Neuroendoscopy Group Research Articles

To explore the efficiency of neuroendoscopy combined with Endport for hypertension intracerebral hemorrhage

Objective To explore the value of neuroendoscopy combined with Endport for the surgery of hypertensive intracerebral hemorrhage. Methods We retrospectively analyzed 92 cases of hypertensive intracerebral hemorrhage in our department from January 2016 to February 2018. According to the different surgical methods, they were divided into small bone window group and neuroendoscopic group, 47 cases in small bone window group and 45 cases in neuroendoscope group.The amount of intraoperative bleeding, operative time, postoperative hematoma clearance, postoperative rebleeding, hospitalization time, postoperative complications and Glasgow prognosis expansion score (GOS-E) were recorded for statistical analysis. Results Compared with neuroendoscopy group, small bone window group had more bleeding loss [(182.6±34.5)ml vs (103.3±25.7)ml] and longer operation time [(168.7±26.3)min vs (115.7±18.7)min], with significant statistically difference (P 0.05); Postoperative rebleeding occured in 3 cases (6.4%) in small bone window group and 2 cases (4.4%) in the neuroendoscopic group, with no statistically significant difference between the two groups (P>0.05). Compared with neuroendoscopy group, small bone window group had longer hospitalization time [(18.5±4.3)days vs (13.5±3.8)days], higher tracheotomy rate [15(31.9%) vs 8(17.8%) ], with significant statistically difference (P 4 in small bone window group 2 months after operation was less than that in neuroendoscopy group [42.6%(20/47) vs 62.2%(28/45)], with significant statistically difference (P<0.05). Conclusions Endoscopic treatment of intracerebral hemorrhage has the advantages of minimally invasive, short operation time, less intraoperative hemorrhage, low incidence of complications and fast recovery of postoperative function. Key words: Intracranial hemorrhage, hypertensive/SU; Neuroendoscopy

Neuroendoscopic lavage for the treatment of CSF infection with hydrocephalus in children.

The treatment of infectious CSF condition with ventriculitis and hydrocephalus in children is an interdisciplinary challenge. Conventional surgical treatment includes external ventricular drain (EVD) and systemic antibiotic therapy. However, infectious contamination of large ventricles combined with CSF protein overload often requires long treatment regimens. We retrospectively investigated neuroendoscopic lavage as a new option for clearance of CSF in children with hydrocephalus and active CSF infection. A database review identified 50 consecutive patients treated for CSF infection with hydrocephalus at our institution. Twenty-seven patients (control group, CG) were treated conventionally between 2004 and 2010, while 23 patients (neuroendoscopic group, NEG) underwent neuroendoscopic lavage for removal of intraventricular debris between 2010 and 2015. Clinical data, microbiology, laboratory measures, shunt dependency, and shunt revision rate were evaluated retrospectively. The patient groups did not differ regarding basic clinical characteristics. Patients in NEG received neuroendoscopic lavage at mean of 1.6 ± 1times (1-4). No immediate postoperative complications were observed in NEG patients. Shunt rate in NEG patients was 91% as compared 100% in CG patients (p= 0.109). Within 24months after shunt implantation, incidence of shunt revision was higher in CG (23/27) compared to NEG (5/23; p< 0.001). Reinfection was observed more often in CG (n= 17) compared to one patient in NEG (p< 0.001). We experienced that neuroendoscopic lavage is a safe and effective treatment for hydrocephalus in children with infectious conditions. Neuroendoscopic lavage resulted in a decreased number of overall shunt revisions in shunt-depended patients as well as a lower number of recurrent infections.

Surgical Management of Supratentorial Intracerebral Hemorrhages: Endoscopic Versus Open Surgery.

Intracerebral hemorrhage continues to be a major global problem. No standard treatment or surgical procedure has been identified for intracerebral hemorrhages. High morbidity and mortality rates caused by conventional approaches and the disease itself have necessitated more-invasive treatment methods. The endoscopic approach is a more minimally invasive method than craniotomy, which is another alternative surgical treatment. We compared intracerebral hematoma drainage in 2 groups of 17 patients each, treated with minimally invasive endoscopic method versus craniotomy. All the patients were treated for supratentorial spontaneous hemorrhage between December 2013 and February 2017 at the Neurosurgery Clinic of Ankara University Faculty of Medicine. We retrospectively evaluated 34 patients surgically treated between December 2013 and February 2017. All patients underwent surgery within the first 24 hours. Patients in the early surgery group had better surgical outcomes. In the neuroendoscopic group, Glasgow Coma Scale increased from 6 to 11 at 1 week postoperatively compared with 5 to 9 in the craniotomy group. Minimally invasive endoscopic hematoma evacuation may be a good alternative surgical method for treating supratentorial spontaneous cerebral hematomas.

Endoscopic surgery versus microsurgery in treating hypertensive basal ganglia hemorrhage: A meta-analysis

Objective To compare the clinical efficacy of neuroendoscopy and microsurgery for the treatment of hypertensive basal ganglia hemorrhage. Methods PubMed, Cochrane Library, Embase, VIP, CNKI, CBM and Wanfang database were retrieved. The randomized controlled trials and semi-randomized controlled trials comparing all the basal ganglia hemorrhage treated with neuroendoscopy and microsurgery were searched. The retrieval time was from the establishment of the database to October 31, 2015. After the detected literature being screened, extracted and evaluated, a Meta-analysis was performed using RevMan 5.3 software, and the GRADE system was used to conduct the quality evaluation of evidence. Results Finally, A total of 9 trials with 700 patients were enrolled. The results of Meta-analysis showed: (1) in the aspect of safety: compared with the microscope group, the hematoma clearance rate was higher (SMD=0.63, 95% CI 0.30-0.95, P<0.001), operation time was shorter (SMD= -2.66, 95% CI -3.71- -1.60, P<0.001), hospitalization time was shorter (SMD=-0.72, 95% CI -1.01- -0.44, P<0.001), and postoperative complications were less (RR=0.56, 95% CI 0.40-0.77, P<0.001) of the neuroendoscopy group. There were no significant differences in the intraoperative bleeding and hospital cost between the 2 groups (all P<0.05). (2) In the aspect of effectiveness: compared with the microsurgery group, the prognosis was better (RR=1.15, 95% CI 1.03-1.27; P=0.002) and the mortality was lower (RR=0.57, 95% CI 0.22-1.00; P=0.05) in the neuroendoscope group. Conclusions Compared with the microsurgery, the prognosis of neuroendoscopy is better, the mortality is lower, the efficacy is better, and the surgical removal rate of the latter is higher, the operation time is shorter, the postoperative complications are less, and the safety is higher. But because of the quality of the original research is lower, the prudent choice and use in clinical practice ARE recommended. More high quality, large sample randomized controlled trials are needed for further argument. Key words: Intracranial hemorrhage, hypertensive; Neuroendoscopy; Microsurgery; Treatment outcome; Meta-analysis

Comparison between Modified Neuroendoscopy and Craniotomy Evacuation of Spontaneous Intra-Cerebral Hemorrhages: Study of Clinical Outcome and Glasgow Outcome Score

Background and Purposes: Stroke is still one of a leading health-care problem in industrial country and in the developing country. Spontaneous Intra-cerebral Hemorrhage accounts for 30–60% of all stroke admissions into a hospital. Presence of intra-cerebral hemorrhage is considered a poor prognostic factor due to the resultant obstruction to the mass effect following the presence of blood resulting in raised intracranial pressure. While the craniotomy procedure failed to show more benefits over functional outcome, a less invasive and quicker surgical decompression might improve the outcome. Neuroendoscopy is one of promising optional on minimal invasive  treatment for spontaneous intra-cerebral hemorrhage. Material and Methods: We evaluated Glasgow Outcome Score and clinical outcome of patients with Spontaneous Intra-cerebral Hemorrhage who underwent modified neuroendoscopic surgery and craniotomy. Randomized control trial was performed during 27 months in 43 patients. Twenty-five patients treated with neuroendoscopy surgery and 18 patients with craniotomy. The removal of intra-cerebral hemorrhage was done by a modified neuroendoscopic transparent sheath made of silastic material, derived from pieces of thoracic tube No. 21F as a conduit working channel. Results: We analyzed statistically, clinical outcome assessment and Glasgow Outcome Scale 6 months post operative follow-up period. The mortality rate was significantly higher by Pearson chi-square methods, in craniotomy group n=12 (63.2%) compared with neuroendoscopy group, n=7 (36.8%) (p&lt;.005). Patients with Glasgow Outcome Scale score 3–5 was higher in neuroendoscopy group, n=18 (75%) compared with craniotomy group n=6 (25%). The survival rate analyzed by Kaplan Meier methods, found that patients in the neuroendoscopy group were a significantly longer survival rate compare with the craniotomy group during 6 months post operative follow-up period. Conclusions: Treatment of spontaneous intra-cerebral hemorrhage with modified neuroendoscopy procedure was faster in action,safer and longer in survival rate and inexpensive.

Effectiveness of neuroendoscopic ventricular irrigation for ventriculitis

ObjectivesVentriculitis is an uncommon condition with a poor prognosis, especially when complicated by brain abscess. We compared the therapeutic efficacy of neuroendoscopic ventricular irrigation with those of conventional treatments such as ventricular drainage and continuous irrigation via a ventricular drain. Patients and methodsWe retrospectively analyzed 14 consecutive patients treated for ventriculitis at our institution between 2001 and 2015. Included were the six patients treated with neuroendoscopic (NE) irrigation (NE group), which we adopted in 2011, and the eight patients treated before 2011 with conventional treatments (non-NE group). We compared mortality, modified Rankin Scale (mRS) score 6 months postoperatively, and duration of ventricular/spinal drainage-catheter placement between groups. ResultsMean age at onset was 49.3 years (range, 32–68 years) in the NE group and 50.3 years (range, 8–78 years) in the non-NE group. At 6-month follow-up, good clinical outcome (mRS≤3) was observed in 66.7% of the NE group, whereas it was observed in 25.0% of the non-NE group. There were three deaths (37.5%) in the non-NE group but none in the NE group. Duration of drainage-catheter placement was significantly shorter in the NE group than in the non-NE group (19.8days vs. 70.9days, p<0.001). Among patients in the NE group, only those who underwent irrigation on the day of diagnosis maintained a low mRS score. ConclusionNeuroendoscopic ventricular irrigation was safe and effective in the treatment of ventriculitis. Immediate intervention after diagnosis may lead to an improved prognosis.

Comparison study of neuroendoscopic surgery and craniotomy in management of hypertensive intracerebral hemorrhage

Objective To investigate the therapeutic effects of neuroendoscopic surgery and craniotomy in the treatment of hypertensive intracerebral hemorrhage(HIH). Methods A total of 54 patients with hypertensive intracerebral hemorrhage treated by operation between May 2011 and June 2013 were analyzed retrospectively, 28 patients in neuroendoscopy group and 26 patients in craniotomy group.All patients were followed up for 3 months, two groups were estimated by the ADL scores, grade 1-3 of ADL was regarded as good prognosis, grade 4-5 of ADL and dead cases as poor prognosis. Results One death case in the neuroendoscopy group and 2 death cases in the craniotomy group, no statistical difference (P>0.05). The good prognosis rate of ADL was 82.1% (23/28) in the neuroendoscopy group and 53.9% (14/26) in the craniotomy group, the therapeutic effects of neuroendoscopy group were better than those of craniotomy group(P>0.05). Conclusion Neuroendoscopic surgery is a kind of method with little injury、favorable recovery of neural function in the treatment of hypertensive intracerebral hemorrhage. Key words: Hypertensive intracerebral hemorrhage; Neuroendoscope; Craniotomy

Minimally invasive surgery treatment for the patients with spontaneous supratentorial intracerebral hemorrhage (MISTICH): protocol of a multi-center randomized controlled trial.

BackgroundThe choice of surgical or conservative treatment for patients with spontaneous intracerebral hemorrhage is controversial. Some minimally invasive treatments have been applied to hematoma evacuation and could improve prognosis to some extent. Up to now, studies on minimally invasive surgery for patients with spontaneous intracerebral hemorrhage are still insufficient.DesignThe MISTICH is a multi-center, prospective, randomized, assessor-blinded, parallel group, controlled clinical trial. 2448 eligible patients will be assigned to neuroendoscopy group, stereotactic aspiration group and craniotomy group randomly. Patients will receive the corresponding surgery based on the result of randomization. Surgeries will be performed by well-trained surgeons and standard medical treatment will be given to all patients. Patients will be followed up at 7 days, 30 days, and 6 months. The primary outcome of this study is unfavorable outcome at 6 months. Secondary outcomes include: mortality at 30 days and 6 months after surgery; neurological functional status of 6 months after surgery; complications including rebleeding, ischemic stroke and intracranial infection; days of hospitalization.DiscussionThe MISTICH trial is a randomized controlled trial designed to determine whether minimally invasive surgeries could improve the prognosis for patients with spontaneous intracerebral hemorrhage compared with craniotomy. (ChiCTR-TRC-12002026. Registered 23 March 2012).

Endoscopic evacuation of basal ganglia hemorrhage via keyhole approach using an adjustable cannula in comparison with craniotomy.

Neuroendoscopic (NE) surgery as a minimal invasive treatment for basal ganglia hemorrhage is a promising approach. The present study aims to evaluate the efficacy and safety of NE approach using an adjustable cannula to treat basal ganglia hemorrhage. In this study, we analysed the clinical and radiographic outcomes between NE group (21 cases) and craniotomy group (30 cases). The results indicated that NE surgery might be an effective and safe approach for basal ganglia haemorrhage, and it is also suggested that NE approach may improve good functional recovery. However, NE approach only suits the selected patient, and the usefulness of NE approach needs further randomized controlled trials (RCTs) to evaluate.

The effectiveness of neuroendoscopic versus non-neuroendoscopic procedures in the treatment of lateral ventricular cysts: a retrospective medical record review study

BackgroundThe aim of this study was to assess the effectiveness of neuroendoscopy compared with non-neuroendoscopic procedures for treating patients with arachnoid membrane cysts in the lateral ventricles.MethodsThe medical records of 28 patients with arachnoid membrane cysts in the lateral ventricles who were treated with neuroendoscopy and 39 such patients treated with non-neuroendoscopic techniques using classic treatment procedures were reviewed. The neuroendoscopic approach combined craniotomy, corticectomy, lesion resection and cyst ventriculostomy or cyst cisternostomy to restore normal cerebrospinal fluid circulation. The non-neuroendoscopic techniques included craniotomy, corticectomy, and lesion resection performed under a microscope. Clinical outcomes of symptoms and cyst size change on imaging were compared between the two treatment groups during follow-up (range: 1–5 years).ResultsPatients in the neuroendoscopy group had significantly less blood loss (P < 0.001) and shorter operative time (P < 0.001), better marked improvement in symptoms (64.3% vs. 5.1%, respectively), and a higher total resection rate (92.9% vs. 66.7%; P = 0.011) compared with the patients in the non-neuroendoscopy group. In the neuroendoscopy group there was no cyst recurrence whereas in the non-neuroendoscopy group 8 (20.5%) patients had cyst recurrence. However, all patients in the neuroendoscopy group had postoperative transient fever and 8 (28.6%) patients had subdural fluid accumulation which was treated and subsequently resolved during follow-up. These symptoms did not occur in the non-neuroendoscopy group.ConclusionWe found that neuroendoscopic therapy for arachnoid cysts in the lateral ventricles was more efficacious than non-neuroendoscopic methods. Our results indicate that neuroendoscopy may produce better clinical outcomes than non-neuroendoscopic procedures in treating patients with arachnoid cysts in the lateral ventricles.

Application of Neuroendoscopy in the Treatment of Intraventricular Hemorrhage

Background: Spontaneous intraventricular hemorrhage is an infrequent but severe complication of hemorrhagic stroke. The conventional treatment of intraventricular hemorrhage consists of ventricular drainage or surgical evacuation, but neither of them is encouraged. The objective of this article is to compare different surgical procedures in order to evaluate a method of minimally invasive treatment for intraventricular hemorrhage. Methods: Neuroendoscopy was applied to treat 22 cases of intraventricular hemorrhage. Twenty cases of the same disease that were treated by external ventricular drainage were taken as a control and comparison. Results: All patients were followed up for 2 months. In the neuroendoscopy group, according to the Glasgow outcome scale, the result was excellent in 5 cases, good in 9, fair in 4, poor in 2 and death in 2. In the external ventricular drainage group, the result was excellent in 1 case, good in 5, fair in 7, poor in 5 and death in 2. More patients in the neuroendoscopy group showed good recovery after 2 months of surgery (p < 0.05). The difference in mortality rate between the 2 groups was not statistically significant (p > 0.05). Conclusions: Neuroendoscopic neurosurgery for intraventricular hemorrhage offers better surgical treatment because it is characterized by visualized manipulation, effective hemorrhage evacuation and excellent postoperative outcomes.

Cooperative study by the Italian neuroendoscopy group on the treatment of 61 colloid cysts

Cooperative study by the Italian neuroendoscopy group on the treatment of 61 colloid cysts

Cooperative study by the Italian neuroendoscopy group on the treatment of 61 colloid cysts

Microsurgical resection, stereotactic aspiration and VP shunt have for years been the choice options for the treatment of colloid cysts of the third ventricle. Recently, endoscopic approaches have aroused increasing interest and gained acceptance. Although safer, this minimally invasive approach is considered less efficacious than microsurgery. Relatively long-term results are now available and some conclusions might be inferred on the usefulness of this procedure. Between 1994 and 2005, 61 patients harbouring a colloid cyst of the third ventricle were treated with neuroendoscopic technique in 11 Italian neurosurgical centres. Cyst diameters ranged from 6 to 32 mm. A flexible endoscope was used in 34 cases, a rigid one in 21, both instruments in six. The technique consisted in cyst fenestrations, colloid aspiration, coagulation of the internal cyst wall and, occasionally, capsule excision. Mean postoperative hospital stay was 6.7 days. Early postoperative neuroimaging revealed a cyst residue in 36 cases (mean diameter 4.3 mm). There were two complications (3.2%). Follow-up varied between 1 and 132 months (mean 32 months, more than 5 years in 17 patients). There were seven asymptomatic recurrences, three of them evolving from a previous residue. The endoscopic approach to the treatment of colloid cysts is safe, effective and well accepted by patients. Although asymptomatic, recurrences (11.4%) cast a persisting shadow on the long-term results, and, therefore, the controversy with the traditional microsurgical treatment remains open.