World Neurosurg
-
Review Historical Article
"Through the looking glass": optical physics, issues, and the evolution of neuroendoscopy.
Although the concept of endoscopy has existed for centuries, a practical, working neuroendoscopic system did not emerge until last century, as a result of numerous contributions and refinements in optical technology, illumination sources, and instrumentation. Modern neuroendoscopy would not be a flourishing field, as it is today, without the dedication, innovation, and implementation of emerging technology by key contributors including Maximilian Nitze, Walter Dandy, and Harold Hopkins. ⋯ In this review, the history of neuroendoscopy, key players who envisioned how the inner workings of the human body could be visualized "through the looking glass," and current state and future potential for neuroendoscopic surgery are discussed. Future directions of neuroendoscopic surgery will likely be guided by further miniaturization in camera and optical technology, innovations in surgical instrumentation design, the introduction of robotics, multi-port minimally invasive surgery, and an enhanced ability to perform bimanual microdissection.
-
Comparative Study
Direct percutaneous puncture approach versus surgical cutdown technique for intracranial neuroendovascular procedures: technical aspects.
To present the authors' experience with a direct transcervical or transbrachial puncture approach in neuroendovascular procedures in which cranial access via the commonly used percutaneous transfemoral route was impossible because of tortuous upstream angioarchitecture. ⋯ Transcervical or transbrachial direct puncture accomplished with PP or by SCD is an effective and safe access route in patients in whom neuroendovascular interventions cannot be done transfemorally. In cases where extensive perioperative anticoagulation is mandatory, bleeding at the puncture site may be a serious problem and can be controlled more effectively through an open surgical approach than by percutaneous maneuvers.
-
Symptomatic chronic subdural hematoma (scSDH) is one of the most frequent diseases in neurosurgical practice, and its incidence is increasing. However, treatment modalities are still controversial. ⋯ Our study shows for the first time a direct comparison of two mainly used surgical techniques in the treatment of scSDH. Both methods proved to be highly effective, and general patient data, complications, outcome and mortality of both groups are equal or superior compared with previously published series. Because there is a clear tendency to less mortality and fewer serious complications, treatment with double burr-hole trepanation, irrigation, and placement of subperiosteal drainage is our treatment of choice in patients with predictable high risk of complications.
-
Treatment of ruptured internal carotid artery anterior wall (ICAW) aneurysms presents a surgical challenge because limitations and difficulties are encountered with either clipping or endovascular treatment. The present study examined clinical outcomes after aneurysmal trapping followed by radial artery grafting for management of these difficult lesions. ⋯ The long-term result was satisfactory, but there was a high rate of acute stage ischemic complications due to delayed vasospasm and low perfusion from the radial artery graft. Based on these results, the investigators recommend that, in addition to intraoperative anticoagulation therapy, in cases where the cerebral blood flow study in the early postoperative period indicates low cerebral perfusion or in cases with World Federation of Neurological Societies grade III-V, the patients should be placed under the highest level of intensive care to detect ischemic complications.
-
Tanzania suffers from a severe lack of health practitioners trained in neurosurgical procedures. To address this problem, we have implemented an initiative, modeled after the experience of other pioneers in international neurosurgery, to establish cost-effective and sustainable neurosurgical care by teaching fundamental neurosurgical skills to local surgeons. In this report we describe our early experience in Northwest Tanzania and discuss the potential for this training model to improve neurosurgical care to a region in need. ⋯ Although numerous challenges remain, our experience demonstrates the potential of this teaching model in providing sustainable neurosurgical care in Northwest Tanzania.