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García-Milán V, Moreno-Madueño G, Urreta Juárez G, Rivero-Garvía M, Márquez-Rivas J. Long-Term Success of Endoscopic Third Ventriculostomy in the Pediatric Population with Aqueductal Stenosis. World Neurosurg 2024; 189:e364-e369. [PMID: 38901481 DOI: 10.1016/j.wneu.2024.06.056] [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: 03/25/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE To evaluate the long-term success rate of endoscopic third ventriculostomy (ETV) in the treatment of hydrocephalus due to aqueductal stenosis in the pediatric population. METHODS Between January 2007 and June 2023, a total of 82 children underwent ETV surgery for hydrocephalus and met the inclusion criteria for our study. The children's medical records were reviewed, and cases requiring additional surgery in the months and years following surgery for ventriculostomy failure were reviewed. RESULTS The mean age was 5.35 years. Successful ETV was observed in 74 children with a successful ETV rate of 90%. The median follow-up was 6.75 years (2 months to 15.5 years). Eight children (10%) underwent additional surgery. In 7 cases, additional surgery was performed within 3 months, while in the remaining case; a delayed failure was noted (more than 3 years later). At 6 months and 3 years, the cumulative proportion of children with revision-free survival was 91%, declining slightly to 89% at 5 years. CONCLUSIONS ETV is highly effective in treating hydrocephalus in pediatric patients with aqueductal stenosis, with a 91% success rate at 6 months and 3 years. Although the success rate drops slightly to 89% at 5 years, it still demonstrates durability. Late failures are usually characterized by symptoms of increased intracranial pressure. While patients with a confirmed successful ETV at 6 months may be considered for reduced follow-up frequency, it is critical to educate them about the symptoms of intracranial hypertension and the importance of seeking medical attention promptly if such symptoms occur.
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Affiliation(s)
- Víctor García-Milán
- Department of Neurological Surgery and Spine Unit, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Gloria Moreno-Madueño
- Pediatric Neurosurgery Unit, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Mónica Rivero-Garvía
- Pediatric Neurosurgery Unit, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Javier Márquez-Rivas
- Pediatric Neurosurgery Unit, Hospital Universitario Virgen del Rocío, Seville, Spain
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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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Roethe AL, Beer L, Schulz M, Schaumann A, Thomale UW. Tailored Concept for Accurate Neuroendoscopy: A Comparative Retrospective Single-Center Study on Image-Guided Neuroendoscopic Procedures. World Neurosurg 2024; 185:60-70. [PMID: 38325702 DOI: 10.1016/j.wneu.2024.01.171] [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: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
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.
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Affiliation(s)
- Anna L Roethe
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Lilian Beer
- Pediatric Neurosurgery, Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Schulz
- Pediatric Neurosurgery, Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Schaumann
- Pediatric Neurosurgery, Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich-Wilhelm Thomale
- Pediatric Neurosurgery, Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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García Pérez F, Vargas López AJ, Gomar Alba M, Velasco Albendea FJ, Guil Ibáñez JJ, Urreta Juárez G, Castelló Ruiz MJ, Narro Donate JM, Masegosa González J. Transcortical transcatheter ultrasound-assisted technique for deep-seated brain tumors. Technical note. J Ultrasound 2024; 27:191-197. [PMID: 38308121 PMCID: PMC10908735 DOI: 10.1007/s40477-023-00845-w] [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: 09/02/2023] [Accepted: 11/09/2023] [Indexed: 02/04/2024] Open
Abstract
PURPOSE Surgery of deep-seated brain tumors can be challenging. Several methods have been described to facilitate transcortical approaches, including ultrasound-assisted resection. Ultrasound-guided placement of a standard ventricular catheter is a widely reported technique and has been used to approach these lesions via the transcortical route. We describe how we usually perform this useful technique to assist and enhance the transcortical resection of some deep-seated brain tumors. METHODS Standard electromagnetic frameless navigation (S8 Neuronavigation System, Medtronic, Minneapolis, USA) was employed to focus the craniotomy and to plan the trajectory of the ventricular catheter. After dural opening, an ultrasound device (Arietta 850, Hitachi-Aloka Medical, Tokyo, Japan) was used for intraoperative ultrasound (IOUS) assessment. A ventricular catheter was placed from the cortex to the lateral wall of the tumor under direct real-time IOUS visualization to guide the further transcortical dissection. RESULTS Transcortical transcatheter ultrasound-assisted technique involved minimal time and infrastructure requirements. There were no major technical difficulties during its use, providing confidence and improving subcortical white matter dissection by guiding the route to the tumor. CONCLUSIONS Recent improvement of IOUS image-quality devices offers several attractive options for real-time navigation. The combination of conventional neuronavigation systems with real-time IOUS assessment during the intradural step provides a higher degree of control by improving the execution of the surgery. We hope this description may be a useful tool for some selected cases and contribute to the further enhancement and improvement of this widely used technique.
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Affiliation(s)
- Fernando García Pérez
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre S/N, 04009, Almería, Spain.
| | - Antonio José Vargas López
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre S/N, 04009, Almería, Spain
| | - Mario Gomar Alba
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre S/N, 04009, Almería, Spain
| | | | - José Javier Guil Ibáñez
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre S/N, 04009, Almería, Spain
| | - Gaizka Urreta Juárez
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre S/N, 04009, Almería, Spain
| | - María José Castelló Ruiz
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre S/N, 04009, Almería, Spain
| | - José María Narro Donate
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre S/N, 04009, Almería, Spain
| | - José Masegosa González
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre S/N, 04009, Almería, Spain
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Teping F, Oertel J. Considerations on surgical strategies and associated risk profiles for endoscopic tumor biopsies within the third ventricle and periaqueductal region. Childs Nerv Syst 2023; 39:3407-3414. [PMID: 37682304 PMCID: PMC10684420 DOI: 10.1007/s00381-023-06122-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Neuroendoscopic techniques have proven to be a successful and minimally-invasive technique for tumor biopsies within the third ventricle in pediatric patients. However, a comprehensive assessment of associated surgical strategies, techniques, and morbidity is essential to optimize patient outcomes. METHODS This retrospective study analyzed full endoscopic tumor biopsies in pediatric patients with tumors in the third ventricle and periaqueductal region. Data from 1995 to 2022 were collected from medical records, imaging, and intraoperative video documentation. RESULTS In this study, 16 shear endoscopic tumor biopsies were performed using the transventricular transforaminal approach. Tumors were located in the anterior or mid part of the third ventricle (50%) or in the periaqueductal and pineal recess region (50%). Preoperative hydrocephalus was seen in 81.25%. Tumor biopsies were harvested successfully in all cases. Simultaneous ETV was performed in 12 (75%) cases and additional septostomy in 3 (18.75%). Significant intraoperative bleeding occurred in 3 cases (18.75%). All bleeding situations could be successfully managed with continuous irrigation. Histopathology revealed astrocytoma as the predominant diagnosis (75%). No new neurologic deficits were observed, except for one case of transient oculomotor nerve paralysis after ETV. Hydrocephalus persisted in 18.6% of all cases with the need of urgent ventriculoperitoneal shunting in two patients. CONCLUSION In conclusion, neuroendoscopy emerges as an effective technique for tumor biopsies within the third ventricle in pediatric patients, offering the added advantage of simultaneous treatment of obstructive hydrocephalus. However, it is essential to acknowledge the specific intra- and postoperative risks associated with various surgical strategies. The safe management and achievement of favorable clinical results demand extensive experience and expertise.
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Affiliation(s)
- Fritz Teping
- Department of Neurosurgery, Faculty of Medicine, Saarland University, Kirrbergerstraße, Building 90.5, D-66421, Homburg, Germany
| | - Joachim Oertel
- Department of Neurosurgery, Faculty of Medicine, Saarland University, Kirrbergerstraße, Building 90.5, D-66421, Homburg, Germany.
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Wei R, Chen H, Cai Y, Chen J. Application of intraoperative ultrasound in the resection of high-grade gliomas. Front Neurol 2023; 14:1240150. [PMID: 37965171 PMCID: PMC10640994 DOI: 10.3389/fneur.2023.1240150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/19/2023] [Indexed: 11/16/2023] Open
Abstract
The incidence of gliomas is approximately 3-5/100,000, with high-grade gliomas accounting for approximately 30-40% of these tumors. Surgery is a confirmed positive factor in prolonging the survival of these patients, and a larger resection range means a longer survival time. Therefore, surgery for high-grade glioma patients should aim to maximize the extent of resection while preserving neurological function to achieve a better quality of life. There is consensus regarding the need to lengthen progression-free survival (PFS) and overall survival (OS) times. In glioma surgery, methods such as intraoperative computed tomography (ICT), intraoperative magnetic resonance imaging (IMRI), navigation, 5-aminolevulinic acid (5-ALA), and intraoperative ultrasound (IOUS) are used to achieve an expanded resection during the surgical procedure. IOUS has been increasingly used in the surgery of high-grade gliomas and various tumors due to its convenient intraoperative use, its flexible repeatability, and the relatively low cost of operating room construction. With the continuous upgrading of ultrasound equipment, IOUS has been able to better assist surgeons in achieving an increased extent of resection. This review aims to summarize the application of ultrasound in the surgery of high-grade gliomas in the past decade, its improvement in patient prognosis, and its prospects.
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Affiliation(s)
- RenJie Wei
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - YuXiang Cai
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - JingCao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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Guil-Ibáñez JJ, Gomar-Alba M, Castelló-Ruiz MJ, García-Pérez F, Narro-Donate JM, Vargas-López AJ, Masegosa-González J. Intraoperative ultrasound-assisted surgery in orbital apex tumours: technical note. J Ultrasound 2023; 26:733-741. [PMID: 36642754 PMCID: PMC10469155 DOI: 10.1007/s40477-022-00762-4] [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: 09/13/2022] [Accepted: 11/28/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Since the introduction of ultrasonography (US) in the operating theatre in the early 1970s, intraoperative ultrasound (IOUS) has become a very useful tool for real-time neurosurgical procedures. The main limitation of US is its innately reduced capacity to penetrate the intact skull. This is the reason why most IOUS-assisted procedures are usually performed via transfontanellar or after a craniotomy or laminotomy is done. OBJECTIVE We present a 54-year-old woman with a right optic nerve sheath meningioma, who was operated on by a right cranio-orbital approach and IOUS-assisted tumour removal. METHODS Data concerning the anamnesis and complementary studies were obtained from the clinical history. Surgical images were obtained in the operating room during surgery. Images obtained by US were compared with the preoperative and postoperative imaging scans. IOUS imaging was also compared with the intraoperative findings. RESULTS The correlation between US and both preoperative and postoperative studies was very high. During surgery, both transpalpebral and transperiorbital IOUS facilitated the resection with no specific technical difficulties or significant time consumption. CONCLUSION Recent improvements in the image quality of IOUS devices offer several attractive options for real-time neuronavigation. We describe our initial experience with the IOUS-assisted technique for orbital apex tumours. In our patient transpalpebral and transperiorbital IOUS provided an excellent source of control over location and over the extent of tumour resection. We hope that this description of how we usually perform this procedure may be useful for some selected cases and contribute to the further enhancement and improvement of the technique.
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Affiliation(s)
- José Javier Guil-Ibáñez
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre s/n, 04009, Almería, Spain.
| | - Mario Gomar-Alba
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre s/n, 04009, Almería, Spain
| | - María José Castelló-Ruiz
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre s/n, 04009, Almería, Spain
| | - Fernando García-Pérez
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre s/n, 04009, Almería, Spain
| | - José María Narro-Donate
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre s/n, 04009, Almería, Spain
| | - Antonio José Vargas-López
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre s/n, 04009, Almería, Spain
| | - José Masegosa-González
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre s/n, 04009, Almería, Spain
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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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Neuroendoscopic training in neurosurgery: a simple and feasible model for neurosurgical education. Childs Nerv Syst 2021; 37:2619-2624. [PMID: 33942143 DOI: 10.1007/s00381-021-05190-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The development of high levels of technical competence and excellent decision-making skills are key goals of all neurosurgical residency training programs. This acquisition of technical skills is becoming increasingly difficult due to many factors including less exposure to operative cases, demand for more time and cost-effective practices, and resident work hour restrictions. We describe a step-by-step method for how to build a low-cost and feasible model that allows residents to improve their neuroendoscopic skills. METHODS The bell pepper-based model was developed as an endoscopic training model. Using continuous irrigation, several hands-on procedures were proposed under direct endoscopic visualization. Endoscope setup, endoscopic third ventriculostomy, septostomy, and tumor biopsy procedures were simulated and video recorded for further edition and analysis. RESULTS The model can be setup in less than 15 min with minimal cost and infrastructure requirements. A single model allows simulation of all the exercises described above. The model allows exposure to the camera skills, instrument handling, and hand-eye coordination inherent to most neuroendoscopic procedures. CONCLUSION Minimal infrastructure requirements, simplicity, and easily setup models provide a proper environment for regular training. The bell pepper-based model is inexpensive, widely available, and a feasible model for routine training. Neurosurgery residents may benefit from the use of this model to accelerate their learning curve and familiarize themselves with the neuroendoscopic core principles in a risk-free environment without time or resource constraints.
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Tirado-Caballero J, Rivero-Garvia M, Moreno-Madueño G, Gómez-González E, Márquez-Rivas J. Cranial expansion and aqueductoplasty for combined isolated fourth ventricle and slit-ventricle syndrome: a surgical alternative. Childs Nerv Syst 2021; 37:885-894. [PMID: 33099694 DOI: 10.1007/s00381-020-04939-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/20/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION An isolated fourth ventricle (IFV) is a rare entity observed in shunted patients and its treatment is still uncertain. Endoscopic aqueductoplasty has shown good results for restoring CSF flux between the third and fourth ventricles. However, it needs some grade of ventricular dilation to be performed. Some patients affected by IFV show slit-ventricle morphology in CT/MRI. Usually, the rise of opening pressure or the shunt externalization gets enough ventricular dilation. However, the lack of intracranial compliance in some patients makes these options unsuitable and high-ICP symptoms are developed without ventricular dilation. METHODS We present a two cases series affected by IFV with no ventricular dilation in radiological exams. ICP sensors were implanted, observing high-ICP and establishing the diagnosis of craniocerebral disproportion. A two-stage surgical plan based on a dynamic cranial expansion followed by a supratentorial endoscopic aqueductoplasty was performed. A physical and mathematical model explaining our approach was also provided. RESULTS Chess-table cranial expansion technique was performed in both patients. Six/seven days after the first surgery, respectively, ventricular dilation was observed in CT. Endoscopic precoronal aqueductoplasty was then performed. No postoperative complications were described. IFV symptoms improved in both patients. Eighteen and 12 months after the two-stage surgical plan, the patients remain symptom-free and void of flow is still observed between the third and the fourth ventricles in MRI. CONCLUSION The two-stage approach was a suitable option for the treatment of these complex patients affected by both craniocerebral disproportion and isolated fourth ventricle.
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Affiliation(s)
- Jorge Tirado-Caballero
- Neurosurgery Service, Virgen del Rocío University Hospital, Av. Manuel Siurot, S/N, 41013, Seville, Spain.
- Group of Applied Neuroscience, Biomedicine Institute of Seville, Seville, Spain.
| | - Mónica Rivero-Garvia
- Neurosurgery Service, Virgen del Rocío University Hospital, Av. Manuel Siurot, S/N, 41013, Seville, Spain
- Group of Applied Neuroscience, Biomedicine Institute of Seville, Seville, Spain
| | - Gloria Moreno-Madueño
- Neurosurgery Service, Virgen del Rocío University Hospital, Av. Manuel Siurot, S/N, 41013, Seville, Spain
| | - Emilio Gómez-González
- Group of Interdisciplinary Physics, Engineering School, Universidad de Sevilla, Seville, Spain
| | - Javier Márquez-Rivas
- Neurosurgery Service, Virgen del Rocío University Hospital, Av. Manuel Siurot, S/N, 41013, Seville, Spain
- Group of Applied Neuroscience, Biomedicine Institute of Seville, Seville, Spain
- Advanced Neurology Center, Seville, Spain
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11
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Tirado-Caballero J, Herreria-Franco J, Rivero-Garvía M, Moreno-Madueño G, Mayorga-Buiza MJ, Marquez-Rivas J. Technical Nuances in Neuroendoscopic Lavage for Germinal Matrix Hemorrhage in Preterm Infants: Twenty Tips and Pearls after More than One Hundred Procedures. Pediatr Neurosurg 2021; 56:392-400. [PMID: 33965954 DOI: 10.1159/000516183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/27/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Posthemorrhagic hydrocephalus in preterm infants is a serious entity related to high mortality and morbidity. Neuroendoscopic lavage (NEL) is a suitable alternative for the management of this pathology. However, as with every endoscopic technique, it requires some experience and several cases to master. METHODS We present a descriptive study of some technical nuances, tips, and tricks that have been learned in the last 8 years with over a hundred NELs performed in preterm infants. These variations are classified into 3 categories according to their temporal relationship with the surgical procedure: preoperative stage, intraoperative stage, and postoperative stage. We include a brief description of each one and the reasons why they are included in our current clinical practice. RESULTS Twenty tips and pearls were described in detail and are reported here. Preoperative, intraoperative, and postoperative variations were exposed and related to the most frequent complications of this procedure: infection, cerebrospinal fluid leak, and rebleeding. CONCLUSIONS NEL is a useful technique for the management of germinal matrix hemorrhage in preterm infants. These technical nuances have improved the results of our technique and helped us to prevent complications related to the procedure.
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Affiliation(s)
- Jorge Tirado-Caballero
- Neurosurgery Service Virgen del Rocío, University Hospital, Seville, Spain.,Group of Applied Neuroscience, Biomedicine Institute of Seville, Seville, Spain.,Department of Neurosurgery, Hospital 12 de Octubre, Madrid, Spain
| | | | - Mónica Rivero-Garvía
- Neurosurgery Service Virgen del Rocío, University Hospital, Seville, Spain.,Group of Applied Neuroscience, Biomedicine Institute of Seville, Seville, Spain
| | | | - Maria Jose Mayorga-Buiza
- Neurosurgery Service Virgen del Rocío, University Hospital, Seville, Spain.,Group of Applied Neuroscience, Biomedicine Institute of Seville, Seville, Spain
| | - Javier Marquez-Rivas
- Neurosurgery Service Virgen del Rocío, University Hospital, Seville, Spain.,Group of Applied Neuroscience, Biomedicine Institute of Seville, Seville, Spain.,Center for Advanced Neurology, Seville, Spain
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12
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Fernández‐Muñoz B, Rosell‐Valle C, Ferrari D, Alba‐Amador J, Montiel MÁ, Campos‐Cuerva R, Lopez‐Navas L, Muñoz‐Escalona M, Martín‐López M, Profico DC, Blanco MF, Giorgetti A, González‐Muñoz E, Márquez‐Rivas J, Sanchez‐Pernaute R. Retrieval of germinal zone neural stem cells from the cerebrospinal fluid of premature infants with intraventricular hemorrhage. Stem Cells Transl Med 2020; 9:1085-1101. [PMID: 32475061 PMCID: PMC7445027 DOI: 10.1002/sctm.19-0323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/10/2020] [Accepted: 04/29/2020] [Indexed: 12/13/2022] Open
Abstract
Intraventricular hemorrhage is a common cause of morbidity and mortality in premature infants. The rupture of the germinal zone into the ventricles entails loss of neural stem cells and disturbs the normal cytoarchitecture of the region, compromising late neurogliogenesis. Here we demonstrate that neural stem cells can be easily and robustly isolated from the hemorrhagic cerebrospinal fluid obtained during therapeutic neuroendoscopic lavage in preterm infants with severe intraventricular hemorrhage. Our analyses demonstrate that these neural stem cells, although similar to human fetal cell lines, display distinctive hallmarks related to their regional and developmental origin in the germinal zone of the ventral forebrain, the ganglionic eminences that give rise to interneurons and oligodendrocytes. These cells can be expanded, cryopreserved, and differentiated in vitro and in vivo in the brain of nude mice and show no sign of tumoral transformation 6 months after transplantation. This novel class of neural stem cells poses no ethical concerns, as the fluid is usually discarded, and could be useful for the development of an autologous therapy for preterm infants, aiming to restore late neurogliogenesis and attenuate neurocognitive deficits. Furthermore, these cells represent a valuable tool for the study of the final stages of human brain development and germinal zone biology.
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Affiliation(s)
- Beatriz Fernández‐Muñoz
- Unidad de Producción y Reprogramación Celular (UPRC)Red Andaluza para el diseño y traslación de Terapias AvanzadasSevillaSpain
- Grupo de Neurociencia aplicadaInstituto de Biomedicina de SevillaSevillaSpain
| | - Cristina Rosell‐Valle
- Unidad de Producción y Reprogramación Celular (UPRC)Red Andaluza para el diseño y traslación de Terapias AvanzadasSevillaSpain
| | - Daniela Ferrari
- Department of Biotechnology and BiosciencesUniversity Milan‐BicoccaMilanItaly
| | - Julia Alba‐Amador
- Unidad de Producción y Reprogramación Celular (UPRC)Red Andaluza para el diseño y traslación de Terapias AvanzadasSevillaSpain
| | - Miguel Ángel Montiel
- Unidad de Producción y Reprogramación Celular (UPRC)Red Andaluza para el diseño y traslación de Terapias AvanzadasSevillaSpain
| | - Rafael Campos‐Cuerva
- Unidad de Producción y Reprogramación Celular (UPRC)Red Andaluza para el diseño y traslación de Terapias AvanzadasSevillaSpain
- Centro de TransfusionesTejidos y Células de Sevilla (CTTS)SevillaSpain
| | - Luis Lopez‐Navas
- Departamento de PreclínicaRed Andaluza de Diseño y Traslación de Terapias AvanzadasSevillaSpain
| | - María Muñoz‐Escalona
- Unidad de Producción y Reprogramación Celular (UPRC)Red Andaluza para el diseño y traslación de Terapias AvanzadasSevillaSpain
- Present address:
Centre for Genomics and Oncological Research (GENYO)GranadaSpain
| | - María Martín‐López
- Unidad de Producción y Reprogramación Celular (UPRC)Red Andaluza para el diseño y traslación de Terapias AvanzadasSevillaSpain
- Grupo de Neurociencia aplicadaInstituto de Biomedicina de SevillaSevillaSpain
| | - Daniela Celeste Profico
- Fondazione IRCCS Casa Sollievo della SofferenzaProduction Unit of Advanced Therapies (UPTA)San Giovanni RotondoItaly
| | - Manuel Francisco Blanco
- Unidad de Producción y Reprogramación Celular (UPRC)Red Andaluza para el diseño y traslación de Terapias AvanzadasSevillaSpain
| | - Alessandra Giorgetti
- Regenerative Medicine ProgramBellvitge Biomedical Research Institute (IDIBELL); Program for Translation of Regenerative Medicine in Catalonia (P‐CMRC)BarcelonaSpain
| | - Elena González‐Muñoz
- Department of Cell BiologyGenetics and Physiology, University of MálagaMálagaSpain
- Department of Regenerative NanomedicineAndalusian Center for Nanomedicine and Biotechnology‐BIONANDMálagaSpain
- Networking Research Center on BioengineeringBiomaterials and Nanomedicine (CIBER‐BBN). Carlos III Health Institute (ISCIII)Spain
| | - Javier Márquez‐Rivas
- Grupo de Neurociencia aplicadaInstituto de Biomedicina de SevillaSevillaSpain
- Neurosurgery DepartmentHospital Virgen del RocíoSevillaSpain
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13
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Tabibkhooei A, Izadpanahi M, Arab A, Zare-Mirzaei A, Minaeian S, Rostami A, Mohsenian A. Profiling of novel circulating microRNAs as a non-invasive biomarker in diagnosis and follow-up of high and low-grade gliomas. Clin Neurol Neurosurg 2019; 190:105652. [PMID: 31896490 DOI: 10.1016/j.clineuro.2019.105652] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 12/24/2019] [Accepted: 12/26/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Glioblastoma (GBM) is the most common primary malignant neoplasm of the central nervous system (CNS). Despite the progress in therapeutic strategies such as surgical techniques, radiotherapy, chemotherapy, and targeted therapy, prognosis and therapeutically convenient monitoring tools in patients with GBM has not improved significantly up to now.Therefore, exosomal miRNAs as novel non-invasive biomarkers having high sensitivity and specificity are required to improve diagnosis and to develop new targeted therapy strategies for GBM patients. The aim of the present study was to investigate a novel miRNA signature as a predictive biomarker for diagnosis and measurement of response to therapeutic interventions in plasma of GBM patients versus traumatic brain injury and diffuse low-grade astrocytoma (LGA) patients. PATIENTS AND METHODS Plasma exosomal-microRNAs were isolated from GBM (n = 25), LGA (n = 25), and head trauma patients (n = 15) as non-glioma control from March 2017 to June 2018 in Department of Neurosurgery at Rasoul-e-Akram Hospital. Through a bioinformatics analysis, we used Miranda, TargetScan, mirBase, DIANA-microT-CDS, and KEGG database as well as microarray data analysis from GEO for microRNA candidates. Finally, miR-210, miR-185, miR-5194, and miR-449 were selected among those miRNAs because they were recorded to target the maximum number of genes in EGFR and c-MET signaling pathways. Then, exosomal microRNAs were extracted from plasma of patients and quantitated by locked nucleic acid real-time PCR in GBM, LGA, and trauma patients. RESULTS This result is the first report on the role of circulating miR-185, miR-449, and miR-5194 in GBM compared to LGA and trauma. The plasma expression of miR-210 as an oncogenic miR was upregulated in GBM and LGA groups (P < 0.0001). Otherwise, miR-185, miR-5194, and miR-449 were significantly downregulated (P ≤ 0.05) in GBM and LGA compared to trauma patients. There was no significant downregulation in the expression of miR-185 between GBM and LGA, while the expression of miR-5194 (P ≤ 0.05) and miR-449 (P ≤ 0.05) was significantly decreased in GBM patients compared with LGA. CONCLUSIONS These results indicate that the levels of miR-210, miR-449, and miR-5194 are a promising diagnostic and prognostic biomarker positively correlated with histopathological grade and invasiveness of GBM. These findings imply that circulating microRNA can be potentially used as novel biomarkers for glioma that might be beneficial in clinical management of glioma patients.
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Affiliation(s)
- Alireza Tabibkhooei
- Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran.
| | - Maryam Izadpanahi
- Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran.
| | - Abolfazl Arab
- Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
| | - Ali Zare-Mirzaei
- Department of Pathology, Iran University of Medical Sciences, Tehran, Iran
| | - Sara Minaeian
- Antimicrobial Resistance Research Center, Institute of Immunology and Infection Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Rostami
- Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mohsenian
- Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran
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Qiu S, Liu T, Cao G, Wu K, Zhao T. Treatment of intracranial hemorrhage with neuroendoscopy guided by body surface projection. Medicine (Baltimore) 2019; 98:e15503. [PMID: 31083190 PMCID: PMC6531271 DOI: 10.1097/md.0000000000015503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND We aimed to study the feasibility of body surface projection in neuroendoscopic treatment of intracranial hemorrhage (ICH), and to evaluate the prognosis of muscle strength using diffusion tensor imaging (DTI) technique. METHODS We utilized 3D-SLICER software and adopted hematoma body surface projection orientation to eliminate ICH by using neuroendoscope for 69 cases of spontaneous intracerebral hemorrhage. The standard of correct location was determined by the direct view of hematoma at the first operation. Evacuation rate by comparing computed tomography (CT) before and after the surgery and Glasgow coma scale (GCS) was computed. DTI was used for pyramidal tract imaging 3 weeks after the operation, while the prognosis of muscle strength was assessed after 6 months. The control group included 69 patients with basal ganglia hemorrhage who received conservative treatment during the same period. RESULTS The hematoma evacuation rate was 90.75% in average. The average GCS score rose by 4 points one week after the surgery. The shape of pyramidal tract affected the prognosis of body muscle strength, and the simple disruption type was the worst. There was no difference in mortality between the surgery group (10.1%) and the conservative group (4.3%). The muscle strength improvement value and modulate RANK score (MRS) in the surgery group were better than the control group. CONCLUSION It is convenient and feasible to use the surface projection to determine the target of operation, and the clearance rate of hematoma is high. Pyramidal tract imaging can predict the prognosis of muscle strength.
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