous meningitis hydrocephalus.

The role of neuroendoscopy in patients of tuberculous meningitis with hydrocephalus (TBMH) is not yet established. We present details of endoscopic morphology, and analyze outcome of Neuroendoscopy performed in 28 patients (15 males and 13 females, average age 23 years) of TBMH in last 2.5 years. Endoscopic procedures performed included endoscopic third ventriculostomy (ETV) alone (n=19), ETV with monroplasty (n=2), and septostomy (n=2), ETV with decompression/biopsy of tuberculoma (n=2) and with abscess drainage (n=1). Outcome was assessed on the basis of clinico-radiological improvement, need for external shunt and complications. Outcome was satisfactory in 14 (50%), acceptable in five (18%) and unsatisfactory in nine (32%) patients. Overall, 19 (68%) patients benefited from endoscopic intervention. Cerebrospinal fluid (CSF) leak (n=2) and per-operative bleeding (n=1) were the only complications encountered. Endoscopy appears to be helpful in a considerable number of patients with TBMH, and should be considered as the first surgical option for CSF diversion surgery in these patients. External shunt should be reserved for those who fail the endoscopic CSF diversion.

Adolescent↗

PubMed1999

Virtual neuroendoscopy, a comparative magnetic resonance and anatomical study.

We evaluated the usefulness and reliability of intraventricular virtual neuroendoscopy based on a comparative anatomical study. Virtual intraventricular endoscopic images were calculated from 3D magnetic resonance images in five anatomic specimens. Contiguous 1.2 mm slices of the specimen heads were acquired at a 1.5 T MR scanner using a 3D-gradient echo sequence. The images were then transferred to an independent 3D-workstation (Sun Spark 20). After scanning the specimen heads, real endoscopy within the cerebral ventricles of these brains was performed with a standard rod lens system. Comparison between real and virtual endoscopic views of the intraventricular topography was based on the same anatomical reference and landmarks. Acquisition of MR data and virtual image post-processing have been possible in all specimens. The virtual endoscopic images of the ventricles were comparable to the intraventricular views obtained by a standard rod lens system. Virtual intraventricular neuroendoscopy can be employed for planning and simulating neuroendoscopic procedures. It enables the neurosurgeon to simulate the endoscopic procedure within the cerebral ventricles on the basis of the patient's individual anatomy prior to surgery.

Cerebral Ventricles↗

PubMed1998

The combined use of image-guided frameless stereotaxy and neuroendoscopy for the surgical management of occlusive hydrocephalus and intracranial cysts.

The objective of the study was to report the initial experiences with the combined use of an infrared-based frameless stereotactic navigation device and neuroendoscopy. Ten hydrocephalic patients underwent endoscopic third ventriculostomy and two patients with intracranial cysts underwent cystoventriculostomy. The trajectory of the rigid endoscope and target point were planned by frameless stereotaxy. An articulated arm served to maintain the predetermined trajectory during the surgery and to guide the endoscope. Endoscopic surgery was successfully performed in 11 of the 12 patients. In one patient with a small third ventricle the ventriculostomy had to be abandoned. We observed no surgical morbidity. In none of the cases was it necessary to correct the predetermined trajectory of the endoscope to reach the planned target area. The planning of the trajectory and the target area, as well as the maintenance of the trajectory during endoscopy reduce the risk of inadvertent damage to vital structures. The combined use of frameless stereotaxy and neuroendoscopy might contribute to a decrease of procedure-related morbidity.

Adolescent↗

PubMed2005

Neuroendoscopy: past, present, and future.

Neuroendoscopy began with a desire to visualize the ventricles and deeper structures of the brain. Unfortunately, the technology available to early neuroendoscopists was not sufficient in most cases for these purposes. The unique perspective that neuroendoscopy offered was not fully realized until key technological advances made reliable and accurate visualization of the brain and ventricles possible. After this technology was incorporated into the device, neuroendoscopic procedures were rediscovered by neurosurgeons. Endoscopic third ventriculostomy and other related procedures are now commonly used to treat a wide array of neurosurgically managed conditions. A seemingly limitless number of neurosurgical applications await the endoscope. In the future, endoscopy is expected to become routine in modern neurosurgical practice and training.

Brain Diseases↗

PubMed2005

Neuroendoscopy for spinal disorders: a brief review.

Neuroendoscopy has grown rapidly in the last 20 years as a therapeutic modality for treating a variety of spinal disorders. Spinal endoscopy has been widely used to treat patients with cervical, thoracic, and lumbosacral disorders safely and effectively. Although it is most commonly used with minimally invasive lumbar spine surgery, endoscopy has gained widespread acceptance for the treatment of thoracic disc herniations and for anterior release and rod implantation in the correction of thoracic spinal deformity. The authors review the use of endoscopy in spine surgery and in the treatment of spinal disorders as well as in the treatment of intrathoracic nonspinal lesions. Endoscopy has some significant advantages over open or other minimally invasive techniques in that it can allow for better visualization of the lesion, smaller incision sizes with reduced morbidity and mortality, reduced hospital stays, and ultimately lower cost. In addition, spinal endoscopy allows observers and operating room staff to be more involved in each case and fosters education. Spinal endoscopy, like any novel modality, carries with it additional risks and the surgeon must always be prepared to convert to an open procedure. The learning curve for spinal endoscopy is steep and the procedure should not be attempted alone by a novice surgeon. Nevertheless, with training and experience, the spine surgeon can achieve better outcomes, reduced morbidity, and better cosmesis with spinal endoscopy, and the operating times are comparable to open procedures. As technology evolves and more experience is obtained, neuroendoscopy will likely achieve further roles as a mainstay in spine surgery.

Education, Medical, Continuing↗

PubMed1998

Laser-assisted neuroendoscopy using a neodymium-yttrium aluminum garnet or diode contact laser with pretreated fiber tips.

OBJECT: Although lasers have proved to be valuable in neuroendoscopy, surgeons are still not comfortable using high-energy laser endoscopic probes in proximity to vital structures such as the basilar artery in third ventriculostomy. The authors have developed a special laser catheter for use in neuroendoscopy; the object of this paper is to present their experimental and clinical experiences using the catheter. METHODS: This laser catheter is fitted with an atraumatic ball-shaped fiber tip that is pretreated with a layer of carbon particles. These carbon particles absorb approximately 90% of the energy emitted, which is very effectively converted into heat. As the heat is generated in this very thin layer of carbon coating, the temperature at the surface of the ball-shaped tip reaches ablative temperatures instantly at powers of only a few watts per second, which has enabled the authors to limit drastically the amount of laser light used and the length of exposure needed, thereby increasing safety even around critical structures. CONCLUSIONS: The authors present experimental data and their clinical experience using these pretreated fiber tips with a neodymium-yttrium aluminum garnet contact laser or a diode contact laser in 49 patients (22 males and 27 females) and a variety of procedures: third ventriculocistemostomy (33 patients), cyst fenestration (nine patients), colloid cyst resection (six patients), and fenestration of the septum pellucidum (one patient). There was no instance of mortality or increased morbidity. To date, the procedure success rate is 100% and the overall outcome success rate is 86%. The authors conclude that pretreated atraumatic ball-shaped fiber tips now make laser application safe and effective in a variety of neuroendoscopic procedures. Because of their low power range (only several watts), compact diode lasers will be the energy source of first choice.

Adolescent↗

PubMed1998

Provision of a neuroendoscopy service. The Southampton experience.

BACKGROUND: A series of 21 patients (aged 1 week to 80 years) underwent a total of 22 neuroendoscopic procedures in our Unit in the period July 1993 to January 1996. METHODS: The procedures were performed by one surgeon familiar with the technique using the Stortz rigid neuroendoscope system. The most common indication for neuroendoscopy was obstructive hydrocephalus. The most frequently performed procedure was third ventriculostomy and tumor biopsy. The intended surgical procedure was successfully performed in all but two of the cases (attempted septostomy and internal cyst drainage) were both abandoned due to unrecognisable anatomy. RESULTS: Of the 19 patients treated by fenestration or ventriculostomy to relieve hydrocephalus, 5 eventually required definitive shunting procedures. CONCLUSIONS: Complications relating directly to the neuroendoscopy occurred in 2 patients (bleeding requiring temporary external ventricular drain) and there were no surgical deaths.

Adolescent↗

PubMed2006

The role of transventricular neuroendoscopy in the management of craniopharyngiomas: three patient reports and review of the literature.

BACKGROUND: Management of craniopharyngiomas is problematic and often requires multimodal protocols. In the last decade neuroendoscopy has been increasingly used in the management of these lesions. PATIENT REPORTS: We report three cases of craniopharyngiomas in which various endsocopic procedures were performed. In the first case the endoscopic approach alone allowed the gross total removal of an intraventricular craniopharyngioma; in the second case the endoscopic fenestration of a cystic intraventricular craniopharyngioma allowed long-term control of the tumor with no further treatment; in the third case endoscopic fenestration and drainage of the cystic part allowed collapse of the cyst with resolution of mass effect on the visual pathway and control of hydrocephalus. The patient later underwent microsurgical removal of the solid portion of the tumor. CONCLUSIONS: Neuroendoscopy has shown great versatility in the management of intra/paraventricular craniopharyngiomas. It can be used alone to achieve gross total removal or marsupialization of cystic tumors, or, more often, in association with additional therapies, such as microsurgery, radiosurgery or intracavitary drug administration.

Biopsy↗

PubMed1997

[Neuroendoscopy: diagnosis and therapeutic uses].

Minimally invasive neurosurgical techniques permit improved ways of approaching problems which could previously only be solved by open surgery or microsurgery. In this field, neuroendoscopy offers a very efficient, clear means of diagnosis and a less aggressive form of treatment of lesions on the central nervous system. Particularly in paediatric neurosurgery, procedures such as implanting valves for ventriculo-peritonial derivations (DVP) may be carried out knowing the exacts anatomical site of the catheter tip, or allowing catheters adherent to structures such as the choroid to be removed. Ventriculoscopy permits review and biopsy of intraventricular and paraventricular structures. Myeloscopy allows intramedullary and paramedullary visualization together with the possibility of syringoscopy. The new option presented by neuroendoscopy, as a help in microneurosurgery, when studying structures which are not visible using a microscope, is particularly useful in vascular surgery and in surgery of the base of the skull. It also permits rapid, efficient drainage of subdural and intraventricular haematomas. This technique has become a useful tool in neurosurgical departments for solving problems and as a support for the classical techniques. Equally it requires practice and the study of neuroendoscopic anatomy.

Brain↗