Use Of Neuroendoscopy Research Articles

Neuroendoscopy: history, endoscopes, and instrumentation.

Endoscopy was first employed in the surgical treatment of neurosurgical diseases early in the twentieth century, but did not become an established practice for a long time, mainly because of poor technology and clinical results. After a slow re-appearance in the 1980s, the 1990s saw an explosion of techniques and instrumentation. Continuing technological improvement has led to further expansion of surgical techniques and indications for use of neuroendoscopy. The expansion of ventricular endoscopy has led to significant understanding of CSF disorders. Aqueduct stenosis as cause of hydrocephalus and arachnoid cysts are an example of pathologies, the concept and understanding of which now is considerably enhanced, due to the application of neuroendoscopy in their treatment. Management of loculated hydrocephalus has been facilitated considerably with the use of the endoscope. The concepts of aqueductoplasty, septostomy, and foraminoplasty of the foramina of Monro and Magendie emerged, which were previously unknown. Skull base surgery, especially surgery for craniopharyngioma, has seen dramatic improvement in results with the use of the endoscope. Coupling of the endoscope with neuronavigation has expanded technical capabilities even further. Overall, we can do a lot more with the endoscope now in comparison to 30years ago. We should always remember that the endoscope is only a tool. Its use has indications and limitations related to its design and our ability to extract the maximum, in the context of its shortcomings. Further technological advances will push surgical frontiers even more in years to come.

Endoscopic Assisted Supraorbital Approach for Tumors of Anterior and Middle Skull Base

Background Data: The supraorbital eyebrow approach is a minimally invasive keyhole technique that offers wide access to the anterior skull base and parasellar region using the subfrontal corridor, with assistances of neuroendoscopy The approach through the eyebrow permits access to a number of lesions in the subfrontal corridor with minimal brain retraction and a much smaller area of potential injury of main structures.
 Study Design: This study is a follow up study.
 Objective: To evaluate the role of supraorbital endoscopic approach for tumors of anterior and middle skull base.
 Patients and Methods: All the operations were performed at Suez Canal University hospitals, in about 24 months, the first 30 patients having tumors of anterior and middle skull base fulfilling the inclusion criteria were included in this prospective study.
 Results: Endoscopy can play an important role in improving visualization through the keyhole corridor. With the use of neuroendoscopy, the reach of this approach may be extended even further to include the pituitary fossa, the top third of the clivus, the interpeduncular cistern, the anterior third ventricle, and the medial and anterior temporal lobe and middle fossa.The major advantage of the supraorbital over the endonasal route is a simplified skull base closure and reduced risk of postoperative CSF leak. It is a valuable approach for selected patients. Neuromonitoring may further increase surgical safety.
 Conclusion: The approach through the eyebrow permits access to a number of lesions in the subfrontal corridor With the use of the assisstence of neuroendoscopy, with minimal brain retraction and a much smaller area of potential injury of anatomical structures.

Endoscopic intraventricular hematoma evacuation surgery versus external ventricular drainage for the treatment of patients with moderate to severe intraventricular hemorrhage: a multicenter, randomized, controlled trial

BackgroundThe application of neuroendoscopy in intraventricular hemorrhage (IVH) has attracted more and more attention in recent years. Studies have shown that the use of neuroendoscopy for IVH evacuation has advantages over external ventricular drainage (EVD) alone. However, the cases of most current research are small and all of them are retrospective studies. The aim of this study is to explore the prognosis of patients with moderate to severe IVH who undergo endoscopic IVH evacuation surgery versus those who undergo EVD alone.MethodsThe study is a prospective, randomized, controlled, multi-center clinical trial. Nine hundred and fifty-six subjects with moderate to severe IVH across four tertiary hospitals in China will be randomly assigned (1:1) to receive either endoscopic IVH evacuation surgery or EVD. The primary objective is to compare patients’ survival rate at 12 months after surgery.DiscussionThe trial is designed to investigate the prognostic benefits of endoscopic IVH evacuation surgery for patients with moderate to severe IVH. Currently, it has never been investigated in a prospective randomized controlled clinical trial.Trial registrationClinicalTrials.gov, NCT04037267. Registered on 26 July 2019.

Pure Endoscopic Excision of Parenchymal Brain Tumors: Feasibilty, Risks, Advantages and Realities - A Beginners Perspective

Abstract Background Neuroendoscopy is gaining popularity and is reaching new realms. Young neurosurgeons are exploring the various possibilities associated with the use of neuroendoscopy. Neuroendoscopy in excision of parenchymal brain tumors is less explored, and young neurosurgeons should be aware of the realities. The present article is an approach to put forward the difficulties faced by a young neurosurgeon and the lessons learnt. Objective To report the experience of surgical excision of parenchymal brain tumors, in selected cases, using pure endoscopic approach and to discuss its feasibility, technical benefits, risks and comparison with conventional microscopic excision. Method Eight patients of variable age group with parenchymal brain tumors were operated upon by a single surgeon and followed up for a period varying from 6 months to 2 years. Data regarding operating time, illumination, clarity of the field, size of craniotomy, blood loss and course of recovery was evaluated. All of the tumors were resected using rigid high definition zero and 30° endoscope. Results Out of eight cases, seven had lesions in the supratentorial and one in the infratentorial location. The age group ranged from 27 to 74 years old. Near to gross total resection was achieved in all except two cases. All of the patients recovered well without any significant morbidity or mortality. Hospital stay was reduced by 1 day on average. Conclusion Excision of parenchymal brain tumors via pure endoscopic method is a safe and efficient procedure. Although there is an initial period of learning curve, it is not steep for those already practicing neuroendoscopy, but the approach has its advantages.

Evolution of transmaxillary approach to tumors in pterygopalatine fossa and infratemporal fossa: anatomic simulation and clinical practice.

Background:The endoscopic transnasal approach has been proven to have advantages on the removal of the tumors in pterygopalatine fossa (PPF) and infratemporal fossa (ITF). Herein, this study aimed to describe a modified approach for resection of the tumors in these areas, both in cadaveric specimen and clinical patients.Methods:The 20 adult cadaveric specimens and five patients with tumors in PPF and ITF were enrolled in this study. For the cadaveric specimens, ten were simulated anterior transmaxillary approach and ten were performed modified endoscopic transnasal transmaxillary approach. The exposure areas were compared between two groups and main anatomic structure were measured. Surgery was operated in the five patients with tumors of PPF and ITF to verify the experience from the anatomy. Perioperative management, intraoperative findings and postoperative complications were recorded and analyzed.Results:The modified endoscopic transnasal transmaxillary approach provided as enough surgical exposure and high operability to the PPF and ITF as the anterior transmaxillary approach did. The diameter of maxillary artery in the PPF was 3.77 ± 0.78 mm (range: 2.06–4.82 mm), the diameter of middle meningeal artery in the ITF was 2.79 ± 0.61 mm (range: 1.54–3.78 mm). Four patients who suffered schwannoma got total removal and one of adenocystic carcinoma got subtotal removal. The main complications were facial numbness and pericoronitis of the wisdom tooth. No permanent complication was found.Conclusions:With the widespread use of neuroendoscopy, the modified endoscopic transnasal transmaxillary approach is feasible and effective for the resection of tumors located in PPF and ITF, which has significant advantages on less trauma and complications to the patients.

Keyhole Approach and Neuroendoscopy for Cerebral Aneurysms.

Treating diseases in the field of neurosurgery has progressed concomitantly with technical advances. Here, as a surgical armamentarium for the treatment of cerebral aneurysms, the history and present status of the keyhole approach and the use of neuroendoscopy are reviewed, including our clinical data. The major significance of keyhole approach is to expose an essential space toward a target, and to minimize brain exposure and retraction. Among several kinds of keyhole approaches, representative keyhole approaches for anterior circulation aneurysms include superciliary and lateral supraorbital, frontolateral, mini-pterional and mini-interhemispheric approaches. Because only a fixed and limited approach angle toward a target is permitted via the keyhole, however, specialized surgical devices and preoperative planning are very important. Neuroendoscopy has helped to widen the indications of keyhole approaches because it can supply illumination and visualization of structures beyond the straight line of microscopic view. In addition, endoscopic indocyanine green fluorescence angiography is useful to detect and correct any compromise of the perforators and parent arteries, and incomplete clipping. The authors think that keyhole approach and neuroendoscopy are just an intermediate step and robotic neurosurgery would be realized in the near future.

Prevalence of Shunt Dependency and Clinical Outcome in Patients with Massive Intraventricular Haemorrhage Treated with Endoscopic Washout and External Ventricular Drainage.

Intraventricular haemorrhage (IVH) causes blockage of ventricular conduits leading to hydrocephalus, increased intracranial pressure (ICP), and a reduced level of consciousness. The current standard management of IVH is insertion of an external ventricular drainage (EVD) catheter. However, this procedure addresses only the problems of acute hydrocephalus and raised ICP. Endoscopic washout allows for a more complete removal of the intraventricular clot. This study compared these two types of treatment in terms of shunt dependency and relevant clinical outcomes. Patients who were 10-80 years old and presented with a Graeb score of more than six were randomised into endoscopic washout and EVD treatment groups. A CT brain was repeated on each patient within 24 hours after surgery, and if a patient's Graeb score was still more than six, a repeat endoscopic washout was performed to clear the remaining clots. All patients were monitored for shunt dependency at two weeks and three months, and clinical outcomes were measured at six months after the procedure. A total of 39 patients were recruited; 19 patients were randomised into the endoscopic washout group, and 20 were randomised into the EVD group. However, three patients in the endoscopic group refused that treatment and opted for EVD insertion. Patients treated with endoscopic washout had significantly less drainage dependency at two weeks (P < 0.005) and at three months (P < 0.004) as compared to patients in the external ventricular drainage group. The reduction in Graeb scores was also significantly greater in the endoscopic washout group (P < 0.001). However, the functional outcome at six months measured via a modified Rankin scale score was no different in the two groups of patients. The difference in the functional outcome of the patients was mainly dependent on the initial pathology, with those presenting with a thalamic bleed with IVH showing a poor functional outcome. This parameter was also influenced by the Glasgow Coma Scale (GCS) score on admission, with those patients with a score of 12 or less having a poor functional outcome (MRS 5-6) at three and six months after the surgery. The use of neuroendoscopy in patients with a massive IVH significantly reduced drainage dependency. However, it did not alter the final functional outcome.

Delayed intraventricular metastasis of clival chordoma.

Sir, Intracranial chordomas are typically clival and extradural in location, yet these tumors can obviously invade the dura. However, primary intradural chordomas without local extension is a rare event with approximately 47 cases reported in literature. Furthermore, all intradural chordoma reports appear to be extraventricular in location.[1,2] In addition, through advances in technology and optics, neuroendoscopy has come to the forefront as a mainstream operative technique. Some tumors are more conducive to endoscopic biopsy or resection than others due to hemorrhagic or consistency. We present this unique case of an intraventricular recurrence of a clival chordoma and successful use of neuroendoscopy to explore and resect the tumor. A 60-year-old male, with a history of clival chordoma resection and adjuvant radiation nearly 10 years prior, presented with an intraventricular lesion on magnetic resonance imaging (MRI) obtained for stroke workup of the left sided weakness. Physical examination showed right third nerve palsy, left facial droop, and left sided weakness. MRI demonstrated an intraventricular enhancing lesion within the right lateral ventricle [Figure ​[Figure1a1a and ​andb].b]. No other evidence of metastasis was identified. The decision was made to endoscopically biopsy and resects the intraventricular lesion via a transcortical-transventricular approach [Figure 1c]. Postoperative MRI demonstrated gross total resection [Figure 1d]. The histopathologic diagnosis of the tumor was chordoma. No postoperative radiation was given. On 6-month follow-up imaging, the lesion has not recurred. Figure 1 (a and b) Preoperative magnetic resonance imaging demonstrates an enhancing lesion, approximately 1.5 cm × 1.0 cm, along the ependymal surface within the right lateral ventricle caudothalamic notch. (c) Intraoperative view of intraventricular ... This case illustrates a unique occurrence of intraventricular recurrence of clival chordoma approximately 10 years after initial resection with good result via an endoscopic technique. Prior reports have typically focused on intradural, extraventricular metastases. A solitary intraventricular chordoma neoplasm is a rare, interesting event. Furthermore, neuroendoscopy is a useful technique for tumor resection and proves viable in the resection of chordomas. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Endoscopic supraorbital eyebrow approach for the surgical treatment of extraaxialand intraaxial tumors.

The supraorbital eyebrow approach is a minimally invasive technique that offers wide access to the anterior skull base region and parasellar area through asubfrontal corridor. The use of neuroendoscopy allows one to extend the approach further to the pituitary fossa, the anterior third ventricle, the interpeduncular cistern, the anterior and medial temporal lobe, and the middle fossa. The supraorbital approach involves a limited skin incision, with minimal soft-tissue dissection and a small craniotomy, thus carrying relatively low approach-related morbidity. All consecutive patients who underwent the endoscopic supraorbital eyebrow approach were retrospectively analyzed for lesion location, pathology, length of stay, complications, and cosmetic results. During a 56-month period, 97 patients (mean age 58.5 years) underwent an endoscopic eyebrow approach to resect extra- and intraaxial brain lesions. The most common pathologies treated were meningiomas (n = 41); craniopharyngiomas (n = 22); dermoid tumors (n = 7); metastases (n = 4); gliomas (n = 3); and other miscellaneous frontal, parasellar, and midbrain (n = 23) lesions. The median length of postoperative hospital stay was 2.7 days (range 1-8 days). In 82 patients a total removal of the lesion was performed, while in 15 patients a near-total or subtotal removal was achieved. There were no postoperative hematomas, cerebrospinal fluid leaks, or severe neurological deficits, with the exception of 2 cases of visual deterioration and 1 case each of meningitis, stroke, and third cranial nerve paresis. Other complications directly related to the approach included 2 cases of skin burn as a direct result of heat transmission from the microscope light, 1 case of right frontal palsy, 2 cases of frontal numbness, and 1 case of bone remodeling 1 year after surgery. The endoscopic supraorbital eyebrow approach is a safe and effective minimally invasive approach to remove extra- and intraaxial anterior skull base, parasellar, and frontal lesions, promoting a rapid recovery and short hospital stay. The location of the eyebrow incision demands a meticulous cosmetic closure, but, with proper technique, cosmetic results are excellent.

Diagnostic Value of Brain Tumor Neuroendoscopic Biopsy and Correlation with Open Tumor Resection

The risks of stereotactic biopsy are increased not only in tumors located in the vicinity of vascular structures, but also in cystic, intraventricular, and periventricular lesions. The use of neuroendoscopy for cystic, intraventricular, or periventricular brain tumors is particularly advantageous because of the possibility of biopsy and immediate hemostasis under direct vision. Neuroendoscopy provides the possibility of controlling tumor-associated obstructive hydrocephalus by means of endoscopic third ventriculostomy or septostomy. The literature gives good evidence for the diagnostic benefits of neuroendoscopic biopsy. The correlation of the histology obtained by neuroendoscopic biopsy and subsequent surgical resection may allow the evaluation of the validity of diagnostic neuroendoscopic biopsy. Between 2003 and 2010, 23 patients with suspected cystic brain tumor (12 males; age range, 21-75 years; mean age, 49.7 years; and 11 females; age range, 22-76 years; mean age, 59.1 years) and 35 patients with intraventricular or periventricular brain tumors (19 males; age range, 6-80 years; mean age, 43.9 years; and 16 females; age range, 11-78 years; mean age, 46.2 years) underwent navigated neuroendoscopic biopsy. Diagnostic samples were obtained in all cystic tumors and in 94.7% of intraventricular or periventricular tumors. Tumor resection after neuroendoscopic biopsy was performed in seven patients with cystic tumors. The results of the histological analysis of samples taken during endoscopic biopsy and surgical resection were identical in five of these patients (70.1%). Four patients with intraventricular or periventricular tumors underwent tumor resection after neuroendoscopic biopsy. The histological results of neuroendoscopic biopsy and tumor resection were identical in three patients (75%). Neuroendoscopic biopsy was performed in six patients with expansive pseudocyst after tumor resection and oncological therapy. The results of the neuroendoscopic biopsy matched the results of open surgery in four patients (66%). In the two remaining patients, there was a difference in tumor grading. The diagnostic accuracy of neuroendoscopic biopsy samples can be compared with the results of stereotactic biopsy. The histological results of endoscopically taken biopsy samples and the final histological results obtained during open surgery correlate in the majority of patients, and underlines the high diagnostic validity of neuroendoscopic biopsy.

ROBOTIC VIRTUAL ENDOSCOPY

The use of neuroendoscopy has increased in the past 20 years. Despite an increase in the number of indications for use, novel adjuncts and modifications to existing endoscopes remain all but nonexistent. We introduce a robotic virtual endoscope with applications for neurosurgery that could serve as a novel step in the evolution of future endoscopic technologies.Over the past 8 years, we have worked on the construction of a prototype endoscope with three degrees of freedom that was designed to allow for enhanced safety while maximizing the benefits of virtual field rendition and robotic control. We have developed a prototype to examine a cerebral ventricular model in vitro that functions via either a direct video- or computer-based interface.Assessment of viewing angulation with robotic feedback has verified the accuracy of the prototype. Models support the ability of the endoscope to localize regions identified via a software interface.The endoscope is a rigid virtual robotic endoscope that provides complete visual coverage of a three-dimensional space by controlling an adjustable viewing direction with three degrees of freedom.

Robotic Virtual Endoscopy: Development of a Multidirectional Rigid Endoscope

The use of neuroendoscopy has increased in the past 20 years. Despite an increase in the number of indications for use, novel adjuncts and modifications to existing endoscopes remain all but nonexistent. We introduce a robotic virtual endoscope with applications for neurosurgery that could serve as a novel step in the evolution of future endoscopic technologies. Over the past 8 years, we have worked on the construction of a prototype endoscope with three degrees of freedom that was designed to allow for enhanced safety while maximizing the benefits of virtual field rendition and robotic control. We have developed a prototype to examine a cerebral ventricular model in vitro that functions via either a direct video- or computer-based interface. Assessment of viewing angulation with robotic feedback has verified the accuracy of the prototype. Models support the ability of the endoscope to localize regions identified via a software interface. The endoscope is a rigid virtual robotic endoscope that provides complete visual coverage of a three-dimensional space by controlling an adjustable viewing direction with three degrees of freedom.

Endoscopic removal of cisternal neurocysticercal cysts

The authors report the use of neuroendoscopy for the treatment of cisternal neurocysticercosis. The utilization of the endoscope is meant to provide a safe and minimally invasive procedure for the removal of symptomatic cysts, minimizing morbidity and mortality relating to the natural history of the disease, as well as possibly avoiding a more extensive standard open craniotomy. A retrospective review of three cases of cisternal cysticercosis was performed. The presenting signs and symptoms, neuroimaging findings, endoscopic treatment, and outcomes are presented. The technical aspect of the endoscopic resection is described, with visual support provided by intraoperative video. Cerebrospinal fluid shunt placement was avoided in one patient in whom complete resection of the cyst was required. In one patient there were extensive interhemispheric and premesencephalic cisternal cysts, some of which could not be removed because of their multiplicity and extensive adhesions. Despite the intraoperative rupture of cysts, there were no cases of arachnoiditis or ventriculitis postoperatively. The minimally invasive endoscopic resection of cisternal cysticercosis is possible and effective in selected patients. Although the most appropriate treatment of cisternal cysticercosis remains a controversial issue, endoscopic resection should be considered as a primary treatment in symptomatic patients in cases that are amenable to endoscopic intervention.

Intracranial endoscopy.

Since 1910, when Lespinasse [73] in Chicago was the first surgeon to use an endoscopic device for the treatment of a neurologic disease, various methods of endoscopy have evolved into accepted diagnostic and therapeutic adjuncts of modern neurosurgery. Nevertheless, until recently technical shortcomings of the available endoscopes have prevented the widespread use of neuroendoscopy. However, now, at the end of the 20th century, endoscopes can be regarded as some of the most important instruments for the development of microneurosurgery into the 3rd millennium. The aim of this review of intracranial endoscopy in neurosurgery, which admittedly might not be completely objective in the authors' personal assessment of various endoscopic techniques, is first to depict the historical evolution of neuroendoscopy, second to describe the technical equipment used in intracranial endoscopic neurosurgery, third to characterize the most frequent endoscopic methods in brain surgery, and fourth to indicate how neuroendoscopy might develop in the near future. It will be shown that this ongoing evolutionary process in neuroendoscopy was only possible with the mutual influence of improved diagnostic techniques, increased microanatomical knowledge, refined neurosurgical instrumentation--especially the introduction of the surgical microscope, and endoscopic diagnostic and therapeutic strategies.

Recent advances in the understanding and treatment of hydrocephalus

Advances in the management of patients with hydrocephalus and other abnormalities of cerebrospinal fluid dynamics and intracranial pressure have come from a variety of sources including an improved understanding of the pathophysiology of the various subtypes of the problem, development of alternative methods of treating the condition without reliance on implantable shunting devices, use of neuroendoscopy, and the development of newer types of shunt valves. The purpose of this review is to put into perspective the relative importance of each of these advances to the overall management of our patients.