World Neurosurg
-
The aim of this report is to review current data on the role of neuroendoscopy in infants. Specific emphasis will be given to the International Infant Hydrocephalus Study (IIHS). Previous studies, available information, and future directions are discussed. ⋯ Neuroendoscopy in infants can be performed with reasonable morbidity. The preferred indications in infants are still not totally refined, especially vis-a-vis shunting procedures. More international, multicenter efforts are required to clarify these points.
-
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.
-
Improvements in preoperative diagnostic imaging as well as in microsurgical techniques significantly advanced the development of transcranial neurosurgery, allowing the treatment of complicated diseases through smaller and more specific approaches. ⋯ In all cases, meticulous preoperative planning was done for determining the site, size, and optimal placement of the craniotomy as well as the trajectory toward the surgical target. Most importantly, the surgical approach was performed either completely or at least under permanent presence of the responsible senior surgeon from the moment of patient positioning until wound closure. The minimally invasive keyhole approaches allowed safe intraoperative control and adequate dealing with intracranial lesions. Essential preconditions for keyhole surgery were 1) careful selection of cases, 2) accurate preoperative planning, 3) placement of the craniotomy tailored to the individual case, and 4) intraoperative use of transcranial endoscope-assisted microsurgery techniques. Advantages of intraoperative endoscopic visualization were increased light intensity, extended viewing angle, and clear depiction of details even in hidden parts of the surgical field.
-
Spinal synovial cysts are a known cause of back pain and radiculopathy. With the advent of high-resolution imaging techniques, synovial cysts are increasingly diagnosed. There are a variety of treatment options for these lesions. ⋯ Based on review of the treatment modalities and outcomes, recommendations for the management of patients with synovial cysts are proposed. Observation can be considered in cases where there is no intractable pain. High-risk surgical patients with intractable pain may consider corticosteroid injection or percutaneous cyst aspiration; however, the failure rate of such a procedure approaches 50%. Patients with intractable pain are candidates for surgical resection of the symptomatic cyst. In cases of significant neurologic deficit, motor weakness, back pain, multiple synovial cysts, or spondylolisthesis, bilateral laminectomy and instrumented fusion may offer the best long-term outcome.
-
Advances in neuroendoscopy have accommodated the development of intraventricular techniques that enhance the management of multiple disease processes. Tumors of the pineal region are amenable to endoscopic management in that they are accessible through the third ventricle and commonly cause hydrocephalus that can be alleviated by endoscopic third ventriculostomy (ETV). We describe the indications for and procedure of simultaneous ETV and biopsy of pineal region tumors, as well as the clinical features favoring different approaches to this procedure. ⋯ Simultaneous ETV and tumor biopsy is a valuable technique that can be used to manage hydrocephalus and establish diagnosis in patients with newly diagnosed pineal region tumors, potentially avoiding traditional craniotomy and ventriculoperitoneal shunt placement. It is favored as an early step in the management of patients with marker-negative tumors.