1,721,005 research outputs found
A restricted neuroendoscopic approach for pathological diagnosis ofintraventricular and paraventricular tumours.
No full textAbstract
BACKGROUND:
There is increasing interest in the use of neuroendoscopic techniques in neuro-oncology. We report our experience of endoscopic biopsy in patients harbouring intraventricular and paraventricular brain tumours in order to define criteria for the use of this technique.
METHODS:
We identified 23 patients (aged 7-78 years) who underwent endoscopic biopsy for intraventricular or paraventricular lesions considered not suitable for surgical removal and too risky for a stereotactical approach. All of the biopsies were obtained with a flexible endoscope using a free-hand technique.
FINDINGS:
In 16 patients specimens were adequate and led to a diagnosis; in three patients they were informative but not completely diagnostic; a pathological diagnosis was unavailable in four patients. In 13 patients with a lesion causing an obstruction of the aqueduct, a third ventriculostomy was performed during the same procedure; in one patient with a lesion occluding the Monro foramen, a septostomy was done, while in another case multiple cystostomies were required. No specific complications were observed, either clinically or radiologically, in particular no major bleeding occurred.
CONCLUSIONS:
In our experience, endoscopic biopsy could provide a pathological diagnosis in 19 of 23 patients. Endoscopic biopsy sampling sufficient tissue should be considered as the first choice in selected lesions that are otherwise difficult to approach
Neuroendoscopic aspiration of hematocephalus totalis: technical note
No full textAbstract
OBJECTIVE AND IMPORTANCE:
Massive intraventricular hemorrhage requires aggressive and rapid management to decrease intracranial hypertension. The amount of intraventricular blood is a strong prognostic predictor, and its fast removal is a priority. Neuroendoscopy may offer some advantages over more traditional surgical approaches. We describe here the technical details and clinical outcomes of the neuroendoscopic management of massive tetraventricular hemorrhage in 25 consecutive patients, highlighting the potential pitfalls and the advantages of the technique.
CLINICAL PRESENTATION:
Twenty-five patients, aged 7 to 80 years, presenting with massive ventricular hemorrhage were admitted between January 1996 and May 2004 to our neurosurgery unit after an emergency computed tomographic scan. Severity of ventricular hemorrhage was graded according to the Graeb scale; the mean Graeb score was 9.8 +/- 2.9. Hemorrhages were secondary to vascular malformation in 12 cases.
INTERVENTION:
Endoscopy was performed on the first day in 17 cases, with a delay of 1 to 5 days in the remaining 8 cases. A flexible endoscope with "free-hand" technique was always preferred. The ventricular cleaning proceeded in three phases: lateral ventricle, third ventricle, and then aqueduct and fourth ventricle. In selected patients, a catheter, both for intracranial pressure monitoring and for drainage, was positioned. The procedure was successfully completed in all cases. There was no surgery-related mortality. The mean length of intensive care unit stay after the operation was 18 +/- 12 days. Short-term mortality (1 mo) was 12%, whereas long-term (> 6 mo) mortality was 24%. Complete recovery (Glasgow Outcome Scale score, 5) was achieved in 40% of cases. A ventriculoperitoneal shunt was necessary in 12% of patients.
CONCLUSION:
Intraventricular hemorrhage, analogously to other ventricular diseases, can be treated successfully with flexible endoscopes. Obviously, the limitation of this study lies in its observational nature; however, the encouraging results reported here should prompt a randomized study to evaluate the effectiveness and efficiency of the endoscopic approach in comparison to the more established semiconservative management offered by external derivation with fibrinolytic agents
Failure of endoscopic third ventriculostomy in the treatment of idiopathic normal pressure hydrocephalus
No full textEven though the main indication for neuroendoscopic management of normal pressure hydrocephalus (NPH) is the presence of an aqueductal block, recent reports suggest the possible efficacy of endoscopic third ventriculostomy (ETVS) in idiopathic NPH. We present 14 cases with apparently idiopathic NPH treated by ETVS, and report on the low rate of success (21 %). A closer analysis of the successful cases reveals possible elements which may explain the good outcome, and should be taken into consideration when defining the best strategy to address NPH
Endoscopic anatomy of the fourth ventricle - Laboratory investigation
No full textOBJECT: Microsurgical anatomy of the fourth ventricle has been comprehensively addressed by masterly reports providing classic descriptions of this complex region. Neuroendoscopy could offer a new, somewhat different perspective of the "inside" view of the fourth ventricle. The purpose of this study was to examine from the anatomical point of view the access to the fourth ventricle achieved by the endoscopic transaqueductal approach, to enumerate and describe the anatomically identifiable landmarks, and to compare them with those described during microsurgery.
METHODS: The video recordings of 52 of 75 endoscopic explorations of the fourth ventricle performed at the authors' institution for different pathological conditions were reviewed and evaluated to identify and describe every anatomical landmark. According to the microsurgical anatomy, at least 23 superficial structures are clearly identifiable in the fourth ventricle, and they represent the comparative basis of parallel endoscopic anatomy of the structures found during the fourth ventricle navigation.
RESULTS: The following anatomical structures were identified in all cases: median sulcus, superior and inferior vela medullare, choroid plexus, inferior fovea, hypoglossal and vagal triangles, area postrema, obex, canalis medullaris, lateral recess, and the foramina of Luschka and Magendie. The median eminence, facial colliculus, striae medullaris, auditory tubercle, and inferior fovea were seen in the majority of cases. The locus caevruleus could never be seen.
CONCLUSIONS: On the whole, 20 anatomical structures could consistently be identified by exploring the fourth ventricle with a fiberscope. Neuroendoscopy offers a quite different outlook on the anatomy of the fourth ventricle, and compared with the microsurgical descriptions it seems to provide a superior and detailed visualization, particularly of the structures located in the inferior triangle
Neuroendoscopic aspiration of tumors in the posterior third ventricle and aqueduct lumen: a technical update
No full textEndoscopic navigation of the fourth ventricle. Technical note and preliminary experience
No full textTransaqueductal navigation of the fourth ventricle has long been considered dangerous and of no clinical relevance. After the refinement of the endoscopic technique and supported by the extensive experience gained at the authors' institution since 1994, endoscopic exploration of the fourth ventricle has been performed by the same surgeon in 54 patients. In all cases reviewed, endoscopic navigation of the fourth ventricle was successfully performed with no related neurological deficit. This preliminary experience shows the feasibility of transaqueductal navigation of the fourth ventricle, which is made possible by the use of small, flexible endoscopes in expert hands
Neuroendoscopic management of intraventricular hemorrhage
No full textBACKGROUND AND PURPOSE:
We reviewed our 7-year experience in neuroendoscopic management of severe intraventricular hemorrhage (IVH) to evaluate its safety, efficiency, and efficacy.
METHODS:
Thirteen patients with spontaneous primary or secondary tetraventricular IVH underwent neuroendoscopy. In all procedures, we used a flexible instrument. CT scans obtained before and after surgery were compared for Graeb score and ventriculocranial ratio. Glasgow Outcome Scale was assessed at 12 months.
RESULTS:
In all patients, the procedure resulted in a substantial removal of ventricular blood. Graeb score was reduced by 65%, and ventriculocranial ratio was reduced by 30% (P<0.002). The procedure was carried out safely even in the presence of a vascular malformation, and no rebleeding or delayed hydrocephalus was observed in any case. Mortality at 12 months was 30.7%. Favorable outcome (Glasgow Outcome Scale, 3 to 5) was observed in 61.5% of cases.
CONCLUSIONS:
Neuroendoscopic management of severe IVH in this cohort of patients was safe, efficiently reduced the amount of ventricular blood and ventricular dilatation, and effectively produced an outcome profile that compares very favorably with other more conventional treatments
Primary obstruction of the fourth ventricle outlets : neuroendoscopic approach and anatomic description
No full textAbstract
OBJECTIVE:
Primary obstruction of the foramina of Magendie and Luschka is an uncommon and still unclear cause of noncommunicating hydrocephalus. The aim of this work is the description, for the first time, of the inner aspect of these velar obstructions of the fourth ventricle outlets and the demonstration of the efficacy of neuroendoscopic treatment.
METHODS:
Of 240 hydrocephalic patients treated in our institution with endoscopic third ventriculostomy, a subgroup of 10 cases with closure of the fourth ventricular outlets without associated Chiari malformation and syringomyelia was selected. In all of these cases, a transaqueductal endoscopic navigation of the fourth ventricle was performed, and the obstructed outlets were inspected. All of the clinical data and, in particular, the videotape records of endoscopic operations, as well as the cine-magnetic resonance imaging scans, were reviewed to evaluate their patency status.
RESULTS:
Various degrees of stenosis were found endoscopically: restriction of the Magendie contour with thick and opaque membrane, transparent spider web-like membrane, and dense membrane with fissures acting as valves. Endoscopic third ventriculostomy was effective in almost all patients, although we noticed an unforeseen high incidence of closure of the stoma. The restored normal cerebrospinal fluid flux after ventriculocisternostomy and magendieplasty was demonstrated by comparative study of cerebrospinal fluid flow measurements by cine-magnetic resonance imaging.
CONCLUSION:
This report demonstrates the effectiveness of neuroendoscopic third ventriculostomy as well as magendiestomy in cases of tetraventricular hydrocephalus attributable to primary obstruction of the outlets of the fourth ventricle and, for the first time, presents direct images of various types of outlet obstructive pathology
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