Experience of Endoscopic Endonasal Approach for 803 Pituitary Tumors With Cavernous Sinus Invasion.

OBJECTIVE: The aim of this study was to investigate the effectiveness, safety, complications, and prognosis of endoscopic endonasal surgery for pituitary adenomas with cavernous sinus invasion (CSI). METHODS: The clinical data of 803 pituitary adenomas with CSI surgeries performed in our single ward between January 1, 2006 and December 31, 2018 were retrospectively reviewed. The resection degree, bone invasion, endocrine examination, complications, and outcome were retrospectively summarized. RESULTS: Gross total resection was achieved in 394 patients (49.1%) subtotal resection in 171 patients (21.3%) and partial resection in 238 patients (29.6%). Clinically variable analyses showed that there was a significant correlation between CSI and female, older age, operation history, and non-gross total resection (NGTR). Among the pituitary adenomas with CSI, there was a significant correlation between bone invasive and NGTR, Knosp classification, recurrence. K-M curves showed that young age, larger tumors, bilateral invasion, Grade 4 of Knosp classification, NGTR, and bone invasion were associated with pituitary adenomas regrowth. Multivariate analysis revealed that bone invasion, NGTR, and Grade 4 of Knosp classification were independent risk factors for pituitary adenomas regrowth. There was a significant correlation between CSI and female, older age, operation history, and tumor resection degree. CONCLUSIONS: There was a significant correlation between CSI and female, older age, operation history, and tumor resection degree. The patients with CSI and bone invasion were likely to recurrent. Non-gross total resection, bone invasion, and Grade 4 of Knosp classification were independent risk factors for pituitary adenomas regrowth. Endoscopic endonasal surgery is an excellent choice for pituitary adenomas with CSI.

Application of endoscopic third ventriculostomy for treating hydrocephalus-correlated Chiari type I malformation in a single Chinese neurosurgery centre.

The correlation between hydrocephalus and Chiari type I malformation (CIM) has been debated since Chiari's first descriptions of CIM but some studies have shown that CIM and hydrocephalus (HCP) could cause symptoms/disease of each other or vice versa. Recent research has found that treatment focused on hydrocephalus with ventricle enlargement also provides alleviation of CIM and even of syringomyelia. However, the lack of consensus among previous studies left unanswered the question of how endoscopic third ventriculostomy (ETV) addresses CIM and why it fails. Ten symptomatic hydrocephalic patients associated with CIM underwent ETV from October 2002 to May 2012. The clinical features and neuroimaging of all patients were reviewed. Statistical analysis was applied to evaluate the changes in the tonsillar ectopia and the ventricle dilation after operation. The mean follow-up period of this series was 92 months (range 24-163 months). Eight patients (80%) remained shunt free or experienced symptom relief following ETV. The remaining two patients were identified as failures due to the deterioration of symptoms or subsequent hindbrain decompression. Endoscopic third ventriculostomy provides an effective treatment for hydrocephalus associated with CIM, which can relieve HCP and improve the symptoms of CIM in most patients. The clinical outcomes are related to the major cause of the tonsillar herniation.

Assessment of endoscopic treatment for quadrigeminal cistern arachnoid cysts: A 7-year experience with 28 cases.

BACKGROUND: Quadrigeminal cistern arachnoid cysts (QACs) are difficult to treat because of their deep location and the presence of nervous and vascular structures of the pineal-quadrigeminal region. There are several surgical procedures available for QACs, including craniotomy and cyst excision or fenestration, ventriculoperitoneal or cystoperitoneal shunting, and endoscopic fenestration. There is a debate about which method is the best. OBJECTIVE: The aim of this study is to evaluate the effectiveness and safety of endoscopic ventriculocystostomy (VC) and third ventriculostomy (ETV) for treatment of arachnoid cysts of the quadrigeminal cistern. METHODS: Twenty-eight patients with QACs who had undergone endoscopic treatment in our department between August 2007 and June 2014 were studied retrospectively. Patient age at the time of endoscopic treatment ranged from 5 months to 42 years, including 25 children (14 males and 11 females) and 3 adults (one male and two females). All patients presented with hydrocephalus and did not undergo shunting prior to neuroendoscopic surgery. The first endoscopic procedures included lateral ventricle cystostomy (LVC) together with ETV in 18 cases, third ventricle cystostomy (3rd VC) together with ETV in 3 cases, and double VC (3rd VC and LVC) together with ETV in 7 cases. Data were obtained on clinical and neuroradiological presentation, indications to treat, surgical technique, complications, and the results of clinical and neuroradiological follow-up. RESULTS: Complete success was achieved in 25 (89.3 %) of 28 cases. During the follow-up period, one case underwent endoscopic reoperation with success. Shunts were implanted in 2 patients due to progression of symptoms and increase in hydrocephalus after the first endoscopic operation. Shunt independency was achieved in 26 (92.9 %) of 28 cases. The cyst was reduced in size in 22 cases (78.6 %). Postoperative images showed a reduction in the size of the ventricles in 23 cases (82.1 %). There was no surgical mortality. Subdural collection developed in 4 cases (14.3 %) and required a transient subduroperitoneal shunt in 2 cases, whereas the other 2 patients were asymptomatic and did not require any surgical treatment. CONCLUSIONS: VC together with ETV through precoronal approach is an effective treatment for symptomatic QACs and should be the initial surgical procedure. The surgical indications should include signs of elevated ICP (including increased head circumference), Parinaud syndrome, gait ataxia, and nystagmus. Also, surgery is indicated by progressive enlargement of the cyst and young children with large cysts even if the patients are asymptomatic. Contraindications to surgery include the absence of symptoms (older children and adult) and isolated developmental delay. The main criterion for successful surgery should be improvement of clinical symptoms instead of reduced cyst volume and/or ventricular size. Repeated endoscopic procedures may be considered only for the patients whose symptoms improved after first endoscopic operation.

Classification and surgical approaches for transnasal endoscopic skull base chordoma resection: a 6-year experience with 161 cases.

The aim of this study is to retrospectively analyze 161 cases of surgically treated skull base chordoma, so as to summarize the clinical classification of this tumor and the surgical approaches for its treatment via transnasal endoscopic surgery. Between August 2007 and October 2013, a total of 161 patients (92 males and 69 females) undergoing surgical treatment of skull base chordoma were evaluated with regard to the clinical classification, surgical approach, and surgical efficacy. The tumor was located in the midline region of the skull base in 134 cases, and in the midline and paramedian regions in 27 cases (extensive type). Resection was performed via the transnasal endoscopic approach in 124 cases (77%), via the open cranial base approach in 11 cases (6.8%), and via staged resection combined with the transnasal endoscopic approach and open cranial base approach in 26 cases (16.2%). Total resection was achieved in 38 cases (23.6%); subtotal resection, 86 cases (53.4%); partial resection of 80-95%, 29 cases (18%); and partial resection <80%, 8 cases (5%). The clinical classification method used in this study seems suitable for selection of transnasal endoscopic surgical approach which may improve the resection degree and surgical efficacy of skull base chordoma. Gross total resection of skull base chordoma via endoscopic endonasal surgery (with addition of an open approach as needed) is a safe and viable alternative to the traditional open approach.

[Combined surgical and endovascular treatments of complex cerebral arteriovenous malformation in hybrid operating room].

OBJECTIVE: To summarize the clinical experiences of microsurgical and endovascular treatments of complicated arteriovenous malformation (AVM) in the conditions of hybrid operating room. METHODS: The clinical data were collected and analyzed for 8 patients of complex AVM between June 2012 to June 2013. There were Spetzler grade III (n = 2) and grade IV (n = 6). And the lesions were complicated with intracranial aneurysms (n = 3) and located in motor area (n = 2) and basal ganglia (n = 2). Five cases of AVM with cerebral hemorrhage underwent emergency surgery, including digital subtraction angiography (DSA) plus intraoperative embolization plus surgical resection of AVM plus intraoperative DSA (iDSA). Two cases underwent embolization plus aneurysm surgery while another had AVM embolization plus AVM resection and γ knife treatment. RESULTS: All surgical procedures, including iDSA, were completed in the same hybrid operating room. There was no change of surgical position or intraoperative mortality. Five patients of AVM hemorrhage undergoing emergency hematoma evacuation had no residue of AVM on iDSA. Their postoperative consciousness improved without neurological dysfunction. Two patients of limb paralysis recovered to paresis at 3 months postoperation. One case with blurry vision improved somewhat. Two cases undergoing elective surgery had a complete resection of AVM after embolization. CONCLUSION: Surgery plus endovascular treatment in hybrid operating room is efficacious for complex cerebral AVM. It avoids multiple surgeries and inspections. And any lesion residue may be assessed immediately with postoperative DSA.

The effectiveness of neuroendoscopic versus non-neuroendoscopic procedures in the treatment of lateral ventricular cysts: a retrospective medical record review study.

BACKGROUND: The aim of this study was to assess the effectiveness of neuroendoscopy compared with non-neuroendoscopic procedures for treating patients with arachnoid membrane cysts in the lateral ventricles. METHODS: The medical records of 28 patients with arachnoid membrane cysts in the lateral ventricles who were treated with neuroendoscopy and 39 such patients treated with non-neuroendoscopic techniques using classic treatment procedures were reviewed. The neuroendoscopic approach combined craniotomy, corticectomy, lesion resection and cyst ventriculostomy or cyst cisternostomy to restore normal cerebrospinal fluid circulation. The non-neuroendoscopic techniques included craniotomy, corticectomy, and lesion resection performed under a microscope. Clinical outcomes of symptoms and cyst size change on imaging were compared between the two treatment groups during follow-up (range: 1-5 years). RESULTS: Patients in the neuroendoscopy group had significantly less blood loss (P < 0.001) and shorter operative time (P < 0.001), better marked improvement in symptoms (64.3% vs. 5.1%, respectively), and a higher total resection rate (92.9% vs. 66.7%; P = 0.011) compared with the patients in the non-neuroendoscopy group. In the neuroendoscopy group there was no cyst recurrence whereas in the non-neuroendoscopy group 8 (20.5%) patients had cyst recurrence. However, all patients in the neuroendoscopy group had postoperative transient fever and 8 (28.6%) patients had subdural fluid accumulation which was treated and subsequently resolved during follow-up. These symptoms did not occur in the non-neuroendoscopy group. CONCLUSION: We found that neuroendoscopic therapy for arachnoid cysts in the lateral ventricles was more efficacious than non-neuroendoscopic methods. Our results indicate that neuroendoscopy may produce better clinical outcomes than non-neuroendoscopic procedures in treating patients with arachnoid cysts in the lateral ventricles.

Endoscopic treatment of convexity arachnoid cysts.

OBJECTIVE: The aim of this study was to investigate the endoscopic treatment of cerebral hemisphere convexity arachnoid cyst. METHODS: Eight cases of hemisphere convexity arachnoid cyst treated with cyst-ventricular or cisternal endoscopic approach in September 2007 to March 2011 were retrospectively recruited. The clinical symptoms, radiological findings, surgical indications, surgical approach, complications, and follow-up studies were analyzed. RESULTS: All patients showed convexity arachnoid cysts adjacent to the ventricles or cisternal. After treatment, all patients showed decrease in size of the cysts (100 %), with preoperative symptoms disappeared in six patients and improved in two cases. In one case, postoperative subdural effusion was found without symptoms reported. CONCLUSION: Endoscopic surgery is ideal for treatment of arachnoid cysts adjacent to the ventricles or cisternal.

Suprasellar cysts: clinical presentation, surgical indications, and optimal surgical treatment.

BACKGROUND: To describe the clinical presentation of suprasellar cysts (SSCs) and surgical indications, and compare the treatment methods of endoscopic ventriculocystostomy (VC) and ventriculocystocisternotomy (VCC). METHODS: We retrospectively reviewed the records of 73 consecutive patients with SSC who were treated between June 2002 and September 2009. Twenty-two patients were treated with VC and 51 with VCC. Outcome was assessed by clinical examination and magnetic resonance imaging. RESULTS: The patients were divided into five groups based on age at presentation: age less than 1 year (n = 6), 1-5 years (n = 36), 6-10 years (n = 15), 11-20 years (n = 11), and 21-53 years (n = 5). The main clinical presentations were macrocrania (100%), motor deficits (50%), and gaze disturbance (33.3%) in the age less than 1 year group; macrocrania (75%), motor deficits (63.9%), and gaze disturbance (27.8%) in the 1-5 years group; macrocrania (46.7%), symptoms of raised intracranial pressure (ICP) (40.0%), endocrine dysfunction (40%), and seizures (33.3%) in the 6-10 years group; symptoms of raised ICP (54.5%), endocrine dysfunction (54.5%), and reduced visual field or acuity (36.4%) in the 11-20 years group; and symptoms of raised ICP (80.0%) and reduced visual field or acuity (40.0%) in the 21-53 years group. The overall success rate of endoscopic fenestration was 90.4%. A Kaplan-Meier curve for long-term efficacy of the two treatment modalities showed better results for VCC than for VC (p = 0.008). CONCLUSIONS: Different age groups with SSCs have different main clinical presentations. VCC appears to be more efficacious than VC.

Assessment of endoscopic treatment for middle cranial fossa arachnoid cysts.

BACKGROUND: Endoscopic cystocisternotomy is one of three surgical methods used to treat middle cranial fossa arachnoid cysts. There is debate about which method is the best. OBJECTIVE: The aim of this study is to evaluate the effectiveness and safety of endoscopic cystocisternotomy for treatment of arachnoid cysts of the middle cranial fossa. METHODS: Thirty-two patients with arachnoid cysts of the middle cranial fossa who had undergone endoscopic cystocisternal fenestration between 2004 and 2009 were studied retrospectively. Data were obtained on clinical and neuroradiological presentation, indications to treat, surgical technique, complications, and the results of clinical and neuroradiological follow-up. RESULTS: Among the 27 patients with symptoms before surgery, 8 had disappearance of symptoms and 17 had improvement of symptoms. The cyst was reduced in size or it completely disappeared in 24 (75%) patients. The incidence rate of complications was 18.8%. CONCLUSIONS: Endoscopic cystocisternal fenestration is an effective treatment for symptomatic arachnoid cysts of the middle cranial fossa and should be the initial surgical procedure.

[Application of neuroendoscope in the treatment of skull base chordoma].

OBJECTIVE: To further explore the application, approach, indication and prognosis of neuroendoscope treatment for skull base chordoma. METHODS: A total of 101 patients of skull base chordoma were admitted at our hospital from May 2000 to April 2010. There were 59 males and 42 females. Their major clinical manifestations included headache, cranial nerve damage and dyspnea. They were classified according to the patterns of tumor growth: Type I (n = 13): tumor location at a single component of skull base, i. e. clivus or sphenoid sinus with intact cranial dura; Type II (n = 56): tumor involving more than two components of skull e. g clivus, sphenoid and nasal/oral cavity, etc. But there was no intracranial invasion; Type III (n = 32) : tumor extending widely and intradurally forming compression of brain stems and multiple cranial nerves. Based on the types of chordoma, different endoscopic approaches were employed, viz. transnasal, transoral, trans-subtemporal fossa and plus microsurgical craniotomy for staging in some complex cases. RESULTS: Among all patients, total resection was achieved (n = 19), subtotal (n = 58) and partial (n = 24). In partial resection cases, 16 cases were considered to be subtotal due to a second-stage operation. Most cases had conspicuous clinical improvements. Self-care recovery within one week post-operation accounted for 58.4%, two weeks 30.7%, one month 6.9% and more than one month 1.9%. Postoperative complications occurred in 13 cases (12.8%) and included CSF leakage (n = 4) cranial nerve palsy (n = 5), hemorrhagic nasal wounds (n = 3) and delayed intracranial hemorrhage (n = 1). All of these were cured or improved after an appropriate treatment. A follow-up of 6 - 60 months was conducted in 56 cases. CONCLUSION: Early detection and early treatment are crucial for achieving a better outcome in chordoma. Neuroendoscopic treatment plays an important role in managing those complicated cases. Precise endoscopic techniques plus different surgical approaches and staging procedures are required to improve the post-operative quality of life for patients.

[Microsurgical treatment of giant cell tumor of skull].

OBJECTIVE: To explore the diagnosis and microsurgical treatment of giant cell tumor (GCT) of skull. METHODS: The investigators reviewed the clinical features, operative approach and prognosis of 23 consecutive cases of GCT of skull operated at our department between July 2000 and November 2008. RESULTS: Headache was the most common presenting symptom (86.96%) found among the patients with GCT of skull. Besides, the symptoms induced by the consequent lesions of II-XII intracranial nerves were also commonly observed. The mean duration of symptoms was 29.3 months and the mean preoperative KPS (Karnofsky performance scale) was 76 +/- 6. Among these cases, 10 tumors occurred in sphenoid bone, 9 in temporal bone, 3 in posterior fossa and 1 in frontal bone. Gross total resections were achieved in 6 cases, subtotal resections in 10 cases and partial resections in 7 cases. There was no operative death case. The follow-up data of 18 patients (78.26%) were collected with a mean follow-up duration of 35.5 months. All patients lived in normal postoperative life. CONCLUSION: GCT of skull is a generally low-degree malignancy showing a local bone invasion mostly in sphenoid and temporal bones.

[Using MR PC cine to evaluate CSF dynamics in neuroendoscopic third ventriculostomy:an analysis of 146 cases].

OBJECTIVE: To evaluate the change of CSF dynamics using MR PC Cine for neuroendoscopic third ventriculostomy. METHODS: 146 cases of hydrocephalus were treated by neuroendoscopic third ventriculostomy including 36 cases checked with MR PC Cine study randomly. The successful result was assessed by clinical symptom and imaging study. All the patients were given 3 months to 1 year follow-up. RESULTS: The symptoms of 121 (83%) patients were recovered soon. CT, MRI and MR PC Cine demonstrated the CSF velocity, flow rate and dynamics change to the normal level compared with preoperative check. The effective rate of this group was 75.3% with one year follow-up. CONCLUSION: The method of MR PC Cine to evaluate the CSF dynamics result for neuroendoscopic third ventriculostomy is simple, fast and safe. It is worth the clinical application.

[Endoscopic treatment of middle fossa arachnoid cysts].

OBJECTIVE: To investigate and evaluate the effectiveness of neuroendoscopic therapy for arachnoid cysts of middle cranial fossa. METHODS: From January 2004 to June 2009, 32 patients with arachnoid cysts of middle cranial fossa who were treated with endoscopic cystocisternal fenestration were retrospectively analyzed. There were 21 male patients and 11 female patients, aged from 6 months to 39 years. The clinical and neuroradiological presentation, indications, surgical technique, complications, and clinical and neuroradiological follow-up were analyzed. RESULTS: The cysts were reduced in size in 20 patients and completely disappeared in 4 patients. For the 27 patients with symptoms before operation, the symptoms disappeared in 8 cases and improved in 17 cases after operation. There were asymptomatic subdural hydroma in 4 patients, intracranial infection and incision cerebro-spinal fluid leakage in 1 patient respectively. The complication incidence rate was 18.8%. CONCLUSIONS: Endoscopic fenestration is an effective treatment for symptomatic arachnoid cysts of middle cranial fossa and could be performed as the first surgical choice for these patients.

Application of endoscopic endonasal approach in skull base surgeries: summary of 1886 cases in a single center for 10 consecutive years.

BACKGROUND: Endonasal endoscopic skull base surgery has undergone rapid technological developments and is now widely performed, but its strengths and weaknesses deserve further investigation and deliberation. This study was performed to investigate the surgical indications, complications, and technical advantages and disadvantages of endonasal endoscopic skull base surgery. METHODS: The clinical data of 1886 endoscopic endonasal skull base surgeries performed in our ward at Beijing Tiantan Hospital from June 2006 to June 2016 were retrospectively analyzed. RESULTS: One thousand ninety-three (73.4%, 1490) pituitary adenomas, 54 (24.9%, 217) chordomas, 28 (80.0%, 35) craniopharyngiomas, and 15 (83.3%, 18) meningiomas underwent total resection. Two patients died postoperatively, both having pituitary adenomas. Other postoperative complications included olfactory disorders (n = 226, 11.9%), postoperative cerebrospinal fluid leakage (n = 78, 4.1%), hypopituitarism (n = 74, 3.9%), diabetes insipidus (n = 64, 3.4%), intracranial infection (n = 36, 1.9%), epistaxis (n = 24, 1.3%), vascular injury (n = 8, 0.4%), optic nerve injury (n = 8, 0.4%), and oculomotor movement impairment (n = 4, 0.2%). In total, 1517 (80.4%) patients were followed up for 6 to 126 months (average, 42.5 months) postoperatively. A total of 196 (13.2%) pituitary adenomas and 13 (37.1%) craniopharyngiomas recurred but no meningiomas recurred. Chordomas recurred in 97 (44.7%) patients, in whom 5-year survival rate was 65%. CONCLUSION: Endoscopic surgery is an innovative surgical technique and the first choice for most midline extradural lesions such as chordomas, and an excellent choice for pituitary adenomas. It probably will be a good technique for many kinds of craniopharyngiomas and a common technique for most of skull base meningiomas, so the surgical indications of these cases should be chosen carefully to make good use of its respective advantages.

Experience of trans-nasal endoscopic surgery for pituitary tumors in a single center in China: Surgical results in a cohort of 2032 patients, operated between 2006 and 2018.

OBJECTIVES: This study was conducted to investigate complications and outcome by endonasal endoscopic approach in our single center. PATIENTS AND METHODS: The clinical data of 2032 pituitary adenoma surgeries performed in our ward between January 2006 and December 2018 were retrospectively reviewed. The GTR (gross total resection) rate, hormonal control, complications, and tumor recurrence rate were retrospectively analyzed. RESULTS: There were 628 (83.5 %) preoperative headache patients, 513 (68.9 %) visual acuity and visual field impaired patients, 218 (66.4 %) endocrine symptom patients and 26 (53.1 %) SIADH (syndrome of inappropriate secretion of antidiuretic hormone) patients experienced improvement after surgery. GTR was achieved in 1627 patients (80.1 %) and NGTR (non-gross total resection) in 405 patients (19.9 %). Clinically variable analyses revealed a significant correlation between GTR and Knosp's grades, large tumor volume, bone-invasive and recurrent tumors. Postoperative complications mainly included 34 (1.7 %) CSF (cerebral spinal fluid) leak, 72 (3.5 %) pituitary insufficiency, 30 (1.5 %) meningitis, 20 (0.98 %) cranial nerve deficits, 5 (0.25 %) hematoma, 5 (0.25 %) patients with internal carotid artery injury, and other complications mainly included nasal complications occurred in 168 patients (8.6 %). Overall, there were 3 deaths (0.15 %) occurred in our series. Univariate analysis showed that larger tumors, invasion, bone invasive, recurrent tumors and NGTR were associated with tumor regrowth. Multivariate analysis showed that NGTR and invasion were independent risk factors for tumor regrowth. CONCLUSIONS: NGTR and invasion were independent risk factors for tumor regrowth. Endoscopic surgery is an excellent choice for pituitary adenomas. It has the advantages of being minimally invasive, safe, and efficacious.

Endoscopic transsphenoidal treatment of pituitary adenomas.

OBJECTIVE: To explore the techniques and methods of endoscopic transnasal transsphenoid surgery for pituitary adenoma. METHOD: We treated 678 cases with pituitary adenoma by endoscopic transsphenoidal surgery between May 2000 and May 2006. All cases were operated through a transnasal transsphenoid approach between the nasal septum and middle nasal concha, first to enlarged sphenoid ostium and opened sellar floor with a high-speed drill and then removed the tumor step by step. Sixty-two percent of cases (420 cases) got 6-24 months of follow-up. RESULTS: Among the 678 pituitary adenomas, tumor removal was total in 543 (80.1%), subtotal in 118 (17.4%) and partial in 17 (2.5%). Ninety-eight percent (643 of 655 cases) obtained an improvement in clinical symptoms at some extent after the operation. Post-operative complication (including subarachnoid hemorrhage, nasal cavity bleed, nostril infection, nasal wing deformation and cerebrospinal fluid nasal leakage) occurred in 21 patients (3%). Among the 420 follow-up patients, tumor in four cases recurred 2 years after the first operation. CONCLUSION: Endoscopic transsphenoidal surgery of pituitary adenomas is a valuable microinvasive neurosurgery technique of minimal invasiveness, being effective and safe, yet requiring simple manipulation. With technological and scientific advancements, endoscopic transsphenoidal surgery will improve and develop step by step.

History, Current Situation, and Future Development of Endoscopic Neurosurgery in China.

OBJECTIVE: During the past few decades, Chinese endoscopic neurosurgery has rapidly developed in synchrony with the rest of the world. The aim of this article is to review the development of Chinese endoscopic neurosurgery, including its birth, growth, current situation, and prospects. METHODS: The history of Chinese endoscopic neurosurgery development can be divided into 3 stages: cognition and initial stage (1964-1995), exploration and maturity stage (1995-2006), and rapid development and promotion stage (2006-present). RESULTS: In the first stage, we mainly began to become aware of endoscopic neurosurgery from the translation and review of literature. In the mid to late 1990s, Chinese neurosurgery pioneers began using neuroendoscopic techniques. In the following decade, many leading neurosurgeons made persistent efforts to push the development of Chinese endoscopic neurosurgery forward, focusing on advocating for and promoting and popularizing neuroendoscopic technology. In the rapid development and promotion stage, many representative national and regional neurosurgical centers became skilled and efficient in the application of neuroendoscopic technology and became new advocates of the technology. The number of cases, level of technology, and treatment effectiveness are gradually nearing international standards. However, future development requires promotion of balanced development to decrease regional disparities, further strengthen international exchanges, follow the latest developments, and constantly innovate for continuous improvement. CONCLUSIONS: Following the dramatic efforts of several pioneers, development of Chinese endoscopic neurosurgery has been considerable, and it has become an important component of neurosurgery worldwide.

[Endoscopic treatment of suprasellar arachnoid cysts].

OBJECTIVE: To analyze the clinical manifestation and neuroendoscopic techniques in treatment of suprasellar arachnoid cysts. METHODS: Between October 2000 and June 2006, 42 patients (22 male and 20 female with a mean age of 10.4 years) with suprasellar arachnoid cysts were treated by endoscopy. All patients presented with hydrocephalus in CT and MRI scanning before operation. Endoscopic ventriculocystostomy was performed in 39 patients and cystocisternostomy was also performed in the other 3 patients. The mean duration of follow-up was 20.8 months. RESULTS: There was no surgery-related death and only two patients (4.8%) had postoperative complications. 25 cases (59.5%) recovered completely and 14 cases (33.3%) improved clinically. Ventriculoperitoneal shunting was performed in 3 patients because of recurrent hydrocephalus. Postoperative CT or/and MRI showed cyst volume decreased in all cases. Cine-MR imaging was performed in 21 patients that confirmed CSF could flow through all fenestration sites and aqueduct fluently. CONCLUSIONS: Endoscopic ventriculocystostomy (ventriculocystocisternostomy) is an effective and safe method in the treatment of suprasellar arachnoid cysts.

[Endoscopic third ventriculostomy in treatment of obstructive hydrocephalus].

OBJECTIVE: To explore the effects, influencing factors, and complications of endoscopic third ventriculostomy for obstructive hydrocephalus. METHODS: The clinical data of 55 patients with obstructive hydrocephalus, 29 males and 26 females, aged 18.4 (6 months - 59 years), who underwent endoscopic third ventriculostomy were analyzed retrospectively. RESULTS: Endoscopic third ventriculostomy was performed successfully in 54 patients, and one patient failed to undergo endoscopic third ventriculostomy because of densely distributed blood vessels at the bottom of the third ventricle. Satisfying post-operative results were obtained in 50 cases and no effect was seen in 4 cases that underwent V-P shunt 3 months later. Subdural hygroma occurred in 4 of the 55 cases, subscale hydrops in 8 cases, post-operative fever in 4 cases, epilepsy in 1 case, and epidural hemorrhage in 1 case. CONCLUSION: Endoscopic third ventriculostomy is safe and effective in the treatment of obstructive hydrocephalus.

Intraoperative Hemorrhage in Ventriculoscopic Surgery: Experience of a Single Chinese Neurosurgery Center.

BACKGROUND: The ventriculoscopic approach has been considered to be more safe and effective in the treatment of hydrocephalus, arachnoid cysts and intraventricular lesions in neurosurgery. We found that intraoperative bleeding-related complications have the greatest impact on ventriculoscopic surgery. Until now, few studies fully discussed this complication. METHODS: Patients who underwent ventriculoscopic surgery between May 2011 and December 2012 at Beijing Tiantan Hospital were analyzed. RESULTS: A total of 126 patients were enrolled in the study. Intraoperative hemorrhage was observed in 75 cases (59.5%). Intraoperative hemorrhage classification of patients was as follows: stage I (n = 62); stage II (n = 11); stage III (n = 2). We found that there was no significant difference in complication rate and rate of symptom improvement between the patients who had hemorrhage and the patients who did not (P < 0.05). CONCLUSIONS: Intraoperative hemorrhage in ventriculoscopic surgery should be paid more attention. Generally, a skilled neurosurgeon can address hemorrhage with a low complication rate. Consequently, the ventriculoscopic approach is safe and effective in the treatment of specified brain ventricular disease.