Endoscope-assisted Microneurosurgery Research Articles

Endoscope-Assisted Microsurgery for Posterior Fossa Skull Base Meningioma Surgery: Technique and Results.

Surgery of posterior fossa meningiomas is extremely challenging even for experienced skull base surgeons because of the close proximity to cranial nerves and tight spaces. Endoscope-assisted surgery for posterior fossa meningiomas can enable a high degree of tumor resection even when using small approaches. This study describes the advantage of endoscope-assisted microneurosurgery in resection of posterior fossa skull base meningiomas and the clinical outcome. All endoscope-assisted surgeries for resection of posterior fossa meningiomas performed between 2002 and 2016 in our department were retrospectively analyzed. For data acquisition, the patient files were used. Tumor size and extent of resection were evaluated on pre- and postoperative magnetic resonance imaging. The value of endoscope assistance was assessed according to the intraoperative videos and the surgical notes. Complications and long-term outcomes were evaluated. We identified 39 female and 10 male patients. The mean age of the patients at the time of surgery was 55 years, ranging from 25 to 78 years. The mean follow-up was 93.8 months. A total of 41% of the tumors were large to giant. The retrosigmoid approach was used in most patients (45). A gross total resection could be achieved in 38 patients (78%). In 11 patients (22%), a near total resection was performed. In 27 patients (55%), a hidden residual tumor, which could not been visualized with the operating microscope, was identified with the endoscope. In 6 patients (22.2%), the internal auditory canal was visualized, in 9 patients (33.3%), the Meckel's cave was visualized, and in 5 patients (18.5%), both were visualized under endoscope assistance. In 26 of those patients (96.3%), the residual tumor was resected under endoscopic view. Endoscope-assisted surgery for posterior fossa skull base meningiomas enables a high degree of tumor resection, avoids more invasive skull base approaches, and reduces the amount of cerebellar retraction.

Endoscopy-Assisted Microneurosurgery for Sella and Optic Foramen Invading Anterior Cranial Fossa Base Meningiomas

Anterior skull base meningioma produces symptoms as a result of mass effect and neurovascular compression. The bony anatomy of the anterior skull base is complex and houses the critical cranial nerves and vessels. Traditional microscopic approaches remove these tumors effectively but require extensive brain retraction and bone drilling. Endoscope assistance offers the advantages of a smaller incision, less brain retraction, and bone drilling. The most significant advantage of endoscope-assisted microneurosurgery for lesions invading the sella and optic foramen is the complete resection of the sellar and foraminal components frequently responsible for recurrence. In this report, we describe the technique of endoscope-assisted microneurosurgical resection of anterior skull base meningiomas invading the sella and foramen. We present 10 cases and 3 case examples of endoscope-assisted microneurosurgery for meningiomas invading the sella and optic foramen. This report presents the operating room setup and surgical details to resect sellar and foraminal tumors. The surgical procedure is presented as a video. Endoscope-assisted microneurosurgery yielded excellent clinical and radiologic results and no recurrence at the last follow-up of meningiomas invading the sella and optic foramen. The present article discusses the challenges faced with endoscope-assisted microneurosurgery, techniques, and challenges in the procedure. Endoscope assistance enables complete tumor excision under vision with less retraction and bone drilling in anterior cranial fossa meningioma, invading the chiasmatic sulcus, optic foramen, and sella. The mixed use of microscope and endoscope makes it safer and saves time and is like bringing out the best of both worlds.

Endoscope-Assisted Microneurosurgery for Neurovascular Compression Syndromes: Basic Principles, Methodology, and Technical Notes.

Background:Microscopic microvascular decompression (MVD) has a low but not negligible failure rate due to some missed conflicts, especially in case of multiple offending vessels. The reported study is aimed to assess the principles, methodology, technical notes, and effectiveness of the endoscope-assisted (EA) MVD for neurovascular compression syndromes (NVCS) in the posterior fossa.Materials and Methods:A series of 43 patients suffering from an NVCS and undergone to an EA MVD were retrospectively reviewed. Syndromes were trigeminal neuralgia in 25 cases, hemifacial spasm in nine cases, positional vertigo in six cases, glossopharyngeal neuralgia in two cases, and spasmodic torticollis in one case. In all cases, a 0°–30° specially designed endoscope was inserted into the surgical field to find/treat those conflicts missed by the microscopic exploration. Each procedure was judged in terms of the effectiveness of the adjunct of the endoscope according to a three types classification system: Type I – improvement in the visualization of the nerve's root entry/exit zone; Type II – endoscopic detection of one or more conflicts involving the ventral aspects of the nerve and missed by the microscope; Type III – endoscope-controlled release of the neurovascular conflict otherwise difficult to treat under the only microscopic view.Results:A total of 55 conflicts were found and treated. Twenty-eight procedures were classified as Type I, nine as Type II, and six as Type III. All the patients had a full recovery from their symptoms.Conclusions:In selected cases, EA MVD offers some advantages in the detection and treatment of neurovascular conflicts in the posterior fossa.

Endoscope-assisted Transorbital Keyhole Surgical Approach to Ruptured Supratentorial Aneurysms.

Many different surgical approaches have been described to treat intracranial aneurysms. A common feature of all the approaches has been relatively extensive brain exposure and brain retraction with increasing surgical morbidity. Transorbital keyhole is one of the minimally invasive approaches. Endoscope-assisted transorbital keyhole surgery (EATOKS) combines minimally invasive transorbital keyhole surgery with endoscope-assisted microneurosurgery. We describe our experience with this approach and its efficacy in treating ruptured supratentorial aneurysms. We retrospectively reviewed 62 patients (18 men [29%] and 44 women [71%]) with a ruptured supratentorial aneurysm who underwent surgical clipping via the EATOKS approach from April 2003 to July 2012. In all our cases, we use a rigid endoscope of 0, 30, or 45 degrees to inspect the aneurysm and its surrounding anatomy before clipping and ultimately to verify the completeness of the aneurysm clipping and the patency of the adjacent neurovascular structures. All patients with ruptured supratentorial aneurysms were successfully clipped including three with multiple aneurysms. Surgically related major and minor as well as medically related complications were 10%, 15%, and 10%, respectively. Three patients (4.8%) died of massive cerebral infarction due to fulminant postoperative vasospasm, multiorgan failure, and adult respiratory distress syndrome. At 6-month follow-up, 81% of patients achieved good outcomes with Glasgow Outcome Scales of 4 and 5. Patients' satisfaction with the cosmetic results was satisfactory to excellent in most cases. EATOKS is a viable and safe option in the neurosurgical armamentarium to treat ruptured supratentorial aneurysms.

Endoscope-Assisted Microneurosurgery for Intracranial Aneurysms

Background: The endovascular techniques has widely changed the treatment of intracranial aneurysms. However surgery still represent the best therapeutic option in case of broad-based and complex lesions. The combined use of endoscopic and microsurgical techniques (EAM) may improve surgical results.Objective: The purpose of our study is to evaluate the advantages and limits of EAM for intracranial aneurysms.Methods: Between January 2002 and December 2012, 173 patients, harboring 206 aneurysms were surgically treated in our department with the EAM technique. One hundred and fifty-seven aneurysms were located in the anterior circulation and 49 were in the posterior circulation. Standard tailored approaches, based on skull base surgery principles, were chosen. The use of the endoscope included three steps: initial inspection, true operative time, and final inspection. For each procedure, an intraoperative video and an evaluation schedule were prepared, to report surgeons’ opinions about the technique itself. In the first cases, we always used the endoscope during surgical procedures in order to get an adequate surgical training. Afterwards we became aware in selecting cases in which to apply the endoscopy, as we started to become familiar with its advantages and limits.Results: After clipping, all patients were undergone postoperative cerebral angiography. No surgical mortality related to EAM were observed. Complications directly related to endoscopic procedures were rare.Conclusion: Our retrospective study suggests that endoscopic efficacy for aneurysms is only scarcely influenced by the preoperative clinical condition (Hunt–Hess grade), surgical timing, presence of blood in the cisterns (Fisher grade) and/or hydrocephalus. However the most important factors contributing to the efficacy of EAM are determined by the anatomical locations and sizes of the lesions. Furthermore, the advantages are especially evident using dedicated scopes and holders, after an adequate surgical training to increase the learning curve.

Microsurgical anti endoscopic anatomy of sellar region related to key hole approach

Objective To study the endoscopic anatomy of operative fissures in the sellar region related to pterional key-hole approach and to provide the anatomic basis for endoscope-assisted microneuro-surgery in the region. Methods Fifteen cadaver heads were dissected via pterional key-hole approach and the five operative fissures(Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ) were studied with both microscope and endoscope, by which the outcomes observed were recorded and compared. Results The basic information obtained by the pterio-nalkeyhole approach was comparable to that of the classic ptefional approach. According to the anatomic guideposts under neuroendoscope, the microstructures of the five fissures and Willis' circle would be well demonstrated. It is better to display the various anatomic structures in sellar region by neuroendoscope rather than microscope, particularly some important microstructures. Angled endoscope can be used to inspec thidden but important structure behind the arteries and nerves. Conclusion According to the anatomic guideposts, an endoscopy can be used to enhance the visible field of an operative microscope related to pterional key-hole approach. The endoscope-assisted microsurgery can reduce complications and injury of the important structures and increase the curative effect on the lesions in the sellar region. Key words: Pterional approach; Sellar region; Key hole approach; Neuro-endoscopy; Microanatomy

TUMORS OF THE LATERAL AND THIRD VENTRICLE

Intraventricular tumors usually are managed by approaches and microsurgical techniques that need retraction and dissection of important brain structures. Minimally invasive endoscopic procedures achieve a remarkable alternative to conventional microneurosurgical techniques. Endoscope-assisted microneurosurgery may be a minimally invasive technique with maximally effective treatment. Using the keyhole concept for planning the surgical strategy, the reduction of the brain retraction is achieved, which is one of the main benefits of this technique. We treated 35 patients (16 female patients and 19 male patients) with tumors in the lateral (n = 8) and the third (n = 27) ventricle. Patient age at the date of surgery ranged from 5 to 73 years. The follow-up period ranged from 6 to 83 months. The tumors were operated on using transcortical, transcallosal, or suboccipital transtentorial or infratentorial supracerebellar approaches after precise planning of the skin incision, the trephination, and the trajectory to the center of the tumor, performed earlier with a magnetic resonance imaging scan. Total removal of the tumor was achieved in 28 patients (78.5%). In 2 patients (6.5%), recurrent tumor occurred. In 5 patients (15%), parts of the tumors remained because of infiltration of eloquent areas. Overall clinical improvement was achieved in 31 patients (87%). Three patients (10%) were unchanged and 1 patient (3%) deteriorated. Endoscope-assisted keyhole neurosurgery seems to be a safe method of removing tumors in all regions inside the ventricular system with a low risk of permanent neurological deficits. The exact surgical corridor planning on the basis of the keyhole strategy offers less traumatic exposure of even deep-seated endoventricular tumors.

Endoscope-Assisted Microneurosurgery for Meningiomas of Frontal and Middle Cranial Fossae

Introduction: The meningiomas of anterior and middle cranial fossae are located near the brain arterial circle, cranial nerves, and hypothalamochiasmal region. In some cases different variations of anatomy and topography make radical surgical removal a problem.

Endoscope-Assisted Microneurosurgery for Intracranial Aneurysms

Endoscope-Assisted Microneurosurgery for Intracranial Aneurysms

Treatment of skull base communicating tumor with endoscope-assisted microneurosurgery and diode laser

Treatment of skull base communicating tumor with endoscope-assisted microneurosurgery and diode laser

Endoscope-Assisted Microneurosurgery for Intracranial Aneurysms

Endoscope-Assisted Microneurosurgery for Intracranial Aneurysms

Endoscope-Assisted Microneurosurgery for Meningiomas of Frontal and Middle Cranial Fossae

Endoscope-Assisted Microneurosurgery for Meningiomas of Frontal and Middle Cranial Fossae

Use of neuroendoscope in intracranial tumor microneurosurgery through a keyhole approach

目的 探讨内镜辅助下锁孔入路显微手术治疗颅内肿瘤的意义及方法.方法应用神经内镜辅助下锁孔入路显微手术治疗颅内肿瘤30例.在显微镜下尽可能切除可见肿瘤部分,再用神经内镜辅助寻找残余肿瘤并切除.结果肿瘤全切除22例,次全切除5例,3例颅内动脉瘤成功夹闭.2例垂体腺瘤患者术后出现一过性多尿,经对症治疗均于术后1周恢复正常;1例胆质瘤患者术后发生无菌性脑膜炎,经对症治疗2周后痊愈.本组无一例死亡,无脑出血、颈内动脉损伤和视神经损伤发生.结论神经内镜辅助下锁孔显微手术治疗颅内肿瘤,有助于提高肿瘤全切除率,减少手术创伤。

Tumors of the Lateral and Third Ventricle: Removal under Endoscope-assisted Keyhole Conditions

Intraventricular tumors usually are managed by approaches and microsurgical techniques that need retraction and dissection of important brain structures. Minimally invasive endoscopic procedures achieve a remarkable alternative to conventional microneurosurgical techniques. Endoscope-assisted microneurosurgery may be a minimally invasive technique with maximally effective treatment. Using the keyhole concept for planning the surgical strategy, the reduction of the brain retraction is achieved, which is one of the main benefits of this technique. We treated 35 patients (16 female patients and 19 male patients) with tumors in the lateral (n = 8) and the third (n = 27) ventricle. Patient age at the date of surgery ranged from 5 to 73 years. The follow-up period ranged from 6 to 83 months. The tumors were operated on using transcortical, transcallosal, or suboccipital transtentorial or infratentorial supracerebellar approaches after precise planning of the skin incision, the trephination, and the trajectory to the center of the tumor, performed earlier with a magnetic resonance imaging scan. Total removal of the tumor was achieved in 28 patients (78.5%). In 2 patients (6.5%), recurrent tumor occurred. In 5 patients (15%), parts of the tumors remained because of infiltration of eloquent areas. Overall clinical improvement was achieved in 31 patients (87%). Three patients (10%) were unchanged and 1 patient (3%) deteriorated. Endoscope-assisted keyhole neurosurgery seems to be a safe method of removing tumors in all regions inside the ventricular system with a low risk of permanent neurological deficits. The exact surgical corridor planning on the basis of the keyhole strategy offers less traumatic exposure of even deep-seated endoventricular tumors.

Application of the neuro-endoscope to the intracranial aneurismal surgery

To study the role of neuro-endoscope in the intracranial aneurismal surgery, analyzing its benefits, and disadvantages. Endoscopy was used as an adjunct in the microsurgical treatment of clipping aneurysms on 88 patients with 89 aneurysms, of which 82 aneurysms in 81 patients were located in the anterior circulation and 7 were located in the posterior circulation. Keyhole approach was performed on all patients, and micro-Doppler ultrasound technique was used before and after clipping. In 84 aneurysms, endoscope-assisted microneurosurgery (EAM) was used in addition to microsurgical dissection and clipping so as to observe the neck anatomic features and perforators and to verify the optimal clipping position. Endoscope-controlled microneurosurgery was used for 5 aneurysms to observe the anatomy around aneurysm, such as the posterior communicating artery and the opposite anterior communicating artery behind the internal carotid artery. Postoperative angiography performed on 86 patients showed satisfactory aneurysm clipping. Operative mortality was 0. There were 7 cases of postoperative complications, with an incidence rate of 7.95%, and none case was directly related to endoscopy. Improving observation of regional anatomy because of its ability in magnification, illumination, and looking around dead angle, neuro-endoscopy is very useful for complex aneurysms.

Endoscopic neurosurgery and endoscope-assisted microneurosurgery for the treatment of intracranial cysts.

Different endoscopic techniques have been introduced into neurosurgery, but accepted terminology and definitions are still missing. We propose a terminology based on whether the endoscope is used alone or in conjunction with an operating microscope and on whether the route of surgical manipulations is through or outside the endoscope. Accordingly, procedures are categorized into endoscopic neurosurgery (EN), endoscope-assisted microneurosurgery (EAM), and endoscope-controlled microneurosurgery (ECM). We treated 36 patients with intracranial arachnoid cysts (ACs) and intraventricular cysts endoscopically. The patients ranged in age from 4 months to 69 years (mean age, 31 yr). The follow-up period ranged from 6 to 44 months (mean follow-up duration, 14 mo). The indications were hydrocephalus in 17 patients, focal neurological deficits in 4 patients, progressive nonlocalizing symptomatology in 13 patients, and space occupation in 2 asymptomatic patients. EN was used in 14 cases, EAM in 15 cases, and ECM in 7 cases. The overall success rate was 70%. Nine patients (25%) had unchanged symptomatology, and the condition of two patients (5%) deteriorated. The best success rates were achieved in patients with intraventricular cysts (89%) and posterior fossa ACs (78%). Symptomatic improvement was best achieved in patients with hydrocephalus or focal neurological deficits (81%). Different endoscopic techniques (i.e., EN, EAM, and ECM) provide sufficient treatment of selected intracranial cysts. Our data suggest that intraventricular cysts and suprasellar ACs should be approached using EN whereas posterior fossa and sylvian ACs may be more effectively treated using a combined technique (EAM or ECM).

Endoscopic Neurosurgery and Endoscope-assisted Microneurosurgery for the Treatment of Intracranial Cysts

Endoscopic Neurosurgery and Endoscope-assisted Microneurosurgery for the Treatment of Intracranial Cysts

Endoscopic Neurosurgery and Endoscope-assisted Microneurosurgery for the Treatment of Intracranial Cysts

Endoscopic Neurosurgery and Endoscope-assisted Microneurosurgery for the Treatment of Intracranial Cysts

Endoscopic Neurosurgery and Endoscope-assisted Microneurosurgery for the Treatment of Intracranial Cysts

Endoscopic Neurosurgery and Endoscope-assisted Microneurosurgery for the Treatment of Intracranial Cysts

Endoscopic Neurosurgery and Endoscope-assisted Microneurosurgery for the Treatment of Intracranial Cysts

Endoscopic Neurosurgery and Endoscope-assisted Microneurosurgery for the Treatment of Intracranial Cysts