Neuroendoscopic Treatment Research Articles

The long-term effect on functional outcome of endoscopic brainwashing for intraventricular hemorrhage compared to external ventricular drainage alone: A retrospective single-center cohort study.

Intraventricular hemorrhage (IVH) is a complex condition with both mechanical and chemical effects, resulting in mortality rates of 50-80%. Recent reports advocate for neuroendoscopic treatment, particularly endoscopic brainwashing (EBW), but long-term functional outcomes remain insufficiently explored. This study aims to outline the step-by-step procedure of EBW as applied in our institution, providing results and comparing them with those of external ventricular drainage (EVD) alone. We performed a retrospective analysis of adult patients with IVH who underwent EBW and patients submitted to EVD alone at our institution. All medical records were reviewed to describe clinical and radiological characteristics. Although both groups had similar baseline factors, EBW patients exhibited a larger hemoventricle (median Graeb score 25 vs. 23 in EVD, P = 0.03) and a higher prevalence of chronic kidney disease and diabetes. Short-term mortality was lower in EBW (52% and 60% at 1 and 6 months) compared to EVD (80% for both), though not statistically significant (P = 0.06). At one month, 16% of EBW patients achieved a good outcome (Modified Rankin scale < 3) versus none in the EVD group (P = 0.1). In the long term, favorable outcomes were observed in 32% of EBW patients and 11% of EVD patients (P = 0.03), with no significant difference in shunt dependency. Comparing EBW and EVD, patients submitted to the former treatment have the highest modified Graeb scores and, at a long-term follow-up, have better outcomes, demonstrated by the improvement of the patients in the follow-up.

Staged Neuroendoscopic Management of a Dandy Walker Malformation Case Presenting with Complex Hydrocephalus

Backgroud: Dandy-Walker malformation is a rare congenital condition characterized by alteration of posterior fossa anatomy. Hydrocephalus is a common finding in these patients. VP-shunt placement remains the treatment of choice. Endoscopic Third Ventriculostomy (ETV) is an acceptable alternative for older children. Other techniques have also been proposed. Case presentation: A full-term infant presented with signs of hydrocephalus. An endoscopic foraminoplasty of the posterior fossa cyst was conducted as a first stage. The cyst’s volume was reduced, without any changes of the supratentorial ventricular dimensions. A month post-surgery signs of hydrocephalus reoccurred. An ETV was performed alongside a fenestration of the tentorium. The toddler was discharged in good condition with amelioration of her symptoms. One month later she presented with recurrent hydrocephalus and subdural hygromas. A shunt was placed in the posterior fossa under endoscopic guidance, and an additional one was introduced in the subdural space. The patient was followed-up for 18 months without any further need for treatment. VP-shunt placement is the treatment of choice. Discussion: Lushka and Magendie foraminoplasty seems to be ineffective. ETV should be reserved for older children. The ventriculoscope can be employed for positioning the VP-shunt in a specific anatomical region. Subdural hygromas may present after neuroendoscopic treatment. A staged approach may be mandatory for complex hydrocephalus treatment.

Interhemispheric arachnoid cysts: case series

Objective: Interhemispheric arachnoid cysts (IHACs) are a rare congenital malformation arising from the duplication of the arachnoid membrane of the cerebral meninges associated with malformations of the corpus callosum. The scope of this study is to describe a series of cases of IHACs treated via neuroendoscopy in a reference center. Method: description of a case series of children diagnosed with IHAC undergoing neuroendoscopic treatment (cystoventriculostomy) between 2015 and 2022, describing the main clinical manifestations, the surgical indication, and the neuroendoscopic technique performed. Results: Four children diagnosed with IHACs, with a predominance of males (3:1), were included in the study. Considering the Mori and Barkovich classification systems, magnetic resonance imaging of the brain showed multiseptate extra-axial interhemispheric cysts without communication with the ventricular system in all cases. Macrocrania and bulging fontanel were the clinical manifestations that indicated urgent hospitalization for the proposed neurosurgical treatment. Conclusion: Signs of increased intracranial pressure were observed in all cases of IHACs in the first months of life. Endoscopic cystoventriculostomy was performed in all cases with satisfactory results, showing that this is an option to be evaluated for the treatment of IHACs classified as multiseptate extra-axial and without communication with the ventricular system or brain cisterns, according to Mori and Barkovich classification systems.

Septum Pellucidum Cyst in Patient with Parkinson’s Disease-minimally Invasive Staged Therapy

Background: The aim of the case report is to present the minimally invasive staged treatment of a patient with motor complications of Parkinson’s disease with a large septum pellucidum cyst.&#x0D; Material and Method: A two-stage surgical strategy was proposed by the movement disorders team: neuroendoscopic cyst fenestration with subsequent implantation of deep brain stimulation electrodes (subthalamic nucleus) depending on the effect of neuroendoscopic treatment.&#x0D; Results: Despite the technical success of a neuroendoscopic cyst fenestration, as evidenced by a reduction in cyst volume, intraoperative ventriculocystography and postoperative CT showing free communication between the cyst and the ventricular system the motor symptoms caused by Parkinson’s disease remained unchanged. A bilateral subthalamic deep brain stimulation system was implanted with good functional results as documented by her UPRDS III score in the off-medication state (52 points preoperative and 34 point after 6 years postoperative) and reduction of L-DOPA equivalent dose (60% of the pre-deep brain stimulation level). &#x0D; Conclusion: Minimally invasive therapy-neuroendoscopic cyst fenestration, followed by a bilateral subthalamic stimulation implantation-led to the substantial and lasting improvement of the patient’s symptoms.&#x0D;

Effect comparison of neuroendoscopic vs. craniotomy in the treatment of adult intracranial arachnoid cyst.

Intracranial arachnoid cysts are common, accounting for about 1%-2% of intracranial space-occupying lesions. There is controversy over the method of surgical intervention, and in order to provide guidance for surgical decision making, this study compares the efficacy of craniotomy vs. neuroendoscopic surgery in treating arachnoid cysts. The adult patients with arachnoid cyst admitted to our department from October 2016 to August 2021 were retrospectively analyzed. Thirteen adult patients were recruited, and divided into two groups: neuroendoscopic group (group A) and craniotomy group (group B). We compared the gender, age, clinical symptoms, preoperative and postoperative cyst sizes, symptom improvement, complications, length of hospital stay, and hospital costs between two groups to analyze the therapeutic effects of these two surgical methods. The cost of hospitalization in group A was significantly lower than that in group B (47,292.8 vs. 65,151.8 yuan, P < 0.05), and there was no difference in the length of hospital stay between the two groups. The preoperative cysts in group A were significantly larger than those in group B (6.38 vs. 2.97 cm, P < 0.05). In groups A and B, the short-term symptom improvement rates were 100% and 75.0%, respectively. The long-term symptom improvement rates were 77.78% and 75.0% (P > 0.05), respectively. Both neuroendoscopic and craniotomy have good curative effects for the treatment of intracranial arachnoid cysts. There was no significant difference in the outcomes between the two surgical techniques. The cost of hospitalization can be reduced with neuroendoscopic surgery. Neuroendoscopic treatment is recommended for large intracranial arachnoid cysts, and craniotomy is suitable for small intracranial arachnoid cysts.

Probable Hydrocephalus Decompensation after Immunization with Pentavalent Vaccine: Case Report and Literature Review

AbstractThere are several complications associated with immunization with the pentavalent vaccine. Most of them are mild reactions, of spontaneous resolution; however, though rare, serious and potentially-fatal adverse effects can occur. We report a case of acute intracranial hypertension syndrome in an infant with a previously-unknown suprasellar arachnoid cyst who developed acute obstructive hydrocephalus after immunization with the pentavalent vaccine. He underwent neuroendoscopic treatment, showing complete resolution of the condition. The present article aims to compare the activation of the immune system by the pertussis component of the vaccine and the mechanisms that hypothetically potentiated the pathological decompensation.

Analysis of neuroendoscopy forthe treatment of macroadenomas and giant pituitary adenomas.

ObjectiveThis study investigated the use and effectiveness of endoscopic transnasal, transsphenoidal surgery, a minimally invasive method for the treatment of macroadenomas and giant pituitary a denomas, in a medical setting. The surgical results of 429 patients who received neuroendoscopic treatment of macroadenomas or giant pituitary adenomas were evaluated, and the experiences and lessons learned from treatment complications were assessed.Patients and methodsFrom January 2012 to December 2021, 429 patients with macroadenomas or giant pituitary adenomas, including 60 patients with giant adenomas (diameter ≥4 cm) and 369 patients with macroadenomas (diameter 1–4 cm), received a 3D head CT, a MRI with contrast enhancement, and an endocrinology examination prior to surgery. Preoperative clinical and radiological features, visual measurements, hormone levels, length of stay, length of surgery, postoperative stay, visual and hormone outcomes, resection range, complication and recurrence rates, and routine patient information were recorded. The patients were followed up for 6–72 months (median = 40 months).ResultsOf 429 patients with macroadenomas or giant pituitary adenomas who received neuroendoscopic treatment, 348 (81.12%) had gross-total resections (GTR), 53 (12.35%) had near-total resections (NTR), and 28 (6.53%) had subtotal resections. There were 138 cases of post-operative diabetes insipidus (32.17%), including 7 cases of permanent diabetes insipidus (1.63%), 16 cases of nasal hemorrhage (3.73%), 39 cases of intraoperative cerebrospinal fluid leakage (9.09%), 4 cases of intracranial infection (0.9%), 16 cases of hypophysis (3.7%), and 15 cases of anosmia (3.50%). The clinical symptoms and endocrinology indices of the patients improved after surgery, and all patients were discharged 5–18 days (8.36 ± 2.65) postop.ConclusionNeuroendoscopy is a safe operation with a short recovery period and hospital stay and is thus an effective method to treat macroadenomas and giant pituitary adenomas. Preoperative evaluation and prediction can help to accurately address possible intraoperative situations and improve GTR.

SURG-03. Durability of an Early Management Strategy Facilitating Endoscopic Removal of Recurrent Choroid Plexus Carcinoma

BACKGROUND: Choroid plexus carcinoma (CPC) is a rare, primarily intraventricular neoplasm with a dismal prognosis. Extent of surgical removal is correlated with improved outcomes but is frequently limited due to tumor vascularity and size. Information related to surgical management and molecular drivers of tumor recurrence is currently limited. Here we characterize a case of multiply recurrent CPC treated solely with sequential endoscopic tumor removals over a 10-year period and highlight its genomic properties. METHODS: We performed a retrospective review of a 16-year-old female treated for CPC with local and distal recurrences undergoing repeat excision with minimally invasive neuro-endoscopy. We describe technical nuances associated with neuro-endoscopic intervention, mean hospital stay, complications, and perioperative MRI. Whole exome sequencing (WES), targeted sequencing, and methylation profiling results over time are reviewed. RESULTS: Five years after standard treatment, the patient was evaluated for a distant intraventricular recurrence. A total endoscopic resection was performed given the local, non-disseminated recurrence pattern. WES results included NF1, PER1, and GLI3 mutations as well as FGFR3 gain, and was negative for TP53 alterations. Repeat sequencing on a recurrence 4 years later showed persistent NF1 and FGFR3 alterations. Methylation profiling was consistent with “plexus tumor, subclass pediatric B”. Overall, short-term surveillance neuroimaging detected four isolated recurrences, all treated with complete endoscopic resections at 5 years, 6.5 years, 9 years, and 10 years after initial CPC diagnosis. Mean hospital stay for all recurrences was 1 day with no complications from treatment. CONCLUSION: We describe a patient with 4 isolated recurrences of CPC over a decade, each treated with complete endoscopic removal, and identify an unusual set of molecular alterations that persisted over time. These outcomes support a strategy encompassing frequent neuroimaging surveillance to facilitate a minimally invasive endoscopic surgical approach at early detection and relatively low tumor mutagenicity.

Endoscopic Monro Foraminoplasty, types, techniques and complications avoidance

AimThis study aimed to unveil the proper selection of suitable pathologies eligible for foraminoplasty, types per surgical target, and avoidance of complications. MethodsOut of 3425 cranial endoscopic procedures performed through over a quarter of a century, in two Egyptian University Medical Centre, 250 cases subjected to “Endoscopic Monro Foraminoplasty (EMF)” were reviewed. Preoperative MRI T2 including coronal sequence were obtained. Solid lesions up to 2 cm above the foramen of Monro were considered for excision foraminoplasty. Dilatation and restoration foraminoplasty were performed using Fogarty balloon catheter. Combined EMF and pellucidotomy eliminated the need for bilateral foraminoplasty. Patients' age ranged from 3 months to 55 years, with a follow-up period of 2–12 years. ResultsTriventricular hydrocephalus with lateral ventricular asymmetry was in 45.2% of the cases, while bilateral foraminal occlusion with equal sized lateral ventricles were detected in 18.8%. Biventricular hydrocephalus was seen in 27.2% of patients. Biventricular hydrocephalus involved both lateral ventricles in 24% of cases while involvement of single lateral ventricle and the third ventricle contributed to 3.2% of cases. Unilateral hydrocephalus was reported in 8.8%%. Congenital bilateral pinhole stenosis was dilated in four infants. Foraminoplasty can be sorted into three types: Dilatation Foraminoplasty used to treat congenital (1.6%), idiopathic (6.4%) or post hemorrhagic/meningitic (15.6%) stenosis; Restoration Foraminoplasty used to fenestrate a membrane (12%) or cyst wall nearby the foramen (22%); and Excision Foraminoplasty for solid space-occupying lesions (SOL) (4%), partially cystic tumors (38.4%) may require combined aspiration and squeeze foraminoplasty especially in retro-foraminal colloid cysts with coapted foramen edges. The only reported -to this specific procedure-complication was transient remediable memory disturbance. ConclusionsEndoscopic Monro Foraminoplasty is a definitive neuroendoscopic treatment procedure. It deserves abbreviation assignment (EMF).

Efficacy of Neuroendoscopic Treatment for Septated Chronic Subdural Hematoma.

Objective: Neuroendoscopic treatment is an alternative therapeutic strategy for the treatment of septate chronic subdural hematoma (sCSDH). However, the safety and efficacy of this strategy remain controversial. We compared the clinical outcomes of neuroendoscopic treatment with those of standard (large bone flap) craniotomy for sCSDH reported in our center. Furthermore, the safety and efficacy of the neuroendoscopic treatment procedure for sCSDH were evaluated.Methods: We retrospectively collected the clinical data of 43 patients (37 men and six women) with sCSDH who underwent either neuroendoscopic treatment or standard (large bone flap) craniotomy, such as sex, age, smoking, drinking, medical history, use of antiplatelet drugs, postoperative complications, sCSDH recurrence, length of hospital stay, and postoperative hospital stay. We recorded the surgical procedures and the neurological function recovery prior to surgery and 6 months following the surgical treatment.Results: The enrolled patients were categorized into neuroendoscopic treatment (n = 23) and standard (large bone flap) craniotomy (n = 20) groups. There were no differences in sex, age, smoking, drinking, medical history, antiplatelet drug use, postoperative complications, and sCSDH recurrence between the two groups (p > 0.05). However, the patients in neuroendoscopic treatment group had a shorter length of total hospital stay and postoperative hospital stay as compared with the standard craniotomy group (total hospital stay: 5.26 ± 1.89 vs. 8.15 ± 1.04 days, p < 0.001; postoperative hospital stay: 4.47 ± 1.95 vs. 7.96 ± 0.97 days, p < 0.001). The imaging and Modified Rankin Scale at the 6-month follow-up were satisfactory, and no sCSDH recurrence was reported in the two groups.Conclusions: The findings of this study indicate that neuroendoscopic treatment is safe and effective for sCSDH; it is minimally invasive and could be clinically utilized.

Neuroendoscopic treatment for isolated fourth ventricle complicated with posthemorrhagic hydrocephalus in the low-birth-weight preterm neonate: a case report

Neuroendoscopic treatment for isolated fourth ventricle complicated with posthemorrhagic hydrocephalus in the low-birth-weight preterm neonate: a case report

Virtual endoscopy assisted pure ventriculoscopic resection of cavernomas occluding foramen of Monroe: Technical note and literature review

ObjectiveCavernomas at Foramen of Monroe (FoM) are rare cases among the intracranial cavernomas. Pure ventriculoscopic removal of cavernoma at FoM through a single burr hole is challenging and rarely reported. MethodsWe herein introduced the virtual endoscopy (VE) assisted ventriculoscopic resection to treat the cavernomas at FoM. Two cases diagnosed with cavernomas at FoM, a 31-year-old male patient (case 1) and a 26-year-old male patient (case 2), were included. Both of them suffered from headache, nausea and vomiting. The pre-operative MRI revealed masses at the FoM. We reconstructed the VE on a free and open-source platform (3D Slicer) for the pre-surgical evaluation. And then ventriculoscopic operation through a single burr hole was made to remove the cavernomas at FoM. ResultsThe VE displayed a 14×19×16 mm lesion in case 1 and an 18×20×29 mm lesion in case 2 and both cases revealed some attachment between the lesions and the periventricular tissue. The ventriculoscopic operations indicated by VE were performed to achieve total resection of the cavernomas without neurological deficit. ConclusionsAlthough the neuroendoscopic treatment to cavernoma at FoM through a single burr hole was rarely reported among the previous literatures, it was a quite effective and useful method in our cases. And the application of VE before ventriculoscopic operation could help to provide a three-dimensional and panorama view of the intraventricular lesions.

Endoscopic Third Ventriculostomy and Endoscopic Intracranial Cyst Fenestration in an Outpatient Ambulatory Surgery Center Yields Reduced Cost But Equal Efficacy and Safety Compared with Surgery in the Hospital

A transition is underway in neurosurgery to perform relatively safe surgeries outpatient, often at ambulatory surgery centers (ASC). We sought to evaluate whether simple intracranial endoscopic procedures such as third ventriculostomy and cyst fenestration can be safely and effectively performed at an ASC, while comparing costs with the hospital. A retrospective chart review was performed for patients who underwent elective intracranial neuroendoscopic (NE) intervention at either a quaternary hospital or an affiliated ASC between August 2014 and September 2017. Groups were compared on length of stay, perioperative and 30-day morbidity, as well as clinical outcome at last follow-up. The total cost for these procedures were compared in relative units between all ASC cases and a small subset of hospital cases. In total, 16 NE operations performed at the ASC (mean patient age 29.8 years) and 37 at the hospital (mean age 15.4 years) with average length of stay of 3.5 hours and 23.1 hours respectively (P < 0.05). There were no acute complications in either cohort or morbid events requiring hospitalization within 30 days. Surgical success was noted for 75% of the ASC patients and 73% of the hospital cohort. The mean cost of 5 randomly selected hospital operations with same-day discharge and 5 with overnight stay was 3.4 and 4.1 times that of the ASC cohort, respectively (P < 0.05). Elective endoscopic third ventriculostomy and other simple NE procedures can be safely and effectively performed at an ASC for appropriate patients with significantly reduced cost compared with the hospital.

Clarity on Palliative Neurosurgery: A Neuroethics Perspective

A transition is underway in neurosurgery to perform relatively safe surgeries outpatient, often at ambulatory surgery centers (ASC). We sought to evaluate whether simple intracranial endoscopic procedures such as third ventriculostomy and cyst fenestration can be safely and effectively performed at an ASC, while comparing costs with the hospital.A retrospective chart review was performed for patients who underwent elective intracranial neuroendoscopic (NE) intervention at either a quaternary hospital or an affiliated ASC between August 2014 and September 2017. Groups were compared on length of stay, perioperative and 30-day morbidity, as well as clinical outcome at last follow-up. The total cost for these procedures were compared in relative units between all ASC cases and a small subset of hospital cases.In total, 16 NE operations performed at the ASC (mean patient age 29.8 years) and 37 at the hospital (mean age 15.4 years) with average length of stay of 3.5 hours and 23.1 hours respectively (P < 0.05). There were no acute complications in either cohort or morbid events requiring hospitalization within 30 days. Surgical success was noted for 75% of the ASC patients and 73% of the hospital cohort. The mean cost of 5 randomly selected hospital operations with same-day discharge and 5 with overnight stay was 3.4 and 4.1 times that of the ASC cohort, respectively (P < 0.05).Elective endoscopic third ventriculostomy and other simple NE procedures can be safely and effectively performed at an ASC for appropriate patients with significantly reduced cost compared with the hospital.

Neuroendoscopic treatment of symptomatic cyst of the septum pellucidum in children: A case series

BackgroundSymptomatic cysts of the septum pellucidum (CSP) are extremely rare in children and surgical indications are not well defined. A very careful clinical and neuroradiologic evaluation is necessary to consider a patient for surgical indication. MethodsWe present a surgical series of 7 pediatric patients. Clinical and radiological features of the patients, including clinical presentation, previous treatment, pre, and post-operative MRI, immediate postoperative, neuropsychiatric assessment, and outcomes were reviewed. ResultsThere were 5 males and 2 females (mean age 8 yrs). Five patients presented a history of severe intermittent headaches, two of them were admitted with acute symptoms of raised intracranial pressure. One patient presented Epilepsy and ADHD and one patient had severe psychosis. Overall, psychiatric disorders were diagnosed in six patients, three patients had Intellectual Disability (ID). In all cases, the cyst presented a ballooning feature, with a mean volume of 18,36 cm3 (range 10,62–28,5) and significant lateral bulging of both layers. All were operated on endoscopically without complications. After surgery, a very significant decrease in cyst volume was observed (mean volume 5,68 cm3; range 3,18–10,1) with complete disappearance of the ballooning aspect. Headaches resolved in all patients. In two patients operated in emergency papilloedema and vision improved in the first week after surgery. No recurrence of the cysts was noted during follow-up in all patients. ConclusionsCSP may be associated with behavioral or psychiatric problems also in children. Neuroendoscopic surgery is a safe and effective therapeutic modality to treat CSP presenting with symptoms and signs of intracranial hypertension with good clinical results.

Telemetric intracranial pressure monitoring after neuroendoscopic treatment of hydrocephalus: a valuable tool to recognise treatment failure

Telemetric intracranial pressure monitoring after neuroendoscopic treatment of hydrocephalus: a valuable tool to recognise treatment failure

Neuroendoscopic treatment of very rare ventricular arachnoid cysts in adults

Neuroendoscopic treatment of very rare ventricular arachnoid cysts in adults

Neurocognitive Complications after Ventricular Neuroendoscopy: A Systematic Review.

In recent years, neuroendoscopic treatment of hydrocephalus and various ventricular pathologies has become increasingly popular. It is considered by many as the first-choice treatment for the majority of these cases. However, neurocognitive complications following ventricular neuroendoscopic procedures may occur leading mostly to amnesia, which might have a grave effect on the patient's quality of life. Studies assessing neurocognitive complications after ventricular neuroendoscopic procedures are sparse. Therefore, we conducted a systematic review assessing the available literature of neurocognitive complications and outcome after ventricular neuroendoscopy. Of 1216 articles screened, 46 were included in this systematic review. Transient and permanent neurocognitive complications in 2804 ventricular neuroendoscopic procedures occurred in 2.0% (n = 55) and 1.04% (n = 28) of the patients, respectively. Most complications described are memory impairment, followed by psychiatric symptoms (psychosyndrome), cognitive impairment not further specified, declined executive function, and confusion. However, only in 20% of the series describing neurocognitive complications or outcome (n = 40) was neurocognition assessed by a trained neuropsychologist in a systematic manner. While in most of these series only a part of the included patients underwent neuropsychological testing, neurocognitive assessment was seldom done pre- and postoperatively, long-term follow up was rare, and patient's cohorts were small. A paucity of studies analyzing neurocognitive complications and outcome, through systematic neuropsychological testing, and the correlation with intraoperative lesions of neuronal structures (e.g., fornix) exists in the literature. Therefore, the neurocognitive and emotional morbidity after ventricular neuroendoscopic procedures might be underestimated and warrants further research.

Neuroendoscopic treatment of arachnoid cysts in the paediatric population. Series results for 20 patients

IntroductionNeuroendoscopy has become an effective and safe treatment for arachnoid cysts in the paediatric population. We review the paediatric patients with arachnoid cysts treated by neuroendoscopy in our hospital and analyse the results. Material and methodsA retrospective analysis of 20 patients operated on from 2005 to 2018. The variables assessed are: gender, age, clinical presentation, cyst site, presence of hydrocephalus and/or extra-axial collections, endoscopic procedures and complications. Procedure success is defined as an improvement in symptoms and reduction in cyst size until end of follow-up. ResultsOur series comprised 13 males and 7 females (mean age: 64.6 months, range: 4–172 months). The most frequent site was suprasellar-prepontine (7), followed by intraventricular (6), quadrigeminal (3), interhemispheric (2) and Sylvian (2).A total of 70% (14/20) of patients had hydrocephalus at diagnosis, which increased to 85% in suprasellar-prepontine cysts and 100% in quadrigeminal cysts. Only 4/14 patients with required a ventriculoperitoneal shunt (median age at diagnosis: 12.5 months). Of these 4 patients, 3 developed severe shunt overdrainage.The procedure was successful in 60% (12/20) of the patients in the series. Success by location was 57% (4/7) in suprasellar cysts, 33% (1/3) in quadrigeminal cysts, 66% (4/6) in intraventricular cysts, 100% (2/2) in interhemispheric cysts and 50% (1/2) in Sylvian cysts. Treatment thus failed in 8 cases, with a mean time to failure of 12.12 months (range: 0–45 months). A new neuroendoscopic procedure was performed in 4 of these 8 cases (success in 2/4), a ventriculoperitoneal shunt was placed in 2 cases, a cystoperitoneal shunt was placed in 1 case and the remaining case was managed conservatively. Mean follow-up time was 52.45 months (range: 3–129 months). ConclusionsNeuroendoscopy is an effective and safe treatment for arachnoid cysts in paediatric patients that also enables managing associated hydrocephalus in most cases. The choice of neuroendoscopic procedure and success rate depend on cyst location. Younger patients have been found to have a higher shunt dependency rate. In these cases, measures to prevent shunt overdrainage are recommended.

Application of multimodal image fusion in neuroendoscopic endonasal treatment of anterior skull base tumors

Objective To explore the value of multimodal image fusion technique in neuroendoscopic endonasal treatment of anterior skull base tumors. Methods The clinical data of 9 patients with anterior skull base tumors who underwent endoscopic surgery at Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University from January 2016 to June 2017 were retrospectively analyzed. CT, MRI, and CT angiography (CTA) images of the patient′s skull were fused before surgery, and intraoperative neuronavigation assisted surgical removal of the tumor was performed based on the results of the image fusion. This paper analyzed the effects of multimodal image fusion technology on demonstration of anterior skull base lesions and adjacent anatomical structures. Results During operation, multimodal image fusion clearly revealed the anterior skull base tumors together with adjacent neural tissues, blood vessels, bone structures, sphenoid sinus and septations. All 9 patients underwent successful operation. Among them, gross total resection of tumor was achieved in 6 cases and subtotal resection in 3 cases. No serious complications such as delayed hemorrhage, brain infection, and cerebrospinal fluid rhinorrhea occurred postoperatively. Conclusions In neuroendoscopic transnasal resection of the anterior skull base tumor, the application of multimodal image fusion technology combined with intraoperative neuronavigation can clearly show the location of tumor and its adjacent important structures, which helps improve the accuracy, safety, and effectiveness of the operation. Key words: Skull base neoplasms; Neurosurgical procedures; Neuronavigation; Natural orifice endoscopic surgery; Multimodal