World Neurosurg
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Previously considered the domain of the otolaryngologists, the endoscopy is now a common part of the armamentarium of a neurosurgeon. Neuroendoscopy or endoscope-assisted microsurgery is now being used in almost all routine procedures performed in the neurosurgical operating room. Hands-on training has become essential to learn the basics of neuroendoscopy, even for neurosurgeons well accustomed to the use of microscopes. ⋯ In this "tech-savvy era," various cadaver or synthetic models are readily available for endoscopy training in a virtually simulated environment. In accord with the results of a surveys conducted by individual groups and societies, the authors firmly believe that incorporation of endoscopy in the neurosurgical curriculum would add a new dimension to the existing protocol. There is an urgent need for dedicated endoscopy training programs similar to postresidency fellowships in addition to translational research and establishment of dedicated societies to formulate guidelines for such research and monitor its progress.
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The technology and instrumentation for neuroendoscopy are described: endoscopes (principles, designs, applications), light sources, instruments, accessories, holders, and navigation. Procedures for cleaning, sterilizing, and storing are included. ⋯ Neuroendoscopic instrumentation is now an established technique in neurosurgical practice and is experiencing rapid development (stereoscopy, integrated operating room).
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Review Historical Article
Neuroendoscopy: general aspects and principles.
When used in medicine, endoscopy describes a procedure used to see inside various parts of the body, such as the interior surfaces of an organ, by inserting a tube through a natural or created orifice. The instrument may have a rigid (borescope) or flexible (fiberscope) tube; it provides an image for visual inspection, photography and video-endoscopy and enables acquisition of biopsy specimens, removal of lesions, and retrieval of foreign objects. It is imperative that young neurosurgeons and residents become familiar and comfortable with endoscopic techniques, and it is hoped that they can contribute to the evolution and development of these surgical methods.
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The purpose of this review is to describe the magnetic resonance imaging (MRI) findings in patients with noncommunicating hydrocephalus (NCH). ⋯ The first step of the diagnostic work-up consists of the detection of an obstacle hindering CSF flow pathways using both constructive interference in steady state and flow-sensitive MR sequences. CSF volumetry and quantification of ventricular wall movement may also improve the diagnosis and follow-up of patients with NCH.
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Endoscopic third ventriculostomy (ETV) is the treatment of choice for noncommunicating hydrocephalus. In the last decade, its routine use also has taken place in patients who have previously undergone shunt placement (secondary ETV). ⋯ Shunt infection should not be considered a contraindication to ETV, even if the success rate may be lower. Considering the higher complication rate and higher risk of intraoperative failure, secondary ETV should be performed by expert neuroendoscopists.