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Gomar-Alba M, Guil-Ibáñez JJ, Ruiz-García JL, Plá-Ruiz JM, García-Pérez F, Vargas-López AJ, Saucedo L, Castelló-Ruiz MJ, Urreta-Juárez G, Bravo-Garrido G, Castro-Luna GM, Parrón-Carreño T, Masegosa-González J. Dynamic Workflow Proposal for Continuous Frameless Electromagnetic Neuronavigation in Rigid Neuroendoscopy. World Neurosurg 2024; 187:19-28. [PMID: 38583569 DOI: 10.1016/j.wneu.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/31/2024] [Accepted: 04/01/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Ventriculoscopic neuronavigation has been described in several articles. However, there are different ventriculoscopes and navigation systems. Due to these different combinations, it is difficult to find detailed neuronavigation protocols. We describe, step-by-step, a simple method to navigate both the trajectory until reaching the ventricular system, as well as the intraventricular work. METHODS We use a rigid ventriculoscope (LOTTA, KarlStorz) with an electromagnetic stylet (S8-StealthSystem, Medtronic). The protocol is based on a modified or 3-dimensionally printed trocar for navigating the extraventricular step and on a modified pediatric nasogastric tube for the intraventricular navigation. RESULTS This protocol can be set up in less than 10 minutes. The extraventricular part is navigated by introducing the electromagnetic stylet inside the modified or 3-dimensionally printed trocar. Intraventricular navigation is done by combining a modified pediatric nasogastric tube with the electromagnetic stylet inside the endoscope's working channel. The most critical point is to obtain a blunt-bloodless ventriculostomy while achieving perfect alignment of all targeted structures via pure straight trajectories. CONCLUSIONS This protocol is easy-to-set-up, avoids head rigid-fixation and bulky optical-based attachments to the ventriculoscope, and allows continuous navigation of both parts of the surgery. Since we have implemented this protocol, we have noticed a significant enhancement in both simple and complex ventriculoscopic procedures because the surgery is dramatically simplified.
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Affiliation(s)
- Mario Gomar-Alba
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Almería, Spain; University of Almería, Almería, Spain; Microneurosurgical and Skull Base Training Laboratory, University of Almería, Almería, Spain.
| | - José Javier Guil-Ibáñez
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Almería, Spain; University of Almería, Almería, Spain; Microneurosurgical and Skull Base Training Laboratory, University of Almería, Almería, Spain
| | - José Luis Ruiz-García
- Department of Radiology, Hospital Universitario Torrecárdenas, Almería, Spain; 3D-Printing Unit. Hospital Universitario Torrecárdenas, Almería, Spain
| | | | - Fernando García-Pérez
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Almería, Spain; Microneurosurgical and Skull Base Training Laboratory, University of Almería, Almería, Spain
| | - Antonio José Vargas-López
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Almería, Spain; University of Almería, Almería, Spain; Microneurosurgical and Skull Base Training Laboratory, University of Almería, Almería, Spain
| | - Leandro Saucedo
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Almería, Spain; Microneurosurgical and Skull Base Training Laboratory, University of Almería, Almería, Spain
| | - María José Castelló-Ruiz
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Almería, Spain; Microneurosurgical and Skull Base Training Laboratory, University of Almería, Almería, Spain
| | - Gaizka Urreta-Juárez
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Almería, Spain; Microneurosurgical and Skull Base Training Laboratory, University of Almería, Almería, Spain
| | - Gema Bravo-Garrido
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Almería, Spain; Microneurosurgical and Skull Base Training Laboratory, University of Almería, Almería, Spain
| | - Gracia María Castro-Luna
- University of Almería, Almería, Spain; Microneurosurgical and Skull Base Training Laboratory, University of Almería, Almería, Spain
| | - Tesifón Parrón-Carreño
- University of Almería, Almería, Spain; Microneurosurgical and Skull Base Training Laboratory, University of Almería, Almería, Spain
| | - José Masegosa-González
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Almería, Spain; Microneurosurgical and Skull Base Training Laboratory, University of Almería, Almería, Spain
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Wu FHW, Cheung CW, Leung YY. Neuronavigation-guided Percutaneous Rhizotomies to Trigeminal Neuralgia: A Systematic Review. Clin J Pain 2024; 40:253-266. [PMID: 38193245 DOI: 10.1097/ajp.0000000000001191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/27/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Neuronavigation improves intraoperative visualization of the cranial structures, which is valuable in percutaneous surgical treatments for patients with trigeminal neuralgia (TN) who are refractory to pharmacotherapy or reluctant to receive open surgery. The objective of this review was to evaluate the available neuronavigation-guided percutaneous surgical treatment modalities with cannulation of foramen ovale to TN, and their relative benefits and limitations. METHODS This review was conducted based on the PRISMA statement. An initial search was performed on electronic databases, followed by manual and reference searches. Study and patient characteristics, rhizotomy procedure and neuronavigation details, and treatment outcomes (initial pain relief and pain recurrence within 2 y, success rate of forman ovale cannulation, and complications) were evaluated. The risk of bias was assessed with a quality assessment based on the ROBINS-I tools. RESULTS Ten studies (491 operations, 403 participants) were analyzed. Three percutaneous trigeminal rhizotomy modalities identified were radiofrequency thermocoagulation rhizotomy (RFTR), percutaneous balloon compression, and glycerol rhizotomy. Intraoperative computed tomography and magnetic resonance imaging fusion-based RFTR had the highest initial pain relief rate of 97.0%. The success rate of foramen ovale cannulation ranged from 92.3% to 100% under neuronavigation. Facial hypoesthesia and masticatory muscle weakness were the most reported complications. DISCUSSION Neuronavigation-guided percutaneous trigeminal rhizotomies showed possible superior pain relief outcomes to that of conventional rhizotomies in TN, with the benefits of radiation reduction and lower complication development rates. The limitations of neuronavigation remain its high cost and limited availability. Higher-quality prospective studies and randomized clinical trials of neuronavigation-guided percutaneous trigeminal rhizotomy were lacking.
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Affiliation(s)
| | - Chi Wai Cheung
- Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yiu Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry
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Niedermeyer S, Terpolilli NA, Nerlinger P, Weller J, Schmutzer M, Quach S, Thon N. Minimally invasive third ventriculostomy with stereotactic internal shunt placement for the treatment of tumor-associated noncommunicating hydrocephalus. Acta Neurochir (Wien) 2023; 165:4071-4079. [PMID: 37676505 PMCID: PMC10739544 DOI: 10.1007/s00701-023-05768-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/11/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Intracranial tumors can cause obstructive hydrocephalus (OH). Most often, symptomatic treatment is pursued through ventriculoperitoneal shunt (VS) or endoscopic third ventriculostomy (ETV). In this study, we propose stereotactic third ventriculostomy with internal shunt placement (sTVIP) as an alternative treatment option and assess its safety and efficacy. METHODS In this single-center, retrospective analysis, clinical symptoms, procedure-related complications, and revision-free survival of all patients with OH due to tumor formations treated by sTVIP between January 2010 and December 2021 were evaluated. RESULTS Clinical records of thirty-eight patients (11 female, 27 male) with a mean age of 40 years (range 5-88) were analyzed. OH was predominantly (in 92% of patients) caused by primary brain tumors (with exception of 3 cases with metastases). Following sTVIP, 74.2% of patients experienced symptomatic improvement. Preoperative headache was a significant predictor of postoperative symptomatic improvement (OR 26.25; 95% CI 4.1-521.1; p = 0.0036). Asymptomatic hemorrhage was detected along the stereotactic trajectory in 2 cases (5.3%). One patient required local revision due to CSF fistula (2.6%); another patient had to undergo secondary surgery to connect the catheter to a valve/abdominal catheter due to CSF malabsorption. However, in the remaining 37 patients, shunt independence was maintained during a median follow-up period of 12 months (IQR 3-32 months). No surgery-related mortality was observed. CONCLUSIONS sTVIP led to a significant symptom control and was associated with low operative morbidity, along with a high rate of ventriculoperitoneal shunt independency during the follow-up period. Therefore, sTVIP constitutes a highly effective and minimally invasive treatment option for tumor-associated obstructive hydrocephalus, even in cases with a narrow prepontine interval.
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Affiliation(s)
- Sebastian Niedermeyer
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Nicole A Terpolilli
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Pia Nerlinger
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Jonathan Weller
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Michael Schmutzer
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Stefanie Quach
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
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Neuroendoscopic septostomy in unilateral and bilateral ventricular hydrocephalus. Childs Nerv Syst 2023; 39:197-203. [PMID: 36161520 DOI: 10.1007/s00381-022-05690-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/20/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This study describes the results of septostomy (SPT) in terms of success and analysis of follow-up in a series of pediatric patients diagnosed with unilateral ventricular hydrocephalus (UHV) and biventricular hydrocephalus (BVH). METHODS A total of 29 pediatric patients diagnosed with UVH or BVH were included in this study. In UVH, a neuroendoscopic SPT was performed (sometimes accompanied by NEFPFMO). In those diagnosed with BVH, an SPT combined with VPS was carried out. Demographic, etiological, clinical, and diagnostic variables and percentage of treatment success were collected. RESULTS SPT was successful during follow-up when no VPS was required in UVH and only unilateral VPS was implanted in BVH. At the time of surgery, 16 patients needed a ventriculoperitoneal shunt. The first SPT was successful in 22 patients, requiring a second surgery in 7 patients, from the oncology group diagnosed with BHV. CONCLUSIONS The surgical management of UVH and BVH still has some disclosure points to be reviewed. However, SPT seems to be a secure, non-traumatic, and efficient procedure.
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Chavaz L, Davidovic A, Meling TR, Momjian S, Schaller K, Bijlenga P, Haemmerli J. Evaluation of the precision of navigation-assisted endoscopy according to the navigation tool setup and the type of endoscopes. Acta Neurochir (Wien) 2022; 164:2375-2383. [PMID: 35764694 PMCID: PMC9427865 DOI: 10.1007/s00701-022-05276-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/01/2022] [Indexed: 12/14/2022]
Abstract
OBJECT Preoperative image-based neuronavigation-assisted endoscopy during intracranial procedures is gaining great interest. This study aimed to analyze the precision of navigation-assisted endoscopy according to the navigation setup, the type of optic and its working angulation. METHODS A custom-made box with four screws was referenced. The navigation-assisted endoscope was aligned on the screws (targets). The precision on the navigation screen was defined as the virtual distance-to-target between the tip of the endoscope and the center of the screws. Three modifiers were assessed: (1) the distance D between the box and the reference array (CLOSE 13 cm - MIDDLE 30 cm - FAR 53 cm), (2) the distance between the tip of the endoscope and the navigation array on the endoscope (close 5 cm - middle 10 cm - far 20 cm), (3) the working angulation of the endoscope (0°-endoscope and 30°-endoscope angled at 90° and 45° with the box). RESULTS The median precision was 1.3 mm (Q1: 1.1; Q3: 1.7) with the best setting CLOSE/close. The best setting in surgical condition (CLOSE/far) showed a distance-to-target of 2.3 mm (Q1: 1.9; Q3: 2.5). The distance D was correlated to the precision (Spearman rho = 0.82), but not the distance d (Spearman rho = 0.04). The type of optic and its angulation with the box were also correlated to the precision (Spearman rho = - 0.37). The best setting was the use of a 30°-endoscope angled at 45° (1.4 mm (Q1: 1.0; Q3: 1.9)). CONCLUSION Navigated-assisted endoscopy is feasible and offers a good precision. The navigation setup should be optimized, reducing the risk of inadvertent perifocal damage.
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Affiliation(s)
- Lara Chavaz
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Torstein R Meling
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Shahan Momjian
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Karl Schaller
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Philippe Bijlenga
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Julien Haemmerli
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
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Unal TC, Gulsever CI, Sahin D, Dagdeviren HE, Dolas I, Sabanci PA, Aras Y, Sencer A, Aydoseli A. Versatile Use of Intraoperative Ultrasound Guidance for Brain Puncture. Oper Neurosurg (Hagerstown) 2021; 21:409-417. [PMID: 34624101 DOI: 10.1093/ons/opab330] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/18/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Intraoperative ultrasound (iUS) is an effective guidance and imaging system commonly used in neuro-oncological surgery. Despite the versatility of iUS, its utility for single burr hole puncture guidance remains fairly underappreciated. OBJECTIVE To highlight the simplicity, versatility, and effectiveness of iUS guidance in brain puncture by presenting the current case series and technical note collection. METHODS We present 4 novel uses of iUS guidance for single burr hole brain puncture: cannulation of normal-sized ventricles, endoscopic third ventriculostomy (ETV) guidance, evacuation of interhemispheric empyema, and stereotactic biopsy assistance. RESULTS All techniques were performed successfully in a total of 16 patients. Normal-sized ventricles were cannulated in 7 patients, among whom 5 underwent Ommaya reservoir placement and 2 underwent ventriculoperitoneal shunt placement for idiopathic intracranial hypertension. No more than 1 attempt was needed for cannulation. All ventricular tip positions were optimal as shown by postoperative imaging. iUS guidance was used in 5 ETV procedures. The working cannula was successfully introduced to the lateral ventricle, providing the optimal trajectory to the third ventricular floor in these cases. Interhemispheric subdural empyema was aspirated with iUS guidance in 1 patient. Volume reduction was clearly visible, allowing near-total evacuation of the empyema. iUS guidance was used for assistive purposes during stereotactic biopsy in 3 patients. No major perioperative complications were observed throughout this series. CONCLUSION iUS is an effective and versatile guidance system that allows for real-time imaging and can be easily and safely employed for various brain puncture procedures.
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Affiliation(s)
- Tugrul Cem Unal
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Cafer Ikbal Gulsever
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Duran Sahin
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Huseyin Emre Dagdeviren
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ilyas Dolas
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pulat Akin Sabanci
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yavuz Aras
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Altay Sencer
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Aydoseli
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Oertel J, Keiner D. Visual-Controlled Endoscopic Biopsy of Paraventricular Intraparenchymal Tumors. World Neurosurg 2019; 126:e208-e218. [PMID: 30797910 DOI: 10.1016/j.wneu.2019.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Frame-based stereotaxy represents the gold standard for biopsy of deep-seated lesions. Visual control of possible bleeding in these lesions is not possible. Neuroendoscopic biopsy represents an alternative procedure for tissue sampling in deep-seated intraventricular lesions. The authors present a technique for transventricular-navigated endoscopic biopsy of lesions that are located in the paraventricular region. METHODS Biopsy of paraventricular pathologies was performed in 6 male and 6 female patients between March 2013 and September 2018. The patient age ranged from 18 to 82 years. All patients underwent a pure endoscopic procedure over a burr hole trepanation supported by frameless navigation of the sedan probe. RESULTS Histologic diagnoses were established in all biopsies. In all patients, a direct control of the biopsy area was feasible, and hemostasis could be obtained. In 5 patients, endoscopic third ventriculostomy was performed first due to obstructive hydrocephalus. In 1 patient suffering from obstructive hydrocephalus, a pellucidotomy was performed. In 9 cases, the initial postoperative course was uneventful. Three patients suffered from persistent hydrocephalus and had to be treated with ventriculoperitoneal shunt insertion. CONCLUSIONS Endoscopically conducted biopsies with the aid of navigated tracking of the probe represent a possible additional technique in selected paraventricular intraparenchymal pathologies. The endoscopic approach enables the direct visualization of the intraventricular surface and its vessels. In contrast to standard stereotactic biopsy, direct visual control of hemostasis can be obtained even in paraventricular tumors.
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Affiliation(s)
- Joachim Oertel
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany.
| | - Dörthe Keiner
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany
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Bertani R, Perret CM, Alberto Almeida Filho J, Souza LF, Góes P, Monteiro R, Paiva WS. Neuronavigation as a minimally invasive tool in the treatment of intracranial gunshot injuries. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2019; 9:19-22. [PMID: 30911432 PMCID: PMC6420707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/27/2019] [Indexed: 06/09/2023]
Abstract
Gunshot injury is the most common cause of penetrating brain injury. The in-hospital mortality for civilians with penetrating craniocerebral injury is 52-95%. There are many surgical techniques suitable for the treatment of survivors. We report a surgical technique consisting of neuronavigation guidance for wound treatment with smaller incisions and craniotomies, followed by bullet removal if feasible. We report case of a 15 year old male patient who sustained an accidental firearm injury to the occipital region, submitted to surgical treatment that consisted in a minimally invasive approach guided by neuronavigation. Immediate neurological examination showed inferior homonymous quadrantanopsia alone as a clinical finding. Patient was discharged after one week, and no complications arised in follow-up. We conclude that using neuronavigation as a tool was effective in the reported case and that minimally invasive neurosurgical techniques may be a safe and efficient option for the treatment of traumatic brain injuries caused by firearm projectiles.
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Affiliation(s)
- Raphael Bertani
- Department of Neurosurgery, Miguel Couto Municipal HospitalRio de Janeiro, Brazil
- Laboratory of Neuroprotection and Neuroregeneration Strategies, Federal University of Rio de JaneiroRio de Janeiro, Brazil
| | - Caio M Perret
- Laboratory of Neuroprotection and Neuroregeneration Strategies, Federal University of Rio de JaneiroRio de Janeiro, Brazil
| | | | - Luiz Felipe Souza
- Intensive Care Unit, Miguel Couto Municipal HospitalRio de Janeiro, Brazil
| | - Pedro Góes
- Paulista School of Medicine, Federal University of São PauloSão Paulo, São Paulo, Brazil
| | - Ruy Monteiro
- Department of Neurosurgery, Miguel Couto Municipal HospitalRio de Janeiro, Brazil
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Radiological Assessment of Hydrocephalus. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-61423-6_15-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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10
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Radiological Assessment of Hydrocephalus Treatment and Treatment-related Complications. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-68536-6_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Moiyadi A, Shaikh S. Intraventricular tumors - A mixed bag. CANCER RESEARCH, STATISTICS, AND TREATMENT 2019. [DOI: 10.4103/crst.crst_68_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mehbodniya AH, Moghavvemi M, Narayanan V, Waran V. Frequency and Causes of Line of Sight Issues During Neurosurgical Procedures Using Optical Image-Guided Systems. World Neurosurg 2018; 122:e449-e454. [PMID: 30347306 DOI: 10.1016/j.wneu.2018.10.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Navigation (image guidance) is an essential tool in modern neurosurgery, and most surgeons use an optical tracking system. Although the technology is accurate and reliable, one often is confronted by line of sight issues that interrupt the flow of an operation. There has been feedback on the matter, but the actual problem has not been accurately quantified, therefore making this the primary aim of this study. It is particularly important given that robotic technology is gradually making its way into neurosurgery and most of these devices depend on optical navigation when procedures are being conducted. METHODS In this study, the frequency and causes of line of sight issues is assessed using recordings of Navigation probe locations and its synchronised video recordings. RESULTS The mentioned experiment conducted for a series of 15 neurosurgical operations. This issue occured in all these surgeries except one. Maximum duration of issue presisting reached up to 56% of the navigation usage time. CONCLUSIONS The arrangment of staff and equipment is a key factor in avoiding this issue.
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Affiliation(s)
- Amir H Mehbodniya
- Centre for Research in Applied Electronics, Department of Electrical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Mahmoud Moghavvemi
- Centre for Research in Applied Electronics, Department of Electrical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia; University of Science and Culture, Tehran, Iran
| | - Vairavan Narayanan
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Vicknes Waran
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Abstract
Abstract
Cerebral activity is extremely complex and requires a super diagnosis investigation - there is no limit to this super investigation, especially in the case of expansive tumor or non-tumoral lesions. Modernization of the diagnosis in these lesions has gained Science Fiction aspects. Adapting to those changes, operatory blocks and neurosurgeons all around the world have been improved to the same extent in order to obtain the most perfect results with keeping the quality of life. The modern slogan of neurosurgery is “MAXIMAL SAFE RESACTION”. Continuing on this theme we can state that the equipment of the surgical apparatus is very special and extremely expensive. Complex but in accordance with one of the most exquisite agglomeration of atoms in the entire known Universe, the human brain!
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Mohammad MH, Diaz RJ. Technical and anatomical aspects of endoscopically assisted septostomy in unilateral ventriculoperitoneal shunt placement for the management of isolated lateral ventricles. INTERDISCIPLINARY NEUROSURGERY 2017. [DOI: 10.1016/j.inat.2017.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Aref M, Martyniuk A, Nath S, Koziarz A, Badhiwala J, Algird A, Farrokhyar F, Almenawer SA, Reddy K. Endoscopic Third Ventriculostomy: Outcome Analysis of an Anterior Entry Point. World Neurosurg 2017; 104:554-559. [PMID: 28532915 DOI: 10.1016/j.wneu.2017.05.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 05/09/2017] [Accepted: 05/11/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Endoscopic third ventriculostomy (ETV) is a safe and effective treatment for hydrocephalus. An entry point located 4 cm anterior to the coronal suture, 3 cm anterior to Kocher point, and approximately 9 cm from the pupil at the midpupillary line has been used successfully for the last 20 years in our center. We aimed to evaluate this alternative anterior entry point routinely used for ETV, with or without concurrent endoscopic biopsy. METHODS Patients undergoing this proposed entry point were examined to evaluate its safety and efficacy. Factors such as patients' age, sex, hydrocephalus etiology, tumor location and pathology, and complication rate were examined through regression analyses to evaluate their impact on tumor biopsy and ETV success rates, and the need for subsequent ventricular shunting. RESULTS A total of 131 patients were included in the study. ETV was successful in 125 (95.4%) patients. Of these, 26 (19.8%) patients required a biopsy, which was successful in 21 (80.8%) cases. A complication was observed in 10 (7.6%) patients, with a trend toward complications occurring after ETV failure. There was no association between ETV success rate and patients' age (P = 0.5) or sex (P = 0.99). CONCLUSIONS The anterior entry point is a safe and effective method for ETV, especially when considering concurrent ventricular tumor biopsy. This entry point may be considered as a more minimally invasive procedure when using rigid endoscopy and may also eliminate the need for a flexible scope.
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Affiliation(s)
- Mohammed Aref
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Amanda Martyniuk
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Siddharth Nath
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Alex Koziarz
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Jetan Badhiwala
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Almunder Algird
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Saleh A Almenawer
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
| | - Kesava Reddy
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
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16
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Lee YH, Kwon YS, Yang KH. Multiloculated Hydrocephalus: Open Craniotomy or Endoscopy? J Korean Neurosurg Soc 2017; 60:301-305. [PMID: 28490156 PMCID: PMC5426446 DOI: 10.3340/jkns.2017.0101.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/21/2017] [Accepted: 03/27/2017] [Indexed: 11/29/2022] Open
Abstract
Multiloculated hydrocephalus (MLH) is a condition in which patients have multiple, separate abnormal cerebrospinal fluid collections with no communication between them. Despite technical advancements in pediatric neurosurgery, neurological outcomes are poor in these patients and the approach to this pathology remains problematic especially given individual anatomic complexity and cerebrospinal fluid (CSF) hydrodynamics. A uniform surgical strategy has not yet been developed. Current treatment options for MLH are microsurgical fenestration of separate compartments by open craniotomy or endoscopy, shunt surgery in which multiple catheters are placed in the compartments, and combinations of these modalities. Craniotomy for fenestration allows better visualization of the compartments and membranes, and it can offer easy fenestration or excision of membranes and wide communication of cystic compartments. Hemostasis is more easily achieved. However, because of profound loss of CSF during surgery, open craniotomy is associated with an increased chance of subdural hygroma and/or hematoma collection and shunt malfunction. Endoscopy has advantages such as minimal invasiveness, avoidance of brain retraction, less blood loss, faster operation time, and shorter hospital stay. Disadvantages are also similar to those of open craniotomy. Intraoperative bleeding can usually be easily managed by irrigation or coagulation. However, handling of significant intraoperative bleeding is not as easy. Currently, endoscopic fenestration tends to be performed more often as initial treatment and open craniotomy may be useful in patients requiring repeated endoscopic procedures.
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Affiliation(s)
- Yun Ho Lee
- Department of Neurosurgery, National Health Insurance Service Ilsan Hospital, Goyang,
Korea
| | - Young Sub Kwon
- Department of Neurosurgery, National Health Insurance Service Ilsan Hospital, Goyang,
Korea
- Department of Neurosurgery, School of Medicine, Kangwon National University, Chuncheon,
Korea
| | - Kook Hee Yang
- Department of Neurosurgery, National Health Insurance Service Ilsan Hospital, Goyang,
Korea
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Manjila S, Mencattelli M, Rosa B, Price K, Fagogenis G, Dupont PE. A multiport MR-compatible neuroendoscope: spanning the gap between rigid and flexible scopes. Neurosurg Focus 2017; 41:E13. [PMID: 27581309 DOI: 10.3171/2016.7.focus16181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Rigid endoscopes enable minimally invasive access to the ventricular system; however, the operative field is limited to the instrument tip, necessitating rotation of the entire instrument and causing consequent tissue compression while reaching around corners. Although flexible endoscopes offer tip steerability to address this limitation, they are more difficult to control and provide fewer and smaller working channels. A middle ground between these instruments-a rigid endoscope that possesses multiple instrument ports (for example, one at the tip and one on the side)-is proposed in this article, and a prototype device is evaluated in the context of a third ventricular colloid cyst resection combined with septostomy. METHODS A prototype neuroendoscope was designed and fabricated to include 2 optical ports, one located at the instrument tip and one located laterally. Each optical port includes its own complementary metal-oxide semiconductor (CMOS) chip camera, light-emitting diode (LED) illumination, and working channels. The tip port incorporates a clear silicone optical window that provides 2 additional features. First, for enhanced safety during tool insertion, instruments can be initially seen inside the window before they extend from the scope tip. Second, the compliant tip can be pressed against tissue to enable visualization even in a blood-filled field. These capabilities were tested in fresh porcine brains. The image quality of the multiport endoscope was evaluated using test targets positioned at clinically relevant distances from each imaging port, comparing it with those of clinical rigid and flexible neuroendoscopes. Human cadaver testing was used to demonstrate third ventricular colloid cyst phantom resection through the tip port and a septostomy performed through the lateral port. To extend its utility in the treatment of periventricular tumors using MR-guided laser therapy, the device was designed to be MR compatible. Its functionality and compatibility inside a 3-T clinical scanner were also tested in a brain from a freshly euthanized female pig. RESULTS Testing in porcine brains confirmed the multiport endoscope's ability to visualize tissue in a blood-filled field and to operate inside a 3-T MRI scanner. Cadaver testing confirmed the device's utility in operating through both of its ports and performing combined third ventricular colloid cyst resection and septostomy with an endoscope rotation of less than 5°. CONCLUSIONS The proposed design provides freedom in selecting both the number and orientation of imaging and instrument ports, which can be customized for each ventricular pathological entity. The lightweight, easily manipulated device can provide added steerability while reducing the potential for the serious brain distortion that happens with rigid endoscope navigation. This capability would be particularly valuable in treating hydrocephalus, both primary and secondary (due to tumors, cysts, and so forth). Magnetic resonance compatibility can aid in endoscope-assisted ventricular aqueductal plasty and stenting, the management of multiloculated complex hydrocephalus, and postinflammatory hydrocephalus in which scarring obscures the ventricular anatomy.
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Affiliation(s)
- Sunil Manjila
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Margherita Mencattelli
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benoit Rosa
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karl Price
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Georgios Fagogenis
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pierre E Dupont
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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18
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Zhang Y, Wang F, Chen X, Zhang Z, Meng X, Yu X, Zhou T. Cerebrospinal fluid rhinorrhea: evaluation with 3D-SPACE sequence and management with navigation-assisted endonasal endoscopic surgery. Br J Neurosurg 2016; 30:643-648. [PMID: 27340877 DOI: 10.1080/02688697.2016.1199787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND This study aimed to assess the efficacy of MR images with three-dimensional sampling perfection with application optimised contrast using different flip-angle evolution (3D-SPACE) sequence for detecting cerebrospinal fluid (CSF) rhinorrhea and image-guided surgery for the management of CSF rhinorrhea. MATERIALS AND METHODS This study included 45 consecutive patients with suspected CSF rhinorrhea from 2010 to 2015. Patients underwent preoperative MRI scan including 3D-SPACE and conventional T2-weighted (T2W) protocol. Two-blinded neuroradiologists determined the presence and location of CSF leakage. Imaging results were compared with surgical findings and/or β-2 transferrin testing. Intraoperative navigation was used during endonasal endoscopic surgery for repairing CSF rhinorrhea. RESULTS 3D-SPACE sequence correctly described 27 cases (93.1%) and conventional T2W sequence described only 20 (69.0%) of the total 29 patients with truly positive CSF leakage. The sensitivity, specificity, positive predictive value and negative predictive value for detecting CSF leakages were 93.1%, 87.5%, 93.1%, and 87.5% for 3D-SPACE, and 69.0%, 81.3%, 87.0% and 59.1% for T2W, respectively. To repair the leakage, 3D-SPACE image-guided navigation was used to locate the CSF leakage sites intraoperatively. Only two CSF leakage sites proved by surgery were missed by navigation. Successful endoscopic repairs were achieved in 25 of 26 (96.2%) patients during the first attempt. During the follow-up, there were no major postoperative complications or recurrences encountered. CONCLUSION MR imaging with 3D-SPACE sequence is an effective and reliable method with higher sensitivity and specificity than T2W for detecting CSF leakage. Intraoperative 3D-SPACE image-guided navigation is helpful in locating the sites of the CSF leakage during endonasal endoscopic surgery.
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Affiliation(s)
- Yanyang Zhang
- a Department of Neurosurgery , PLA General Hospital , Beijing , China
| | - Fuyu Wang
- a Department of Neurosurgery , PLA General Hospital , Beijing , China
| | - Xiaolei Chen
- a Department of Neurosurgery , PLA General Hospital , Beijing , China
| | - Zhizhong Zhang
- a Department of Neurosurgery , PLA General Hospital , Beijing , China
| | - Xianghui Meng
- a Department of Neurosurgery , PLA General Hospital , Beijing , China
| | - Xinguang Yu
- a Department of Neurosurgery , PLA General Hospital , Beijing , China
| | - Tao Zhou
- a Department of Neurosurgery , PLA General Hospital , Beijing , China
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Endoscopic Versus Stereotactic Procedure for Pineal Tumor Biopsies: Focus on Overall Efficacy Rate. World Neurosurg 2016; 92:223-228. [PMID: 27060509 DOI: 10.1016/j.wneu.2016.03.088] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 03/27/2016] [Accepted: 03/29/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The management of pineal region tumors depends on the histologic subtypes. Two minimally invasive techniques are available: endoscopic intraventricular biopsies and stereotactic biopsies. The recent Southampton and Lille series are the largest endoscopic and stereotactic series of pineal region tumors reporting both diagnosis rate and accuracy rate, respectively; we elaborated on these results in the light of other recent studies. METHODS We compared the Southampton endoscopic series with the Lille series, reflecting our 25-year experience of stereotactic biopsies, and the metadata of the literature for both approaches, as reported in the 2013 Report of the French-Speaking Society of Neurosurgery on tumors of the pineal region. RESULTS The results of the Southampton series match the endoscopic literature, in particular regarding the diagnosis rate (81.2%) and the perioperative morbidity (25.0%), and provide a rarely reported accuracy rate (78.6%), giving access to the overall efficacy rate (63.8%). The results of the Lille series match the stereotactic literature and show better results than endoscopic biopsies concerning the diagnosis rate (98.9%), accuracy rate (100%), resulting overall efficacy rate (98.9%), and perioperative morbidity (6.4%). CONCLUSIONS The Southampton and Lille series provide a unique opportunity to compare the overall efficacy rates of endoscopic and stereotactic biopsies, respectively. The stereotactic approach is safer and more effective for biopsies of pineal region tumors. To improve the safety and reliability of endoscopic biopsies, various methods have to be evaluated: alternative burr-hole strategies, use of neuronavigation, and a combination of flexible and rigid endoscopes.
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20
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Diagnostic Yield, Morbidity, and Mortality of Intraventricular Neuroendoscopic Biopsy: Systematic Review and Meta-Analysis. World Neurosurg 2016; 85:315-24.e2. [DOI: 10.1016/j.wneu.2015.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 09/03/2015] [Indexed: 11/19/2022]
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21
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Gaab MR. Commentary: Endoscopic Third Ventriculostomy in 250 Adults With Hydrocephalus: Patient Selection, Outcomes, and Complications. Neurosurgery 2015; 78:120-3. [PMID: 26418875 DOI: 10.1227/neu.0000000000001037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Michael R Gaab
- Department of Neurosurgery, Hannover Nordstadt Hospital, Hannover, Germany
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22
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Abstract
BACKGROUND The emphasis regarding intracranial neuroendoscopy has been traditionally advocated and focused on the role in pediatric patients, although a significant usage has developed in adult patients. In this study, we examine and contrast the role of predominantly intracranial neuroendoscopy in both a pediatric and adult population with a minimum postprocedure follow-up of 5 years. METHODS A retrospective review was conducted for patients in the two hospitals that manage neurosurgical care for Southern Alberta, Canada, undergoing neuroendoscopic surgery between 1994 and 2008. The pediatric group was defined as age ≤17 years and the adult group as age ≥18 years. RESULTS A total of 273 patients who underwent a total of 330 procedures with a mean postprocedure follow-up of 12.9 years were identified. There were 161 adult and 112 pediatric patients, and both groups underwent surgery by the same surgeons. The most common procedure was endoscopic third ventriculostomy, accounting for 55% of procedures. One postoperative death occurred in an adult patient. Endoscopic third ventriculostomy success 1-year postprocedure was 81%, with only three late-term failures. Postoperative infection was the most common serious complication (two pediatric/four adult patients). Adult and pediatric patients had similar major complication rates (4.2% vs 5.7%, p=0.547). CONCLUSIONS Neuroendoscopy overall had a similar role in both pediatric and adult neurosurgical populations, with the most commonly associated complication being infection. Neuroendoscopy is an important therapeutic modality in the management of appropriate adult patients.
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Schulz M, Spors B, Thomale UW. Stented endoscopic third ventriculostomy—indications and results. Childs Nerv Syst 2015; 31:1499-507. [PMID: 26081175 DOI: 10.1007/s00381-015-2787-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 06/05/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE In patients with risk of reclosure of a performed opening in the floor of the third ventricle, a stented endoscopic third ventriculostomy (sETV) was performed to maintain continuous cerebrospinal fluid (CSF) diversion in patients with occlusive hydrocephalus. A retrospective analysis of a patient series is presented. METHODS A cohort of nine patients (median age 12 years and 9 months; range 1 month to 25 years and 9 months) was studied retrospectively. Etiology of hydrocephalus was aqueduct stenosis due to tumorous occlusion and tumorous infiltration of the third ventricular floor in seven of nine patients. For two patients with simple aqueductal stenosis, a sETV was performed because of young age of 1 month in one and because of previous ETV failure in the other. RESULTS Correct placement of the implanted stent was demonstrated in all treated patients. There was no operative morbidity after the performed sETV. Resolution or improvement of symptoms was achieved in eight of nine patients (88.9%), and failure to control clinical symptoms was observed in one patient (11.1%), who needed subsequent shunt insertion. Decreased ventricular dimensions were seen after the sETV procedure. The median fronto-occipital horn ratio (FOHR) decreased from 0.46 (range 0.43-0.58) to 0.45 (range 0.37 to 0.59) after a median of 3 months and to a median of 0.40 (range 0.30 to 0.50) after 17 months. The median fronto-occipital horn width ratio FOHWR decreased from 0.31 (range 0.22 to 0.52) to 0.28 (range 0.14 to 0.52, p = 0.06) after a median of 3 months and to a median of 0.21 (range 0.09 to 0.36, p < 0.05). CONCLUSION sETV is a feasible and safe alternative procedure which when performed with an appropriate trajectory allows treatment of occlusive hydrocephalus with altered anatomy of the third ventricular floor. sETV has been demonstrated to resolve or improve clinical and radiological signs of disturbed CSF circulation.
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Affiliation(s)
- Matthias Schulz
- Division of Pediatric Neurosurgery, Charité Universitätsmedizin, Berlin, Germany
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Endoscopic intracranial surgery enhanced by electromagnetic-guided neuronavigation in children. Childs Nerv Syst 2015; 31:1327-33. [PMID: 25933601 DOI: 10.1007/s00381-015-2734-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 04/20/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Navigated intracranial endoscopy with conventional technique usually requires sharp head fixation. In children, especially in those younger than 1 year of age and in older children with thin skulls due to chronic hydrocephalus, sharp head fixation is not possible. Here, we studied the feasibility, safety, and accuracy of electromagnetic (EM)-navigated endoscopy in a series of children, obviating the need of sharp head fixation. METHODS Seventeen children (ten boys, seven girls) between 12 days and 16.8 years (mean age 4.3 years; median 14 months) underwent EM-navigated intracranial endoscopic surgery based on 3D MR imaging of the head. Inclusion criteria for the study were intraventricular cysts, arachnoid cysts, aqueduct stenosis for endoscopic third ventriculostomy (ETV) with distorted ventricular anatomy, the need of biopsy in intraventricular tumors, and multiloculated hydrocephalus. A total of 22 endoscopic procedures were performed. Patients were registered for navigation by surface rendering in the supine position. After confirming accuracy, they were repositioned for endoscopic surgery with the head fixed slightly on a horseshoe headholder. EM navigation was performed using a flexible stylet introduced into the working channel of a rigid endoscope. Neuronavigation accuracy was checked for deviations measured in millimeters on screenshots after the referencing procedure and during surgery in the coronal (z = vertical), axial (x = mediolateral), and sagittal (y = anteroposterior) planes. RESULTS EM-navigated endoscopy was feasible and safe. In all 17 patients, the aim of endoscopic surgery was achieved, except in one case in which a hemorrhage occurred, blurring visibility, and we proceeded with open surgery without complications for the patient. Navigation accuracy for extracranial markers such as the tragus, bregma, and nasion ranged between 1 and 2.5 mm. Accuracy for fixed anatomical structures like the optic nerve or the carotid artery varied between 2 and 4 mm, while there was a broader variance of accuracy at the target point of the cyst itself ranging between 2 and 9 mm. CONCLUSIONS EM-navigated endoscopy in children is a safe and useful technique enhancing endoscopic intracranial surgery and obviating the need of sharp head fixation. It is a good alternative to the common opto-electric navigation system in this age group.
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D'Amico RS, Kennedy BC, Bruce JN. Neurosurgical oncology: advances in operative technologies and adjuncts. J Neurooncol 2014; 119:451-63. [PMID: 24969924 DOI: 10.1007/s11060-014-1493-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 05/22/2014] [Indexed: 12/31/2022]
Abstract
Modern glioma surgery has evolved around the central tenet of safely maximizing resection. Recent surgical adjuncts have focused on increasing the maximum extent of resection while minimizing risk to functional brain. Technologies such as cortical and subcortical stimulation mapping, intraoperative magnetic resonance imaging, functional neuronavigation, navigable intraoperative ultrasound, neuroendoscopy, and fluorescence-guided resection have been developed to augment the identification of tumor while preserving brain anatomy and function. However, whether these technologies offer additional long-term benefits to glioma patients remains to be determined. Here we review advances over the past decade in operative technologies that have offered the most promising benefits for glioblastoma patients.
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Affiliation(s)
- Randy S D'Amico
- Department of Neurological Surgery, Neurological Institute, Columbia University Medical Center, 4th Floor, 710 West 168th Street, New York, NY, 10032, USA,
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Wachter D, Behm T, von Eckardstein K, Rohde V. Indocyanine green angiography in endoscopic third ventriculostomy. Neurosurgery 2014; 73:ons67-72; ons72-3. [PMID: 23313981 DOI: 10.1227/neu.0b013e318285b846] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endoscopic third ventriculostomy (ETV) has become a well-established method for the treatment of noncommunicating hydrocephalus with a high success rate and a relatively low morbidity rate. However, vessel injury has been repeatedly reported, often with a fatal outcome. Vessel injury is considered to be the most threatening complication. The use of indocyanine green (ICG) angiography has become an established tool in vascular microneurosurgery. OBJECTIVE We report our initial experience with endoscopic ICG angiography in ETV for intraoperative visualization of the basilar artery and its perforators to reduce the risk of vascular injury. METHODS Eleven patients with noncommunicating hydrocephalus underwent ETV. Before opening of the third ventricular floor, ICG angiography was performed using a prototype neuroendoscope for intraoperative visualization of ICG fluorescence. RESULTS In 10 patients, ETV and ICG angiography were successfully performed. In 1 case, ICG angiography failed. Even in the presence of an opaque floor of the third ventricle (n = 5), ICG angiography clearly demonstrated the course of the basilar artery and its major branches and was considered useful. CONCLUSION ICG angiography has the potential to become a useful adjunct in ETV for better visualization of vessel structures, especially in the presence of aberrant vasculature, a nontranslucent floor of the third ventricle, or in case of reoperations.
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Affiliation(s)
- Dorothee Wachter
- Department of Neurosurgery, Georg-August-University Göttingen, Göttingen, Germany.
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Barber SM, Rangel-Castilla L, Baskin D. Neuroendoscopic resection of intraventricular tumors: a systematic outcomes analysis. Minim Invasive Surg 2013; 2013:898753. [PMID: 24191196 PMCID: PMC3804403 DOI: 10.1155/2013/898753] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 07/08/2013] [Accepted: 08/08/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction. Though traditional microsurgical techniques are the gold standard for intraventricular tumor resection, the morbidity and invasiveness of microsurgical approaches to the ventricular system have galvanized interest in neuroendoscopic resection. We present a systematic review of the literature to provide a better understanding of the virtues and limitations of endoscopic tumor resection. Materials and Methods. 40 articles describing 668 endoscopic tumor resections were selected from the Pubmed database and reviewed. Results. Complete or near-complete resection was achieved in 75.0% of the patients. 9.9% of resected tumors recurred during the follow-up period, and procedure-related complications occurred in 20.8% of the procedures. Tumor size ≤ 2cm (P = 0.00146), the presence of a cystic tumor component (P < 0.0001), and the use of navigation or stereotactic tools during the procedure (P = 0.0003) were each independently associated with a greater likelihood of complete or near-complete tumor resection. Additionally, the complication rate was significantly higher for noncystic masses than for cystic ones (P < 0.0001). Discussion. Neuroendoscopic outcomes for intraventricular tumor resection are significantly better when performed on small, cystic tumors and when neural navigation or stereotaxy is used. Conclusion. Neuroendoscopic resection appears to be a safe and reliable treatment option for patients with intraventricular tumors of a particular morphology.
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Affiliation(s)
- Sean M. Barber
- Houston Methodist Neurological Institute, Department of Neurological Surgery, Suite 944, 6560 Fannin Street, Houston, TX 77030, USA
| | - Leonardo Rangel-Castilla
- Houston Methodist Neurological Institute, Department of Neurological Surgery, Suite 944, 6560 Fannin Street, Houston, TX 77030, USA
| | - David Baskin
- Houston Methodist Neurological Institute, Department of Neurological Surgery, Suite 944, 6560 Fannin Street, Houston, TX 77030, USA
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Mert A, Gan LS, Knosp E, Sutherland GR, Wolfsberger S. Advanced Cranial Navigation. Neurosurgery 2013; 72 Suppl 1:43-53. [DOI: 10.1227/neu.0b013e3182750c03] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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