Neuronavigational neuroendoscopic surgery. Frameless free-hand maneuvering of a handy rigid-rod neuroendoscope on visualized three-dimensional computerized image guidance: trajectory to the prepontine cistern in cadaver study

Tailored Concept for Accurate Neuroendoscopy: A Comparative Retrospective Single-Center Study on Image-Guided Neuroendoscopic Procedures

OBJECTIVE

Precise planning and execution is key for neuroendoscopic interventions, which can be based on different available aiding technologies. The aim of this retrospective study is to report a case-based use of guided neuroendoscopy and to develop a stratification algorithm for the available technologies.

METHODS

We reviewed consecutive neuroendoscopic cases performed at our center from 2016 to 2018. We distinguished between patients receiving a new burr hole (group A) and those with a preexisting burr hole (group B). Case-specific technical requirements for procedure planning and execution, complication rate, surgical outcome, and possible subsequent surgery were evaluated. From this experience, a stratification system was developed to tailor the available guiding technologies.

RESULTS

A total of 309 neuroendoscopic interventions in 243 patients were included in the present study. The cases included hydrocephalic (81.6%) and nonhydrocephalic (18.4%) conditions. The interventions were supported by coordinate-based (group A, n = 49; group B, n = 67), guide-based (group A, n = 42; group B, n = 0), ultrasound-guided (group A, n = 50; group B, n = 7), or navigated augmented reality-guided (group A, n = 85; group B, n = 9) techniques. The overall complication rate was 4.5%. Stratified by the surgical indication, fontanel status, entry point localization, presence of a preexisting burr hole, ventricular size, and number of targets, an approach toward image-guided neuroendoscopy is suggested.

CONCLUSIONS

Planning and technical guidance is essential in neuroendoscopic procedures. The stratified decision-making algorithm for different available technologies aims to achieve lower cost and time consumption, which was found to be safe and efficient. Further investigations are warranted to deliver solid data on procedure efficiency.

Neuronavigational neuroendoscopy--to be or not to be? An international pilot questionnaire-based study

OBJECTIVE

The almost age-old neuroendoscopy (NE) and neuronavigation (NN) in its twenties independently and indisputably have proved their high value as neurosurgical armamentarium and became even indispensable in some pathologies. However, nowadays the effectiveness of their simultaneous and combined application still is a matter of debate. The purpose of our pilot international, questionnaire-based survey was to assess the position of the opinion leaders in the field of neuroendoscopy worldwide toward the neuronavigational neuroendoscopy (NNNE).

METHODS

Within 3 months, a questionnaire with 17 questions was emailed repeatedly to 55 leading academic neuroendoscopic neurosurgeons from 50 institutions in 24 countries. The questionnaire covered aspects of personal and institutional experience in NE, NN, and NNNE, the most frequently treated pathologies by NNNE as well as inquiring the neurosurgeons' opinion for the importance and future of NNNE.

RESULTS

Forty-one questionnaires were returned (response rate = 74.6%). Six questionnaires were excluded because of incomplete or incorrect answers, leaving in the survey 35 respondents from 35 institutions in 18 countries. The less experienced neurosurgeons rely in higher degree on NNNE. Most frequently, NNNE is performed for hydrocephalus (procedures other than third ventriculostomy), transsphenoidal surgery, tumor biopsy, and cyst fenestration. Regardless their neurosurgical and NE experience, more than 75% of the respondents state that NNNE extends the range of neuroendoscopic procedures in their neurosurgical departments.

CONCLUSION

NNNE represents a valuable operative technique with excellent future prospects. NNNE extends the range of neuroendoscopic procedures, transforming some number of patients from "nonoperable" neuroendoscopically to suitable for neuroendoscopy.

Pinless frameless electromagnetic image-guided neuroendoscopy in children

OBJECTIVES

Frameless imaged-guided neuronavigation is a useful adjunct to neuroendoscopy in paediatric patients, especially those with abnormal or complex ventricular or cyst anatomy. The development of electromagnetic neuronavigation has allowed the use of image-guided navigation in the very young patient in whom rigid fixation in cranial pins is contraindicated. The technique and the authors' experience of its use in a series of paediatric patients are described.

MATERIALS AND METHODS

Nineteen paediatric patients were treated with endoscopic surgery at two paediatric neurosurgery centres over a period of 18 months. A total of 29 endoscopic procedures were performed. The cases were reviewed and surgical outcomes assessed. In all of the cases, the goal of surgery was realised successfully at the time of surgery, as confirmed by post-operative imaging. No technical failures were encountered. None of the patients suffered worsened neurological function as a result of their procedures.

CONCLUSION

Pinless, frameless electromagnetic neuronavigation was found to be a safe technique that can supplement endoscopic surgery in the very young patient. It allows the use of direct navigation of the endoscope in patients that are unable safely to undergo rigid cranial fixation in pins due to young age or thin skull vaults. This has proven to be a useful adjunct to neuroendoscopy in the subset of infants who have complicated or distorted ventricular anatomy and can improve the safety and accuracy of this type of surgery. It is also an alternative to optical neuronavigation in conjunction with neuroendoscopy in patients of any age.

Neuroendoscopic foraminal plasty of foramen of Monro

OBJECTIVES

The aims of this study were to describe and analyze the technique of neuroendoscopic foraminal plasty of foramen of Monro (NEFPFMO) in the treatment of isolated unilateral hydrocephalus (IUH) due to membranous occlusion, to evaluate its efficacy and safety, and to define the benefits of neuronavigational guidance of the procedure.

MATERIALS AND METHODS

Two symptomatic neonates with IUH, as a result of congenital atresia of foramen of Monro, underwent NEFPFMO plus neuroendoscopic septostomy in the first case and neuronavigational guidance in the second one. Clinical results were excellent in both neonates. The postoperative ventricular size decreased and the progressive IUH changed to the state of arrested hydrocephalus. The neuronavigation was precise.

CONCLUSION

NEFPFMO should be the primary treatment option in patients with IUH due to membranous occlusion of foramen of Monro. It reestablishes natural anatomical communication and provides real physiological cerebrospinal fluid flow. Neuronavigation is a useful adjunct of NEFPFMO.