World Neurosurg
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The treatment of choice for several types of obstructive hydrocephalus is endoscopic third ventriculostomy (ETV). However, in certain cases ETV is not clearly superior to shunt placement, and a question of choice arises. Apart from the possibility of success in each case, knowledge of complication rates is of major importance as well. ⋯ The complication rate of ETV is low, and rarely is a reason for choosing shunt placement instead. However, as a method it requires considerable experience, and several studies report a relation of experience not only with success rates but also with complication avoidance.
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Review Case Reports
Endoneurosurgical resection of intraventricular and intraparenchymal lesions using the port technique.
Deep-seated intraventricular and intraparenchymal lesions have traditionally been resected via transcortical routes, often requiring the use of retractors to maintain the corridor created to reach the lesion and proceed with a bimanual microsurgical resection. A transparent cylindrical conduit (port) has been developed to resect deep-seated lesions using the endoscope or, more recently, Video Telescopic Operating Microscopy (VTOM) for visualization. We describe the surgical technique of the port technique and discuss the evolution of the concept of intraaxial brain surgery performed through a conduit. ⋯ The port technique is an option for resection of intraventricular and intraparenchymal lesions. Additional studies are required to assess its impact on adjacent cerebral tissue morphology, blood flow, and metabolism. Quality-of-life assessments are also needed. High-definition fiber tracking, new visualization techniques (VTOM), and new instrumentation will add to the progress of endoscopic port surgery. We have already seen a significant evolution of the technology even since the preparation of this article.
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This paper discusses indications for and the technique of endoscopic aqueductoplasty with stenting. ⋯ Aqueductoplasty with stenting is the procedure of choice for the treatment of isolated fourth ventricle. Membranous and tumor-related aqueductal stenosis should be treated by endoscopic third ventriculostomy.
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To describe the neuroendoscopic technique to deal with intraventricular tumors. ⋯ Intraventricular tumors and related CSF pathway obstructions can be safely and effectively treated with endoscopic techniques. Small tumors may be totally removed via a ventriculoscope.
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Motor palsy is a serious complication that can result from cervical surgery. We introduced cases of motor palsy after posterior cervical foraminotomy (PCF) and consider cervical anatomy. ⋯ Although PCF is a good alternative treatment with minimal morbidity for cervical radiculopathy, surgeons should keep in mind the possibility of motor palsy, especially at C4-5.