World Neurosurg
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Neurocysticercosis is the most common parasitosis of the central nervous system. Many forms, especially those inside the ventricles, carry a poor prognosis. Drug therapy is far from ideal. ⋯ Neurocysticercosis treatment remains challenging and multimodal. Endoscopes can be helpful in this setting.
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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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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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The goal of the present article was to describe our dissection training system applied to a variety of endoscopic endonasal approaches. It allows one to perform a 3D virtual dissection of the desired approach and to analyze and quantify critical surgical measurements. ⋯ The present model results are found to be effective, providing a valuable representation of the surgical anatomy as well as a 3D visual feedback, thus improving study, design, and execution in a variety of approaches. Such a system can also be developed as a preoperative planning tool that will allow the neurosurgeon to practice and manipulate 3D representations of the critical anatomic landmarks involved in the endoscopic endonasal approaches to the skull base.
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Review Case Reports
Third ventriculostomy in normal pressure hydrocephalus.
Endoscopic third ventriculostomy (ETV) has become established as the treatment of choice in cases of uncomplicated occlusive hydrocephalus, but the clinical indications are continually being challenged. The role of ETV in so-called communicating hydrocephalus is often discussed within the context of the ongoing debate on cerebrospinal fluid flow pathways and the disruption caused by varying pathological entities. The increasing number of published reports outlining the efficacy of ETV in noncommunicating or obstructive hydrocephalus, with comparatively low complication rates, has led to attempts by some in the neurosurgical community to redefine its role in patients with communicating hydrocephalus and in particular normal pressure hydrocephalus. A randomized matched cohort with similar inclusion/exclusion criteria and objective and independent multidisciplinary assessments of preoperative assessment and postoperative outcome would be required to define the role of ETV in this group of patients.