1,721,066 research outputs found
Third Ventriculostomy and Fourth Ventricle Outlets Obstruction
No full textA dilated fourth ventricle due to outlet obstruction is a clinical-radiologic entity with symptoms similar to those of a posterior fossa space-occupying lesion. Indeed, blockage of the foramina of Luschka and Magendie and of the aqueduct results in a "trapped" fourth ventricle. Continued cerebrospinal fluid (CSF) production within the fourth ventricle leads to cystic dilatation of the fourth ventricle. We could not, until now, understand the phenomenon, mainly on exploring endoscopically the permeability of the whole aqueduct. In adults, we call this condition the functional trapped fourth ventricle because in none of our cases have we found physical obstruction of CSF flow. Third ventricle-fourth ventriculostomy is by far the most frequently used technique for cannulation of the aqueduct in a trapped fourth ventricle. In our reported cases, we have introduced a silicone tube stent from below after accessing the fourth ventricle through a small suboccipital craniectomy, ascending it on the aqueduct in order to reach the third ventricle. Management of this infrequently isolated fourth ventricle, but communicated with the rest of ventricular system, remains a challenge for neurosurgeons. Lack of knowledge of the pathophysiology makes it difficult to treat a problem that we do not understand
Letter to the Editor Regarding “Exposure of the Cavernous Sinus via the Endoscopic Transorbital and Endoscopic Endonasal Approaches: A Comparative Study”
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Three-Dimensional versus 2-Dimensional Endoscopic Third Ventriculostomy: Surgical Results of a Preliminary Comparative Study
No full textBackground: Three-dimensional (3-D) endoscopes have been widely used for a large variety of approaches in neurosurgical practice. However, in the last decade, 3-D scopes were barely used for ventricular surgery. In this study, we illustrated our preliminary experience with a 3-D endoscope for third ventriculostomy using new dedicated endoscopic equipment.
Methods: Over a 12-month period, a high-definition 3-D endoscopic third ventriculostomy (ETV) was performed in 14 patients with obstructive hydrocephalus. Patients were followed prospectively and compared retrospectively with a matched group of 16 similar patients who underwent ETV with a standard 2-dimensional (2-D) endoscope. Surgical outcome and intra- and postoperative course were retrospectively reviewed.
Results: 3-D ETV provided excellent surgical results, and no significant difference was shown in terms of outcome, complication, and length of hospitalization between the 2 groups. Moreover, operative time (minutes) was significantly shorter in the 3-D group than the 2-D ETV group (19.9 ± 4.8 vs. 22.9 ± 1.4, respectively; P < 0.05), and the use of the 3-D endoscope provided subjective improvements of depth perception, hand-eye coordination, and surgeon comfort.
Conclusions: Our preliminary study clearly demonstrated the effectiveness of 3-D ETV and provided a significant reduction of operative time. Depth information from the 3-D scope appears to facilitate rapid and stable ETV maneuvers, representing a critical development that may become a valuable tool for neuroendoscopy
From Vesalius to Modern Neuroanatomical Training: The “Surgical Grammar” for the Next Generation of Neurosurgeons in Italy
No full textAnatomical knowledge plays a crucial role in the field of neurosurgery, originating from the rigorous requirements of surgical training. The study examines the training programs for young and future generations of neurosurgeons, highlighting the significance of rigorous dissection program in the laboratory of anatomy along with the challenges they face. It also details the training paths of aspiring surgeons, focusing on the high demands and challenges encountered in the anatomy laboratory and in a real surgical scenario. A historical overview of anatomic training in Italy is provided, emphasizing the contributions of the Schola Medica Salernitana, one of the earliest medical schools in Europe. The article also traces the development of the Neuroanatomy section within the Italian Society of Neurosurgery, the first dedicated neuroanatomy section within European societies, illustrating its importance in advancing neurosurgical education and practice. In conclusion, neuroanatomy remains as the surgical grammar essential to the field of neurosurgery, offering a foundation for those on the path to expertise
Rerum magistra experientia est: The Evolution of Modern Endoscopic Endonasal Skull Base Surgery and Reconstruction Techniques
No full textRerum magistra experientia est: The Evolution of Modern Endoscopic Endonasal Skull Base Surgery and Reconstruction Techniques.
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