Endoscopic options in children: experience with 134 procedures

2009 ◽  
Vol 3 (2) ◽  
pp. 81-89 ◽  
Author(s):  
Joachim M. K. Oertel ◽  
Joerg Baldauf ◽  
Henry W. S. Schroeder ◽  
Michael R. Gaab
Keyword(s):  
Success Rate ◽  
Endoscopic Surgery ◽  
Complication Rate ◽  
Tumor Resection ◽  
Third Ventriculostomy ◽  
Tumor Biopsy ◽  
Endoscopic Procedures ◽  
Endoscopic Techniques ◽  
Shunt Placement ◽  
Csf Circulation

Object There are frequent applications for endoscopy in neurosurgery. However, endoscopic surgery in children has peculiar characteristics and is associated with different rates of success. In this study, the authors report on their experience with 134 consecutive endoscopy procedures performed in 126 patients < 18 years of age. Methods Between April 1993 and October 2007, 134 endoscopic procedures were performed in 126 children. Indications for surgery included brain tumors in 48 children, cystic lesions in 24, aqueductal stenosis in 23, various malformations in 20, hemorrhage and infarction in 6, and isolated ventricles in 5 children. In this long-term followup study, data were analyzed with respect to clinical and radiological success rates, as well as shunt dependence both in relation to lesion origin, and to the type of endoscopic procedure performed (endoscopic third ventriculostomy [ETV], septostomy, aqueductoplasty, or cystocisternostomy). Finally, the influence of patient age on the success rate was evaluated. Results In 114 patients, restoration of CSF circulation was the goal of endoscopy, but in 2 patients only ventriculoscopy was performed followed by ventriculoperitoneal shunt placement. In 12 of 114 patients, tumor biopsy sampling or resection was performed simultaneously with shunt placement. In another 12 patients, only endoscopic tumor resection without CSF circulation restoration was done. The follow-up period ranged from 1 to 6 years. Thirteen tumor biopsies, 7 partial tumor resections, and 4 endoscopically complete tumor resections were performed. An intraoperative switch to microsurgery was made in 2 patients because of recurrent hemorrhage and an overly time-consuming endoscopic surgery. Cerebrospinal fluid circulation was successfully restored in 81 (72%) of 112 patients, with the use of endoscopy in the setting of tumor-related hydrocephalus providing the best results (86% success rate). However, of the various endoscopic procedures, cyst openings (cystocisternostomy, cystoventriculostomy, and ventriculocystocisternostomy) provided the best results—superior even to ETV—with a success rate of 77% and no complications. In contrast, endoscopic aqueductoplasty had a high failure and complication rate. Patients < 6 months old who underwent ETV, septostomy, or aqueductoplasty had poor results and became more frequently shunt dependent than older children. Conclusions Overall, endoscopy can be considered safe and effective in children. Based on the authors' data, acute hydrocephalus cases such as those caused by tumors are the best candidates for endoscopic CSF flow restoration. Interestingly, cyst openings to the ventricles or cisterns were the most successful endoscopic techniques with the lowest complication rate. Aqueductoplasty should be reserved for selected cases. Finally, the success rate of endoscopic techniques remains poor in infants < 6 months of age; this was not only true of ETV, but also other techniques such as septostomy and aqueductoplasty.

scholarly journals Early outcome of combined endoscopic third ventriculostomy and choroid plexus cauterization in childhood hydrocephalus

2015 ◽  
Vol 15 (5) ◽  
pp. 524-528 ◽  
Author(s):  
Olufemi B. Bankole ◽  
Omotayo A. Ojo ◽  
Mathias N. Nnadi ◽  
Okezie O. Kanu ◽  
John O. Olatosi
Keyword(s):  
Spina Bifida ◽  
Success Rate ◽  
Choroid Plexus ◽  
Endoscopic Third Ventriculostomy ◽  
Subsequent Treatment ◽  
Third Ventriculostomy ◽  
Shunt Insertion ◽  
Endoscopic Techniques ◽  
Childhood Hydrocephalus ◽  
Choroid Plexus Cauterization

OBJECT Although shunts have been the mainstay in treating hydrocephalus over the past 5 decades, the use of endoscopic techniques in addressing this disorder in children offers both the neurosurgeon and the patient a unique opportunity to avoid shunting and its attendant complications. The combination of endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) remains uncommon in most centers despite its potential promise. The authors sought to investigate the efficacy of combining ETV and CPC (ETV+CPC) in treating childhood hydrocephalus in Nigeria. Infection and spina bifida contribute a high percentage of the cases of hydrocephalus in Nigeria. METHODS Over a 2-year period, all children 0–18 years of age who had endoscopic treatment for hydrocephalus were prospectively evaluated to determine the need for subsequent treatment. Children who had the combination of ETV+CPC were identified as a subcategory and form the basis of this retrospective study. RESULTS Twenty-two of 38 endoscopically treated children had undergone the combination of ETV+CPC for hydrocephalus of varied etiology. There was a male preponderance (2.5:1), and 90% of the patients were infants. The overall success rate was 75%, with the best outcome in children with spina bifida. One child required a repeat ETV. CONCLUSIONS The combination of ETV+CPC is useful in treating children with hydrocephalus of varied etiology. The complication profile is acceptable, and the overall success rate is comparable to that associated with shunt insertion.

A NEW MULTIPURPOSE VENTRICULOSCOPE

Neurosurgery ◽  
2008 ◽  
Vol 62 (2) ◽  
pp. 489-492 ◽  
Author(s):  
Henry W.S. Schroeder
Keyword(s):  
Endoscopic Treatment ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Intraventricular Tumor ◽  
Tumor Biopsy ◽  
Endoscopic Procedures ◽  
Clot Removal ◽  
Adults And Children ◽  
Intraventricular Cyst

Abstract THIS ARTICLE DESCRIBES a new multipurpose ventriculoscope that combines the advantages of several neuroendoscopic systems that are already available and provides some new features. This system can be used for all intracranial endoscopic procedures, such as endoscopic third ventriculostomy, septum fenestration, foraminoplasty, aqueductoplasty, stenting, cyst fenestrations, intraventricular tumor biopsy or resection, or intraventricular cyst or clot removal. The ventriculoscope can be used in both adults and children. Because of its diameter, it is not designed for the endoscopic treatment of newborns.

Don't take the plunge: avoiding adverse events with cranial perforators

2011 ◽  
Vol 115 (3) ◽  
pp. 570-575 ◽  
Author(s):  
Timothy W. Vogel ◽  
Brian J. Dlouhy ◽  
Matthew A. Howard
Keyword(s):  
Postoperative Complications ◽  
Adverse Events ◽  
Pediatric Patients ◽  
Endoscopic Third Ventriculostomy ◽  
Tumor Resection ◽  
Third Ventriculostomy ◽  
Fisher Exact Test ◽  
Consecutive Series ◽  
Tumor Biopsy ◽  
Exact Test

Object The object of this study was to evaluate the causes of plunging events associated with automatic-releasing cranial perforators at the authors' institution. Methods The authors analyzed a consecutive series of 1652 cranial procedures involving one type of automaticreleasing cranial perforator over a 2-year period. Plunging occurrences were recorded for 2 drill speeds: 1000 rpm in the 1st year and 800 rpm during the 2nd year. Intraoperative observations, neuroimaging studies, and clinical data were evaluated for each plunging event. Results The authors identified 9 plunging events for an overall incidence of 0.54%. In the 1st year, they identified 2 plunging events at a speed of 1000 rpm for an incidence of 0.19%. In an effort to reduce this occurrence, the speed of the drill was lowered to 800 rpm. There were 7 additional events, for a significantly increased incidence of 1.16% (p = 0.014, Fisher exact test) after the change was implemented. These cases spanned a number of procedures in adults and pediatric patients, including ventriculostomy placement, craniotomies for tumor resection, tumor biopsy, and endoscopic third ventriculostomy. Despite plunging, no immediate postoperative complications were noted on clinical examination. Conclusions While technology continues to improve cranial perforator performance, the use of such a device is still associated with a risk of complications causing dural lacerations and injury to the underlying cortex. Decreasing the drill speed may not decrease the incidence of plunging.

scholarly journals A bi-foraminal craniometric-guided approach to endoscopic third ventriculostomy and biopsy of a pineal tumour

2021 ◽  
Vol 12 ◽  
pp. 582
Author(s):  
Panduranga Seetahal-Maraj ◽  
Patrick Knight ◽  
Narindra Ramnarine
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Third Ventriculostomy ◽  
Tumor Biopsy ◽  
Foramen Of Monro ◽  
Pineal Tumour ◽  
Pineal Tumors ◽  
Endoscopic Techniques ◽  
Intracranial Lesions

Background: Pineal tumors are very rarely encountered, with an incidence of <1% of intracranial lesions in adults. Life-threatening hydrocephalus due to obstruction of the third ventricle can result from the location of these tumours. Endoscopic third ventriculostomy (ETV) and tumor biopsy is a safe and feasible strategy, particularly if the tumor appears benign. This mitigates the high risks of uncontrollable venous bleeding from open and stereotactic biopsies. While typically performed using either ipsilateral single or dual bur holes, the location of the tumor may require modifications to the standard endoscopic techniques. Case Description: A 55-year-old male presented with signs of intracranial hypertension and was found to have obstructive hydrocephalus due to a pineal tumour. The tumour displayed a right-sided dominance when the pre-operative imaging was assessed, which would risk forniceal injury if biopsied via a right-sided burr hole. Craniometric measurements revealed a superior trajectory to the tumour via the left foramen of Monro. A biforaminal approach was performed, with a traditional ETV using a right coronal bur hole and biopsy via a left frontal bur hole. This minimized forniceal stretching and allowed a safe biopsy. Conclusion: The bi-foraminal approach has not been widely described in the literature but can potentially avoid morbidity with biopsy in patients with right-sided pineal tumours. We believe this technique should be considered, particularly in low-resource settings where neuroendoscopy is not commonly done, and where the use of ipsilateral single or dual-bur holes may lead to forniceal injury.

Endoscopic third ventriculostomy in patients with cerebrospinal fluid infection and/or hemorrhage

2002 ◽  
Vol 97 (3) ◽  
pp. 519-524 ◽  
Author(s):  
Vitaly Siomin ◽  
Giuseppe Cinalli ◽  
Andre Grotenhuis ◽  
Aprajay Golash ◽  
Shizuo Oi ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Success Rate ◽  
Endoscopic Third Ventriculostomy ◽  
Aqueductal Stenosis ◽  
Third Ventriculostomy ◽  
Content Type ◽  
Vp Shunt ◽  
Shunt Placement ◽  
History Of ◽  
Fine Print

Object. In this study the authors evaluate the safety, efficacy, and indications for endoscopic third ventriculostomy (ETV) in patients with a history of subarachnoid hemorrhage or intraventricular hemorrhage (IVH) and/or cerebrospinal fluid (CSF) infection. Methods. The charts of 101 patients from seven international medical centers were retrospectively reviewed; 46 patients had a history of hemorrhage, 42 had a history of CSF infection, and 13 had a history of both disorders. All patients experienced third ventricular hydrocephalus before endoscopy. The success rate for treatment in these three groups was 60.9, 64.3, and 23.1%, respectively. The follow-up period in successfully treated patients ranged from 0.6 to 10 years. Relatively minor complications were observed in 15 patients (14.9%), and there were no deaths. A higher rate of treatment failure was associated with three factors: classification in the combined infection/hemorrhage group, premature birth in the posthemorrhage group, and younger age in the postinfection group. A higher success rate was associated with a history of ventriculoperitoneal (VP) shunt placement before ETV in the posthemorrhage group, even among those who had been born prematurely, who were otherwise more prone to treatment failure. The 13 premature infants who had suffered an IVH and who had undergone VP shunt placement before ETV had a 100% success rate. The procedure was also successful in nine of 10 patients with primary aqueductal stenosis. Conclusions. Patients with obstructive hydrocephalus and a history of either hemorrhage or infection may be good candidates for ETV, with safety and success rates comparable with those in more general series of patients. Patients who have sustained both hemorrhage and infection are poor candidates for ETV, except in selected cases and as a treatment of last resort. In patients who have previously undergone shunt placement posthemorrhage, ETV is highly successful. It is also highly successful in patients with primary aqueductal stenosis, even in those with a history of hemorrhage or CSF infection.

Neuroendoscopic treatment of arachnoid cysts of the quadrigeminal cistern: a series of 14 cases

2010 ◽  
Vol 6 (5) ◽  
pp. 489-497 ◽  
Author(s):  
Giuseppe Cinalli ◽  
Pietro Spennato ◽  
Laura Columbano ◽  
Claudio Ruggiero ◽  
Ferdinando Aliberti ◽  
...  
Keyword(s):  
Success Rate ◽  
Endoscopic Third Ventriculostomy ◽  
Endoscopic Procedure ◽  
Arachnoid Cysts ◽  
Shunt Revision ◽  
Third Ventriculostomy ◽  
Type I ◽  
Temporal Fossa ◽  
Endoscopic Procedures ◽  
Quadrigeminal Cistern

Object In this paper, the authors' goal was to evaluate the role of neuroendoscopy in the treatment of arachnoid cysts of the quadrigeminal cistern. Methods Between March 1995 and February 2008, 14 patients affected by arachnoid cysts of the quadrigeminal cistern were treated endoscopically. The cysts were classified according to their anatomical and radiological appearance. The most frequent form (Type I) extended infratentorially and supratentorially with a dumbbell shape. Type II cysts were confined to the infratentorial space and were associated with the most severe and acute form of hydrocephalus. Type III cysts presented a significant asymmetric expansion toward the temporal fossa. Ten patients underwent an endoscopic procedure as primary treatment and 4 as an alternative to shunt revision. In 6 cases, the first endoscopic procedure was ventriculocystostomy (VC) together with endoscopic third ventriculostomy (ETV). In the other 8 cases, the first endoscopic procedure was VC alone. Results In the 6 cases in which VC was performed with an ETV, the procedure was successful, and the patients did not require further surgery. Of the 8 cases in which the first endoscopic procedure performed was VC without ETV, 7 underwent reoperation. Four of these patients underwent endoscopic procedures (by reopening the obstructed VC and performing ETV or cystocisternostomy) 2, 4, 4, and 5 months later with final success in all cases. Three patients (all of whom were previously treated using ventriculo- or cystoperitoneal shunts) required shunt reimplantation (complete failure). Subdural collection developed in 1 case, which was managed by transient insertion of a subduroperitoneal shunt. Neurological and developmental outcomes were good except for 1 patient who did not show improvement in preoperative developmental delay. No transient or permanent morbidity or mortality was observed. Conclusions The analysis of this series suggests that arachnoid cysts of the quadrigeminal cistern and the associated hydrocephalus can be effectively treated by endoscopy; this approach allows the patient to be shunt independent in more than 78% of the cases. If endoscopy is used as first option, the success rate of endoscopic procedures observed in this series was 90%. Endoscopic third ventriculostomy should be associated with a VC to offer the highest success rate with a single procedure.

A new method of ultrasonic guidance of neuroendoscopic procedures

2002 ◽  
Vol 96 (3) ◽  
pp. 628-632 ◽  
Author(s):  
Martin Strowitzki ◽  
Michael Kiefer ◽  
Wolf-Ingo Steudel
Keyword(s):  
Third Ventricle ◽  
Tumor Resection ◽  
Colloid Cyst ◽  
Third Ventriculostomy ◽  
Outer Diameter ◽  
Intraventricular Tumor ◽  
Tumor Biopsy ◽  
Foramen Of Monro ◽  
Content Type ◽  
Fine Print

✓ The authors present a newly designed device for ultrasonic guidance of neuroendoscopic procedures. It consists of a puncture adapter that attaches to a rigid endoscope having an outer diameter of 6 mm and is mounted on a small, bayonet-shaped ultrasound probe. This adapter directs the movement of the endoscope precisely within the ultrasonic field of view. The targeted region is identified by transdural insonation via an enlarged single burr-hole approach, and the endoscope is tracked in real time throughout its approach to the target. The procedure has been performed in 10 patients: endoscopic ventriculocystostomy in four cases; removal of a colloid cyst of the third ventricle in two cases; and intraventricular tumor biopsy, intraventricular tumor resection, third ventriculostomy, and removal of an intraventricular hematoma in one case each. The endoscope was depicted on ultrasonograms as a hyperechoic line without disturbing echoes and, consequently, the target (cyst, ventricle, or tumor) was safely identified in all but one case, in which intraventricular air hid a colloid cyst in the foramen of Monro. The method presented by the authors proved to be very effective in the guidance and control of neuroendoscopic procedures. Combining this method with image guidance is recommended to define the entry point of the endoscope precisely.

A technique for endoscopic pituitary tumor removal

1996 ◽  
Vol 1 (1) ◽  
pp. E3 ◽  
Author(s):  
Michael D. Cusimano ◽  
Ronald S. Fenton
Keyword(s):  
Case Report ◽  
Minimally Invasive ◽  
Pituitary Tumor ◽  
Tumor Resection ◽  
Region Of Interest ◽  
Operating Microscope ◽  
Tumor Removal ◽  
Endoscopic Techniques ◽  
Effective Manner ◽  
Highly Effective

A number of milestones have marked the development of transsphenoidal pituitary tumor resection this century. The introduction of headlamp illumination, followed by the use of the operating microscope and fluoroscopy have allowed neurosurgeons to perform this surgery in a safe and highly effective manner. With the aid of a case report, we describe the incorporation of endoscopic techniques in pituitary tumor resection. The technique described is minimally invasive, avoiding septal dissection and allowing unsurpassed, unobstructed, and panoramic visualization of the region of interest to the surgeon and operative team.

scholarly journals Comparative outcome analysis of bleb needling of fibrotic blebs in the clinic versus the operating room: a retrospective case series

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Vikram Ponnusamy ◽  
Van Nguyen ◽  
Jella A. An
Keyword(s):  
Success Rate ◽  
Operating Room ◽  
Complication Rate ◽  
Primary Outcome ◽  
Case Series ◽  
Outcome Analysis ◽  
Retrospective Case ◽  
Xen Gel Stent ◽  
Retrospective Case Series ◽  
Ab Interno

Abstract Background To compare 6 month outcomes of bleb needling performed in the clinic vs. the operating room (OR) in adult glaucoma patients with failed bleb. Methods A retrospective case series of 47 eyes from 41 glaucoma patients who received needling with mitomycin C (MMC) of scarred bleb from prior bleb-forming procedures in clinic (32 eyes) vs. the OR (15 eyes), including trabeculectomy (14 eyes), ExPress shunt (16 eyes), and ab-interno XEN gel stent (17 eyes). The primary outcome was needling success, defined as IOP ≤ 18 mmHg on 0 glaucoma medications without requiring an additional IOP lowering procedure within 6 months after needling. Results At 6 months, bleb needling success rate was similar when performed in the clinic vs. in the OR (28% vs. 20%, P = 0.54). Success rate was not statistically different in patients with prior trabeculectomy, ExPress shunt, and XEN gel stent (29% vs. 38% vs. 12%, P = 0.26). When comparing clinic vs. the OR needling procedures at 6 months, there was no difference in mean IOP (14.2 vs. 14.9 mmHg, P = 0.73), mean glaucoma medications (1.4 vs. 1.7, P = 0.69), additional IOP-lowering procedure rate (16% vs. 27%, P = 0.37), or complication rate (0% vs. 7%, P = 0.32). Conclusion Bleb needling with MMC in clinic may be a safe and effective way to revise failed bleb after trabeculectomy, ExPress shunt, and XEN gel stent procedures when compared to needling in the OR.

Utility of transcervical management of Zenker's diverticulum

2015 ◽  
Vol 130 (S1) ◽  
pp. S16-S19 ◽  
Author(s):  
B Jackson ◽  
Z Ahmad ◽  
R P Morton
Keyword(s):  
Hospital Stay ◽  
Complication Rate ◽  
Length Of Hospital Stay ◽  
Zenker’S Diverticulum ◽  
Cricopharyngeal Myotomy ◽  
Pharyngeal Pouch ◽  
Recent Systematic Review ◽  
Transcervical Approach ◽  
Endoscopic Techniques ◽  
Zenker's Diverticulum

AbstractObjective:To evaluate our results in treating Zenker's diverticulum via the transcervical approach, and to compare our experiences with a recent systematic review of both open and endoscopic approaches to the pharyngeal pouch.Method:An audit yielded 41 consecutive cases of Zenker's diverticulum treated between 2003 and 2013.Results:All 41 patients underwent transcervical cricopharyngeal myotomy; 29 sacs also required ‘inversion’. The median and mean length of hospital stay was 1 night and 2.5 nights respectively. The recurrence rate was 2.4 per cent and the complication rate was 9.8 per cent.Conclusion:When compared to reported endoscopic techniques, transcervical cricopharyngeal myotomy (with or without inversion) in our unit resulted in: shorter hospital stay, a comparable complication rate and fewer recurrences.

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