Fetal Endoscopic Third Ventriculostomy Is Technically Feasible in Prenatally Induced Hydrocephalus Ovine Model.

BACKGROUND: Congenital obstructive hydrocephalus generates progressive irreversible fetal brain damage by ventricular enlargement and incremental brain tissue compression that leads to maldevelopment and poor clinical outcomes. Intrauterine treatments such as ventriculo-amniotic shunting have been unsuccessfully tried in the eighties. OBJECTIVE: To assess if prenatal endoscopic third ventriculostomy (ETV) is feasible in a large animal model and optimize this technique for ventricular decompression and potential arrest of fetal brain damage in fetal lambs. METHODS: We generated hydrocephalus in 50 fetal lambs by injecting a polymeric agent into the cisterna magna at midgestation (E85). Subsequently, 3 weeks later (E105), fetal ETV was performed using a small rigid fetoscope. The endoscopy entry point was located anterior to the coronal suture, 7 mm from the midline. RESULTS: We obtained clear visualization of the enlarged lateral ventricles by endoscopy in the hydrocephalic fetal lambs. The floor of the third ventricle was bluntly perforated and passed with the scope for a successful ETV. Total success was achieved in 32/50 cases (64%). Causes of failure were blurred vision or third ventricle obliteration by BioGlue in 10/50 (20%) cases, anatomic misdirection of the endoscope in 5 (10%) cases, 2 cases of very narrow foramen of Monro, and 1 case of choroid plexus bleeding. If we exclude the cases artificially blocked by the polymer, we had a successful performance of prenatal-ETV in 80% (32/40) of hydrocephalic fetuses. CONCLUSION: Despite the inherent difficulties arising from ovine brain anatomy, this study shows that innovative fetal ETV is technically feasible in hydrocephalic fetal lambs.

Operative techniques of percutaneous endoscopic mini-hemilaminectomy using a uniportal approach in dogs.

The present study aimed to investigate the technical feasibility of percutaneous endoscopic mini-hemilaminectomy via a uniportal approach, and to evaluate the possibility of decompression and endoscopic examination of the thoracic and lumbar spinal canals in small dogs during such procedures. Fresh canine cadavers of mixed-breed dogs (n=7) were used in this study. Following injection of a barium and agarose mixture (BA-gel) to stimulate intervertebral disc herniation, percutaneous endoscopic mini-hemilaminectomy was performed using a lateral approach to the thoracic and lumbar vertebrae. BA-gel was removed to decompress the spinal cord using an elevator and rongeurs after mini-hemilaminectomy. Pre and post-operative computed tomography (CT) scans were obtained to evaluate surgical outcomes. Intra-operative complications, incision length, and procedure time were recorded. All procedures were completed with clear visualization of the spinal cord and floor of the spinal canal. The mean total operating time was 58.00 ± 18.06 min. Lengths of incision were under 1 cm in all dogs. Intra-operative complications included iatrogenic nerve root injuries caused by the micro-rongeur in two dogs. CT imaging revealed that removal of BA-gel resulted in sufficient spinal cord decompression. Our findings indicated that percutaneous endoscopic thoracolumbar mini-hemilaminectomy is feasible for spinal cord decompression and allows for adequate observation of the spinal canal. Thus, this technique may be an alternative surgical option for treatment of thoracolumbar disk disease in dogs.

A review of neuroendoscopy and potential applications in veterinary medicine.

The endoscope was first developed over 200 yr ago. Endoscopy has since been applied to many disciplines of medicine. Its application to the nervous system was initially slow and not widely accepted and mainly involved the biopsy of tumors and the treatment of hydrocephalus. Several reasons for neuroendoscopy's limited use include inadequate endoscope technology, high skill level required, the advent of the surgical microscope, and the development of other treatments such as ventricular shunting. Over the past 50 yr, improvements in optical glass lenses, fiber optics, and electrical circuitry has led to better equipment and a revival of neuroendoscopy. Neuroendoscopy is now used in many diseases in human medicine including hydrocephalus, neoplasia, and intracranial cysts. This review presents the history of neuroendoscopy, the equipment and technology used, and the possible translation of techniques currently used in human medicine to veterinary medicine.

Use of an endoscope in minimally invasive lesion biopsy and removal within the skull and cranial vault in two dogs and one cat.

CASE DESCRIPTION- 2 dogs and 1 cat underwent endoscopic-assisted intracranial procedures for lesion biopsy (1 dog and 1 cat) and definitive lesion removal (1 dog). CLINICAL FINDINGS- 1 cat was treated for an interhemispheric, pedunculated meningioma with an associated arachnoid cyst. Two dogs underwent endoscopic surgery procedures; 1 dog underwent removal of an intranasal dermoid cyst with extension to the olfactory bulb dura, and the other underwent lesion biopsy for histologic confirmation of suspected intracranial granular cell tumor. TREATMENT AND OUTCOME- Minimally invasive intracranial procedures were achieved by use of an endoscope to aid in lesion biopsy in a dog and a cat with neoplasia and complete lesion removal in 1 dog with a dermoid cyst. No obvious morbidity from the use of the endoscope was observed. Rapid recovery from surgery was seen in all 3 animals, and hospitalization times were a few days. CLINICAL RELEVANCE- In human and veterinary neurosurgery, minimally invasive surgical approaches for diagnosis and treatment are gaining in popularity. Minimally invasive techniques are used to achieve a decrease in surgical time, minimize brain exposure, and decrease postoperative recovery times. Keyhole and minimally invasive approaches require some degree of dexterity and knowledge of where the endoscope is in a 3-dimensional orientation and its relationship to the topography of an anatomic region. Anticipation of complications should allow for potential conversion to an open craniotomy. Use of the endoscope in minimally invasive procedures is associated with a steep learning curve to understand orientation, topography, and normal versus abnormal anatomy.