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Kim YH, Phi JH, Kim SK, Wang KC. Endoscopic biopsy of pineal tumors: two burr hole trans-foramen of Monro approach and endonasal trans-tuber cinereum approach. Childs Nerv Syst 2023; 39:2367-2375. [PMID: 36112201 DOI: 10.1007/s00381-022-05654-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/16/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The pineal region is a challenging area for neurosurgeons due to its innate anatomical features, such as its deep location, surrounding large draining veins, and adjacent critical neural structures. DISCUSSION There is a high proportion of malignant tumors in the pineal gland, especially in children, and they are frequently accompanied by obstructive hydrocephalus. These cases require that surgical procedures can make a pathological diagnosis to guide further treatment strategies and immediately resolve increased intracranial pressure. Simultaneous endoscopic third ventriculostomy and biopsy have been regarded as the first-line surgical intervention before establishing a definite treatment plan. However, it is not always successful because various factors affect the surgical procedures, such as the location and extent of the tumor, degree of ventriculomegaly, location and size of the massa intermedia, and size of the foramen of Monro. CONCLUSION Here, we briefly reviewed the points to be considered in endoscopic biopsy of pineal tumors and introduced an alternative surgical procedure, the endoscopic endonasal trans-tuber cinereum approach, to surmount the anatomical hurdles.
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Affiliation(s)
- Yong Hwy Kim
- Pituitary Center, Department of Neurosurgery, Seoul National University of College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University of College of Medicine, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University of College of Medicine, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Kyu-Chang Wang
- Neuro-Oncology Clinic, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Kyounggi-do, 10408, Republic of Korea.
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Farag AA, Asiri FA, Khoudir MA, Ismaeel M, Hamouda W, Alaghory IM, Moshref RH. Endoscopic third ventriculostomy complications: avoidance and management in a stepwise manner. EGYPTIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1186/s41984-022-00166-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Various complications of endoscopic third ventriculostomy (ETV) have been described. One has to recognize these complications and learn how to avoid them.
Methods
We performed a literature review regarding the reported complications of ETV procedures discussed in a correlated manner with the surgical steps. Furthermore, we reviewed the technical notes described by experienced neuroendoscopists, including surgical indications, choice of the endoscopic entry point and trajectory, anatomic orientation, proper bleeding control and tight closure, to prevent and deal with such complications.
Results and conclusion
A lesson learned that comprehensive knowledge of ventricular anatomy with proper orientation by studying the preoperative images is mandatory and one should be aware of all complication types and rates.
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Ishikawa T, Takeuchi K, Yamamoto T, Nagata Y, Natsume A. Importance of Hydrostatic Pressure and Irrigation for Hemostasis in Neuroendoscopic Surgery. Neurol Med Chir (Tokyo) 2020; 61:117-123. [PMID: 33390557 PMCID: PMC7905298 DOI: 10.2176/nmc.oa.2020-0278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Recently neurosurgical operations have been carried out with water irrigation such as endoscopic third ventriculostomy and tumor resections in ventricles. Water irrigation is one of several published methods that promote hemostasis; however, not enough experimental evidence exists on its efficacy. In this study, we investigate whether hydrostatic pressure and persistent irrigation promote hemostasis in neuroendoscopic surgery. We dissected tails of 12-16-week-old C57BL/6 male mice at 5 mm proximal from the tip and checked for bleeding times under dry and wet conditions at pressures of 0 cmH2O, 10 cmH2O, 15 H2O, and 20 cmH2O without persistent irrigation to bleeding point and 10 cmH2O with persistent irrigation. We then examined the dissected edge with hematoxylin-eosin staining and measured the size of vessels. The average bleeding time of each group is as follows: dry: 203.4 sec, wet: 164.4 sec, 5 cmH2O: 138.6 sec, 10 cmH2O: 104.6 sec (P <0.001), 20 cmH2O: 56 sec (P <0.001), and 10 cmH2O with persistent irrigation: 72.8 sec (P <0.01 compared to 10 cmH2O without persistent irrigation). The maximum caliber of mice's tail artery was 50-60 μm. Hydrostatic pressure and irrigation are important factors contributing to hemostasis.
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Affiliation(s)
- Takayuki Ishikawa
- Department of Neurosurgery, Nagoya University, Nagoya, Aichi, Japan.,Department of Neurosurgery, Ichinomiya Municipal Hospital, Ichinomiya, Aichi, Japan
| | | | - Taiki Yamamoto
- Department of Neurosurgery, Nagoya University, Nagoya, Aichi, Japan
| | - Yuichi Nagata
- Department of Neurosurgery, Nagoya University, Nagoya, Aichi, Japan
| | - Atsushi Natsume
- Department of Neurosurgery, Nagoya University, Nagoya, Aichi, Japan
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Matsushita K, Kawashima R, Uesugi K, Okada H, Sakaguchi H, Quantock AJ, Nishida K. Assessment of a self-assembling peptide gel, SPG-178, in providing a clear operative field for trabeculectomy surgery for glaucoma in an animal model. Sci Rep 2020; 10:11326. [PMID: 32647319 PMCID: PMC7347556 DOI: 10.1038/s41598-020-68171-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/10/2020] [Indexed: 11/18/2022] Open
Abstract
The presence of blood during ophthalmic surgery is problematic, as it can obstruct a surgeon’s view of the operative field. This is particularly true when performing trabeculectomy surgery to enhance ocular fluid outflow and reduce intraocular pressure as a treatment for glaucoma, one of the most common vision loss conditions worldwide. In this study, we investigated the performance of a transparent, self-assembling peptide gel (SPG-178) and its ability to maintain visibility during trabeculectomy surgery. Unlike the hyaluronic acid gel commonly used in ophthalmic surgery, SPG-178 did not permit the ingress of blood into the gel itself. Rather, it forced blood to flow peripherally to the gel. Moreover, if bleeding occurred under the SPG-178 gel, perfusion with saline was able to effectively flush the blood away along the interface between the SPG-178 and the ocular tissue (in this case scleral) to clear the surgical field of view. In experimental trabeculectomy surgeries with mitomycin C used as an adjuvant, there were no differences in the postoperative recovery of intraocular pressure or bleb morphology with or without the use of SPG-178. SPG-178, therefore, when used in a gel formulation, represents a new material for use in intraocular surgery to ensure a clear operative field with likely beneficial treatment outcomes.
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Affiliation(s)
- Kenji Matsushita
- Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Rumi Kawashima
- Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Koji Uesugi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan.,Menicon Co., Ltd., 5-1-10 Takamoridai, Kasugai, Aichi, 487-0032, Japan
| | - Haruka Okada
- Menicon Co., Ltd., 5-1-10 Takamoridai, Kasugai, Aichi, 487-0032, Japan
| | - Hirokazu Sakaguchi
- Department of Advanced Device Medicine, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Andrew J Quantock
- School of Optometry and Vision Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ, Wales, UK
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan. .,Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Osaka, Japan.
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Jung TY, Chong S, Kim IY, Lee JY, Phi JH, Kim SK, Kim JH, Wang KC. Prevention of Complications in Endoscopic Third Ventriculostomy. J Korean Neurosurg Soc 2017; 60:282-288. [PMID: 28490153 PMCID: PMC5426448 DOI: 10.3340/jkns.2017.0101.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 02/19/2017] [Accepted: 02/21/2017] [Indexed: 11/27/2022] Open
Abstract
A variety of complications in endoscopic third ventriculostomy have been reported, including neurovascular injury, hemodynamic alterations, endocrinologic abnormalities, electrolyte imbalances, cerebrospinal fluid leakage, fever and infection. Even though most complications are transient, the overall rate of permanent morbidity is 2.38% and the overall mortality rate is 0.28%. To avoid these serious complications, we should keep in mind potential complications and how to prevent them. Proper decisions with regard to surgical indication, choice of endoscopic entry and trajectory, careful endoscopic procedures with anatomic orientation, bleeding control and tight closure are emphasized for the prevention of complications.
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Affiliation(s)
- Tae-Young Jung
- Department of Neurosurgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea
| | - Sangjoon Chong
- Division of Pediatric Neurosurgery and Clinical Pediatric Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea
| | - In-Young Kim
- Department of Neurosurgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea
| | - Ji Yeoun Lee
- Division of Pediatric Neurosurgery and Clinical Pediatric Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea.,Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery and Clinical Pediatric Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery and Clinical Pediatric Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea
| | - Jae-Hyoo Kim
- Department of Neurosurgery, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Kyu-Chang Wang
- Division of Pediatric Neurosurgery and Clinical Pediatric Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea
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Montidoro TA, Burgess JE, Antaki JF. Characterizing Pressure and Flow Rate for Aqueous Immersion Surgery. Surg Innov 2015; 23:36-41. [DOI: 10.1177/1553350615585415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hemorrhage control during surgery remains a major clinical challenge for surgeons. Bleeding can affect the safety and efficacy of any surgical procedure. There are well-established methods to address this side-effect of surgery, but all current technologies require the surgeon to direct attention to hemostasis rather than the continuance of the procedure. We have developed a novel surgical method, titled aqueous immersion surgery (AIS), that is able to sustain a bloodless surgical field by providing a controlled hydraulic pressure (immersion pressure) on the bleeding site. Together with the replenishment of an immersion fluid (immersion flow rate), AIS maintains optical clarity of the surgical field. This numerical study was undertaken to investigate the influence of the rate exchange of the immersion fluid on the concentration of blood, hence optical clarity therein. A 3-dimensional multicomponent simulation was performed to evaluate the mixing of blood from an idealized arterial bleeding vessel under pulsatile conditions. With an increase in immersion pressure, bleeding was reduced and increased perfusion was observed. Additionally, the magnitude and direction of the flow field affected the deflection of the bleeding trajectory and, in turn, affected the removal rate of blood from the surgical field. For an idealized case, an optimal immersion flow rate was found for immersion pressures of 100 and 110 mm Hg. From this study, fluid dynamic guidelines are postulated to support future development of AIS.
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Affiliation(s)
| | - James E. Burgess
- Carnegie Mellon University, Pittsburgh, PA, USA
- Allegheny General Hospital, Pittsburgh, PA, USA
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Whalen JG, Gehris RP, Kress DW, English JC. Surgical Pearl: Instrument tamponade for punch biopsy of the scalp. J Am Acad Dermatol 2005; 52:347-8. [PMID: 15692483 DOI: 10.1016/j.jaad.2004.06.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jason G Whalen
- University of Pittsburgh Department of Dermatology, Pittsburgh, Pennsylvania 15213, USA
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Kim DG, Kim HJ. The Department of Neurosurgery at Seoul National University: past, present, and future. Neurosurgery 2001; 48:919-28. [PMID: 11322453 DOI: 10.1097/00006123-200104000-00047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The Department of Neurosurgery at Seoul National University College of Medicine is one of the oldest neurosurgical departments in Korea, and it is a center of academic leadership in neurosurgery. In September 1957, the department was established by Bo Sung Sim, and it has produced many leaders of neurosurgery in Korea. Chairmen Bo Sung Sim, Kil Soo Choi, Dae Hee Han, and Byung-Kyu Cho each brought special skills and talents to the development of the department. The current and fifth chair, Hyun Jib Kim, assumed the chairmanship in July 2000. The department comprises 11 full-time faculty members, 5 fellows, and 14 residents. More than 1,700 neurosurgical procedures are performed annually in four operating theaters. A gamma knife was installed in 1997, and approximately 200 gamma knife procedures are performed each year. In addition to clinical activities, research and education for graduate and postgraduate students are also particular strengths of the department. This article traces the clinical, academic, and scientific development of the department, its present activities, and its future direction.
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Affiliation(s)
- D G Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Korea
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Kim DG, Kim HJ. The Department of Neurosurgery at Seoul National University: Past, Present, and Future. Neurosurgery 2001. [DOI: 10.1227/00006123-200104000-00047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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