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Neurosurgical endoscopic training via a realistic 3-dimensional model with pathology

Waran V, Narayanan V, Karuppiah R, Thambynayagam HC, Muthusamy KA, Rahman ZA, et al.

Simul Healthc, 2015 Feb;10(1):43-8.
PMID: 25514588 DOI: 10.1097/SIH.0000000000000060

Training in intraventricular endoscopy is particularly challenging because the volume of cases is relatively small and the techniques involved are unlike those usually used in conventional neurosurgery. Present training models are inadequate for various reasons. Using 3-dimensional (3D) printing techniques, models with pathology can be created using actual patient's imaging data. This technical article introduces a new training model based on a patient with hydrocephalus secondary to a pineal tumour, enabling the models to be used to simulate third ventriculostomies and pineal biopsies.

Matched MeSH terms: Neuroendoscopy/education*
Fully Endoscopic Retrosigmoid Approach for Cerebellopontine Angle Tumors

Saied M, Najibullah M, Shabbir Z, Saleem A, Ali A, Azab WA

Adv Tech Stand Neurosurg, 2024;52:229-244.
PMID: 39017797 DOI: 10.1007/978-3-031-61925-0_16

BACKGROUND: Fully endoscopic or endoscope-controlled approaches are essentially keyhole approaches in which rigid endoscopes are the sole visualization tools used during the whole procedure. At the early attempts of endoscope-assisted cranial surgery, it was noted that rigid endoscopes enabled overcoming the problem of suboptimal visualization when small exposures are used. The technical specifications and design of the currently available rigid endoscopes are associated with a group of unique features that define the endoscopic view and lay the basis for its superiority over the microscopic view during brain surgery. Fully endoscopic retrosigmoid approach for cerebellopontine angle tumors is a minimally invasive approach that is not routinely practiced by neurosurgeons, with few series published so far. Unfamiliarity with the technique, steep learning curve, and concerns about inadequate exposure, neurovascular injury, and decreased visibility may explain this fact. In this chapter we elaborate on the surgical technique and nuances of the fully endoscopic retrosigmoid approach and present an overview of the published series.
METHODS: From a prospective database of endoscopic procedures maintained by the senior author, clinical data, imaging studies, operative charts, and videos of cases undergoing fully endoscopic retrosigmoid approach for cerebellopontine angle tumors were retrieved and analyzed. The pertinent literature was also reviewed.
RESULTS: The surgical technique of the fully endoscopic retrosigmoid approach was formulated.
CONCLUSION: The endoscopic technique has many advantages over the conventional procedures. In our hands, the technique has proven to be feasible, efficient, and minimally invasive with excellent results.

Matched MeSH terms: Neuroendoscopy/methods
Anaesthetic challenges in a patient with acromegaly and multinodular goitre undergoing endoscopic pituitary surgery

Jamil J, Wan Hassan WMN, Ghani AR, Yeap TB

BMJ Case Rep, 2023 Feb 16;16(2).
PMID: 36796871 DOI: 10.1136/bcr-2022-250640

Acromegaly is a progressive systemic disorder which is common among middle-aged women. A functioning growth hormone-secreting pituitary adenoma is the most common cause. Anaesthesia for pituitary surgery in patients with acromegaly is challenging. Rarely, these patients may develop thyroid lesions that may compromise the airway. We present the case of a young man with newly diagnosed acromegaly caused by a pituitary macroadenoma complicated by a large multinodular goitre. The aim of this report is to discuss the perianaesthetic approach in patients with acromegaly with a high risk of airway compromise undergoing pituitary surgery.

Matched MeSH terms: Neuroendoscopy
Neuroendoscopy for post-infective hydrocephalus in children

Deopujari CE, Padayachy L, Azmi A, Figaji A, Samantray SK

Childs Nerv Syst, 2018 10;34(10):1905-1914.
PMID: 30099619 DOI: 10.1007/s00381-018-3901-z

The treatment of hydrocephalus has changed in recent years with better imaging and introduction of endoscopic procedures as well as enhanced shunts. Indications of endoscopic third ventriculostomy (ETV) are now more refined with better quantification of outcome. This article reviews the current state of neuroendoscopy for infective hydrocephalus in children. The roles of third ventriculostomy as a primary procedure or after shunt malfunction, endoscopic interventions in multiloculated hydrocephalus and introduction of intraventricular lavage to salvage severely infected children are evaluated.

Matched MeSH terms: Neuroendoscopy/methods*
Fully Endoscopic Resection of Frontal Osteomas

Yousef W, Najibullah M, Shabbir Z, Shamo S, Azab WA

Adv Tech Stand Neurosurg, 2024;52:253-257.
PMID: 39017799 DOI: 10.1007/978-3-031-61925-0_18

BACKGROUND: Osteomas are the most common primary bone tumors of the calvaria, with an incidence of less than 0.5%. In skull vault osteomas, the exostotic form that grows from the outer table is more common than the enostotic ones which arise from the inner table and grow intracranially. Osteomas of the forehead are very noticeable and disfiguring; patients usually seek medical advice for cosmetic reasons. Forehead osteomas were traditionally excised via either a direct incision over the lesion using the naturally occurring creases or a conventional bicoronal flap. More recently, endoscopic approaches for excision of forehead osteomas were introduced. The results were very encouraging and the technique was adopted by many groups worldwide yet with many technical variations. In this chapter we elaborate on the surgical technique and nuances of the fully endoscopic resection of frontal osteomas.
METHODS: From a prospective database of endoscopic procedures maintained by the senior author, clinical data, imaging studies, operative charts, and videos of cases of forehead osteomas were retrieved and analyzed. The pertinent literature was also reviewed.
RESULTS: The surgical technique of the fully endoscopic resection of frontal osteomas was formulated.
CONCLUSION: The endoscopic technique has many advantages over the conventional procedures. In our hands, the technique has proven to be less time-consuming, efficient, and minimally invasive with excellent cosmetic results.

Matched MeSH terms: Neuroendoscopy/methods
Neuronavigation-guided endoscopic management of a pineal region tumour with obscured floor of the third ventricle: case report

Idris Z, Ghani AR, Idris B, Muzaimi M, Awang S, Pal HK, et al.

Minim Invasive Neurosurg, 2011 Jun;54(3):125-7.
PMID: 21863520 DOI: 10.1055/s-0031-1277198

Shunt surgery is frequently chosen to manage periventricular metastasis of pineal region tumours which obscured the floor of the third ventricle. However, this procedure falls short due to distant metastasis. Neuronavigation-guided endoscopic surgery offers a viable alternative.

Matched MeSH terms: Neuroendoscopy/instrumentation; Neuroendoscopy/methods*
Fulltext Prevalence of Shunt Dependency and Clinical Outcome in Patients with Massive Intraventricular Haemorrhage Treated with Endoscopic Washout and External Ventricular Drainage

Johnson JR, Idris Z, Abdullah JM, Alias A, Haspani MS

Malays J Med Sci, 2017 Mar;24(1):40-46.
PMID: 28381928 DOI: 10.21315/mjms2017.24.1.5

BACKGROUND: Intraventricular haemorrhage (IVH) causes blockage of ventricular conduits leading to hydrocephalus, increased intracranial pressure (ICP), and a reduced level of consciousness. The current standard management of IVH is insertion of an external ventricular drainage (EVD) catheter. However, this procedure addresses only the problems of acute hydrocephalus and raised ICP. Endoscopic washout allows for a more complete removal of the intraventricular clot. This study compared these two types of treatment in terms of shunt dependency and relevant clinical outcomes.
METHODS: Patients who were 10-80 years old and presented with a Graeb score of more than six were randomised into endoscopic washout and EVD treatment groups. A CT brain was repeated on each patient within 24 hours after surgery, and if a patient's Graeb score was still more than six, a repeat endoscopic washout was performed to clear the remaining clots. All patients were monitored for shunt dependency at two weeks and three months, and clinical outcomes were measured at six months after the procedure.
RESULTS: A total of 39 patients were recruited; 19 patients were randomised into the endoscopic washout group, and 20 were randomised into the EVD group. However, three patients in the endoscopic group refused that treatment and opted for EVD insertion. Patients treated with endoscopic washout had significantly less drainage dependency at two weeks (P < 0.005) and at three months (P < 0.004) as compared to patients in the external ventricular drainage group. The reduction in Graeb scores was also significantly greater in the endoscopic washout group (P < 0.001). However, the functional outcome at six months measured via a modified Rankin scale score was no different in the two groups of patients. The difference in the functional outcome of the patients was mainly dependent on the initial pathology, with those presenting with a thalamic bleed with IVH showing a poor functional outcome. This parameter was also influenced by the Glasgow Coma Scale (GCS) score on admission, with those patients with a score of 12 or less having a poor functional outcome (MRS 5-6) at three and six months after the surgery.
CONCLUSIONS: The use of neuroendoscopy in patients with a massive IVH significantly reduced drainage dependency. However, it did not alter the final functional outcome.

Matched MeSH terms: Neuroendoscopy
A new expandable cannula system for endoscopic evacuation of intraparenchymal hemorrhages

Waran V, Vairavan N, Sia SF, Abdullah B

J. Neurosurg., 2009 Dec;111(6):1127-30.
PMID: 19408977 DOI: 10.3171/2009.4.JNS081506

The authors describe a newly developed expandable cannula to enable a more efficient use of an endoscope in removing intraparenchymal spontaneous hypertensive intracerebral hematomas. The cannula is introduced like a conventional brain cannula, using neuronavigation techniques to reach the targeted hematoma accurately, and, once deployed, conventional microsurgical techniques are used under direct endoscopic visualization. This method was used in 6 patients, and, based on the results of intraoperative intracranial pressure monitoring and postoperative CT scanning, the authors were able to achieve good hematoma removal. They found that by using the expandable cannula, efficient endoscopic surgery in the brain parenchyma was possible.

Matched MeSH terms: Neuroendoscopy/methods*