Application of transfrontal neuroendoscopic surgery in the treatment of chronic subdural hematoma / 中国内镜杂志

Objective To evaluate the efficacy of transfrontal neuroendoscopic surgery in the treatment of chronic subdural hematoma.Methods Analysis of clinical data of 80 cases of chronic subdural hematoma.According to the surgical method,40 cases were divided into traditional external drainage of parietaltuber,40 cases were divided into transfrontal neuroendoscopic small bone window hematoma removal.The treatment efficiency,hematoma recurrence rate,operation time and intraoperative blood loss were compared between the two groups.Results Treatment efficiency of neuroendoscopic group was 95.0%,significantly higher than drainage group 75.0%,hematoma recurrence rate one month after surgery of neuroendoscopic group was 5.0%,significantly lower than that in drainage group 25.0%,operation time of neuroendoscopic group was(54.1±7.5)min,longer than that of drainage group(40.7±9.4)min,the differences were statistically significant(P<0.05).The intraoperative blood loss of neuroendoscopic group was(30.1±4.5)mL,compared with(27.1±6.4)mL in the drainage group,the difference was not statistically significant(P>0.05).Conclusion Transfrontal neuroendoscopic surgery can significantly improve the efficacy of chronic subdural hematoma,and hematoma recurrence rate is extremely low.It is worthy of clinical application.

Analysis of individualised strategy in microvascular decompression for trigeminal neuralgia / 中华显微外科杂志

Objective:To investigate the clinical efficacy of individualised microvascular decompression (MVD) for trigeminal neuralgia (TN), so as to provide individualised treatment strategies and new thoughts for treatment.Methods:Clinical data of 46 patients who had TN and treated in the Department of Neurosurgery at the First Affiliated Hospital of Anhui Medical University from January 2021 to September 2023 were retrospectively studied. The study consisted of 19 males and 27 females, with an average age of morbidity at (58.3 ± 9.0) years old. Preoperative pain ratings and surgical outcomes were evaluated using the Barrow Neurological Institute (BNI) pain rating scale, and of which 27 patients were rated at BNI grade IV and 19 at grade V before surgery. A posterior trans-sigmoid sinus approach was applied in surgery on all patients, which could be performed in various ways depending on the vascular conditions identified during surgery. Ten patients were treated with microsurgery, 12 with endoscopic surgery and 24 with combined endoscopic surgery and microsurgery. After having identified the responsible vessel(s), a vascular decompression for the affected trigeminal nerve was performed and the nerve decompression was achieved by a polyester pad. Long-term postoperative follow-ups were conducted via telephone interviews or outpatient visits.Results:A total of 46 patients received the microvascular decompression surgery. Among them, 43 cases (93.5%) achieved immediate and complete pain relief of BNI grade I after surgery, and 3 cases (6.5%) achieved partial pain relief of BNI grade Ⅱ. Four patients developed facial numbness and sensory reduction, 2 developed facial paralysis (of House-Brackmann grade Ⅱ of 1 patient and grade Ⅲ of the other), 8 developed pneumocephalus, 4 developed postoperative fever, and 2 developed subcutaneous effusion. After treatment, the pneumocephalus and fever were cured, subcutaneous effusion was disappeared in 1 patient, but remained in the other. The mean follow-up period for the 46 patients was 16.2 (1-33) months. During the follow-up, 2 of the 3 patients of BNI grade Ⅱ immediately after surgery had complete remission to BNI grade Ⅰ and the other had recurrence and aggravation at BNI grade Ⅳ.Conclusion:The complexity of the responsible vessels is one of the important factors to be considered in the microvascular decompression strategy for trigeminal neuralgia. An individualised surgical plan according to a specific vascular condition identified in the surgery, is a best possible or worthiness surgical strategy in the treatment for a TN.

Neuroendoscopic resection of residual or recurrent sellar and clivus tumors / 中华神经医学杂志

Objective:To investigate the clinical value of neuroendoscopic resection in recurrent or residual sellar and clivus tumors and the prevention and treatment of operative complications.Methods:A retrospective study was performed. Clinical data of 49 patients with residual or recurrent sellar and clivus tumors after neuroendoscopic resection in Department of Neurosurgery, First Affiliated Hospital of Sun Yat-sen University from November 2021 to October 2023 were collected; 45 patients were with pituitary adenoma, 3 were with craniopharyngioma, and 1 patient was with clivus chordoma; their surgical efficacy and complications were summarized and analyzed.Results:Total resection was achieved in 29 patients (59.2%), subtotal resection in 12 (24.5%), and partial resection in 8 (16.3%). Two patients (4.1%) had intraoperative internal carotid artery rupture and were given emergency laminar stenting, discharging with good recovery, but one of them left with unilateral motor nerve palsy. During 1-24 months of follow-up, 97.2% patients (35/36) had headache relief and visual acuity improvement, and no patient had permanent diabetes insipidus or cerebrospinal fluid rhinorrhea. Residual tumors increased in 3 patients (6.1%); no tumor recurrence after total resection was noted.Conclusion:Endoscopic resection of recurrent or residual sellar and clivus tumors is safe and effective; attention should be paid to the internal carotid artery during the operation.

Tercerventriculostomía endoscópica del paciente adulto. Resultados tras la aplicación de nuestro protocolo / Endoscopic third ventriculostomy of the adult patient. Results from the application of our protocol

Introducción: La tercerventriculostomía endoscópica (TVE) es una técnica quirúrgica ampliamente reconocida para el tratamiento de la hidrocefalia obstructiva. Al igual que otras técnicas para el manejo de la hidrocefalia, la protocolización del manejo intra y peri-operatorio deviene en mejores resultados. Sin embargo, no existe en la literatura en castellano alguna publicación que exponga en detalle un protocolo de trabajo de TVE. El objetivo de este estudio es presentar los resultados tras la aplicación de nuestro protocolo. Materiales y Métodos: Se realizó una descripción del protocolo para TVE prequirúrgico, intraoperatorio y post-operatorio. Se realizó un análisis prospectivo de una serie de casos. Resultados: Un detallado protocolo fue presentado. Un total de 70 pacientes fueron incluidos para su análisis. La tasa de éxito del procedimiento fue del 82.43%. Hubo una mejoría en la escala de Karnofsky tras la TVE [media de 26.22 puntos (IC 95% 13,77 -36,92)]; siendo esta estadísticamente significativa (p=<0,001). Conclusión: La TVE demostró ser un procedimiento seguro y efectivo para el tratamiento de la hidrocefalia obstructiva. El protocolizar el procedimiento quirúrgico demostró una alta tasa de éxito en nuestra cohorte de pacientes, comparando con los resultados de la literatura internacional

Background. Endoscopic third ventriculostomy (ETV) is a worldwide accepted technique to treat obstructive hydrocephalus. As per many other techniques to treat hydrocephalus, protocols had improved the overall results and reduced the complications rate. However, there are no protocols written in Spanish literature, that illustrate in detailed a step by step on how to perform and follow up patients with ETV.The aim of this study is to present the results after the application of our protocol. Methods. A protocol with surgical technique, management and follow up for ETV in adults was written and a retrospective analysis of several cases was presented. Results. A detailed protocol was presented. Forty-three patients included in the protocol were analysed after ETV. The success rate of the procedure was 82.43%. There was a statistically significant improvement of a mean 26.22 points (IC 95% 13.77 -36.92) in the Karnofsky scale after the ETV (p=<0.001). Conclusion: ETV has shown to be a safe and effective procedure to treat obstructive hydrocephalus. The protocolization of the procedure proved a high success rate in our cohort of patients, comparable with the international literature results

Cirugía neuroendoscópica intraventricular en pacientes adultos con hidrocefalia obstructiva. Serie corta de casos

Introducción: la hidrocefalia es una patología neuroquirúrgica que presenta varias alternativas de tratamiento. A pesar de esto, el índice de disfunción y reintervención de los pacientes es considerablemente elevado. Objetivo: describir los resultados de la cirugía neuroendoscópica intraventricular en pacientes operados de hidrocefalia obstructiva. Materiales y métodos: se trata de un estudio observacional, descriptivo, transversal, de serie de casos, en el que se describen variables clínicas, de imagen y quirúrgicas de pacientes operados mediante neuroendoscopia intraventricular. Después de aplicar criterios de inclusión y exclusión, la muestra quedó conformada por cinco pacientes. Resultados: la escala de coma de Glasgow de los pacientes al momento de la cirugía, fue mayor de 12 puntos en todos los casos. El 60 % de los casos presentó un grado 4 en la escala de Frisen para evaluar la gravedad del papiledema. El promedio del índice de Evans medido por tomografía fue de 0,39; el del tercer ventrículo fue de 14,75 mm, mientras que el promedio de los cuernos temporales fue de 4,1 mm. En tres casos se presentaron variedades anatómicas dilatadas de los forámenes de Monro, mientras que en dos presentaban diámetros medianos. El tiempo quirúrgico promedio fue de 45 minutos. Entre las complicaciones posoperatorias estuvo la disfunción del estoma quirúrgico en un paciente con tercer ventriculostomía. Conclusiones: la cirugía neuroendoscópica intraventricular es un método efectivo para tratar pacientes con hidrocefalia obstructiva en pacientes seleccionados.

Introduction: hydrocephalus is a neurosurgical pathology that presents several treatment alternatives. Despite this, the rate of dysfunctions and re-interventions of the patients is considered high. Objective: to describe the results of intraventricular neuro-endoscopic surgery in patients operated on for obstructive hydrocephalus. Materials and methods: this is an observational, descriptive, cross-sectional study, of case series, where clinical, imaging and surgical variables of patients operated by intraventricular neurosurgery are described. After applying inclusion and exclusion criteria, the sample was made up of five patients. Results: the Glasgow coma scale of the patients at the moment of surgery was greater than 12 points in all cases. 60% of the cases presented a grade 4 on Frisen scale to assess the severity of papilledema. The average Evans index, measured by tomography was 0.39; that of the third ventricle was 14.75 mm, while the average of the temporal horns was 4.1 mm. In three cases there were dilated anatomical variants of the foramens of Monro f, while in two they presented medium diameters. The average surgical time was 45 minutes. Surgical stoma dysfunction in one patient with a third ventriculostomy was among the postoperative complications. Conclusions: intraventricular neuro-endoscopic surgery is an effective method for treating patients with obstructive hydrocephalus in selected patients.

Resection of anterior skull base meningiomas in 12 patients via neuroendoscopic supraorbital keyhole approach / 中华神经医学杂志

Objective:To analyze the clinical efficacy of resection of anterior skull base meningiomas via neuroendoscopic supraorbital keyhole approach. Methods:Twelve patients with anterior skull base meningiomas resected via neuroendoscopic supraorbital keyhole approach in Department of Neurosurgery, Huaihe Hospital of He'nan University from May 2020 to May 2022 were chosen. A retrospective analysis was performed on the clinical data of these patients. Results:Postoperative brain enhanced MRI showed resection degree of Simpson grading Ⅰ in 2 patients and Simpson grading Ⅱ in 10 patients. Pathological examination indicated meningiomas in all patients. All patients were followed up for 3 months-2 years, and no cerebrospinal fluid leakage or endoscopy-related complications occurred. Among the 6 patients with preoperative vision and visual field changes, 4 patients got obviously improved and 2 patients got slightly improved. The 2 patients with blunt headache before surgery had completely normal symptoms. Of the 2 patients with preoperative hyposmia, one recovered to normal and the other one got slightly improved in symptoms.Conclusion:Resection of anterior skull base meningiomas via neuroendoscopic supraorbital keyhole approach can effectively improve resection rate, reduce complication incidence, and improve cure rate.

Clinical efficacy and safety of neuro-endoscopic evacuation and microsurgery via keyhole approach in early spontaneous supertentorial intracerebral hemorrhage: a prospective multi-center randomized controlled trial / 中华神经医学杂志

Objective:To evaluate the clinical efficacy and safety of neuro-endoscopic evacuation and microsurgery via keyhole approach in early spontaneous supertentorial intracerebral hemorrhage (ICH). Methods:A prospective multi-center randomized controlled trial was performed; 114 patients with spontaneous supertentorial ICH (time from onset to surgery<6 h) admitted to Departments of Neurosurgery, Shunde Hospital of Southern Medical University, Jiangmen Central Hospital, Affiliated Hospital of School of Medicine of Yanbian University from January 2019 to December 2021 and met the surgical indications were selected. They were divided into endoscopic group (evacuation of intracerebral hematoma under neuroendoscope, n=71) and microscopic group (microsurgery of intracerebral hematoma via keyhole approach, n=43) according to different surgical methods. After 1:1 propensity score matching of the general data, surgical time, hematoma clearance rate, early postoperative re-bleeding rate, Glasgow coma scale (GCS) scores 7 d after surgery, activity of daily living (ADL) scores 6 months after surgery, mortality, and surgery-related complications of 66 patients (33 from each group after matching) were compared. Results:The difference of surgical time between endoscopic group and microscopic group was statistically significant (125[102, 157] mins vs. 175[125, 260] mins, P<0.05). However, hematoma clearance rate (93.00%[80.88%, 96.52%] vs. 93.31%[88.15%, 96.03%]), early postoperative re-bleeding rate (15.2% vs. 9.1%), GCS scores 7 d after surgery (13[10, 15] vs. 12[8, 14]), ADL scores 6 months after surgery (65[45, 85] vs. 55[0, 85]), mortality rate (18.2% vs. 21.2%) and incidences of postoperative intracranial infection and acquired pulmonary infection were not statistically significant between the two groups ( P>0.05). Conclusion:Comparing with microsurgery via keyhole approach, neuro-endoscopy could shorten the surgical time, but not improve the prognosis or safety in early spontaneous supertentorial ICH patients.

Effects of neuroendoscopic hematoma removal versus soft channel drainage in the treatment of chronic subdural hematoma / 中国基层医药

Objective:To investigate the clinical efficacy of neuroendoscopic hematoma removal versus soft channel drainage in the treatment of chronic subdural hematoma. Methods:The clinical data of 102 patients with chronic subdural hematoma who received treatment in Jincheng People's Hospital from May 2018 to May 2020 were retrospectively analyzed. They were divided into the neuroendoscopy group ( n = 50) and the soft channel group ( n = 52) according to different surgical methods. Perioperative indexes, hematoma clearance rate, China Stroke Scale score, the activity of daily living score, and oxidative stress indexes were compared between the two groups. All patients were followed up for 3 months. The incidence of complications during the follow-up period was calculated. Results:The retention time of the drainage tube in the neuroendoscopy group was shorter than that in the soft channel group [(2.45 ± 0.63) days vs. (3.30 ± 0.78) days, t = 6.06, P < 0.001]. The length of hospital stay in the neuroendoscopy group was shorter than that in the soft channel group [(7.14 ± 1.65) days vs. (9.07 ± 2.11) days, t = 5.15, P < 0.001]. The hematoma clearance rate at postoperative 7 days in the neuroendoscopy group was higher than that in the soft channel group [(93.45 ± 5.50)% vs. (81.86 ± 7.24)%, χ2 = 9.12, P < 0.001]. There were no significant differences in operation time and intraoperative blood loss between the two groups (both P > 0.05). At postoperative 30 days, the China Stroke Scale score in the neuroendoscopy group was lower than that in the soft channel group [(12.74 ± 2.23) points vs. (18.67 ± 2.45) points, t = 12.79, P < 0.001]. The activity of daily life score in the neuroendoscopy group was significantly higher than that in the soft channel group [(77.69 ± 7.11) points vs. (91.35 ± 7.25) points, t = 9.60, P < 0.001]. At postoperative 7 days, glutathione peroxidase level in the neuroendoscopy group was significantly lower than that in the soft channel group [(130.75 ± 13.66) U/L vs. (148.60 ± 14.64) U/L, t = 6.37, P < 0.001]. Malondialdehyde level in the neuroendoscopy group was significantly lower than that in the soft channel group [(5.11 ± 0.65) nmol/L vs. (6.19 ± 0.74) nmol/L, t = 7.83, P < 0.001]. Superoxide dismutase level in the neuroendoscopy group was significantly higher than that in the soft channel group [(275.60 ± 22.33) U/L vs. (254.60 ± 18.55) U/L, t = 5.15, P < 0.001]. There was no significant difference in the incidence of complications between the two groups ( P > 0.05). Conclusion:Compared with soft channel drainage, neuroendoscopic hematoma removal can obtain better short-term curative effects and less oxidative stress response in the treatment of chronic subdural hematoma. Neuroendoscopic hematoma removal does not increase the incidence of postoperative complications and is highly safe.

Resección de astrocitoma fibrilar cerebeloso con apoyo endoscópico. Presentación de un caso

Se presentó paciente femenina de 7 años de edad, con antecedentes de salud aparente, atendida en el Hospital Pediátrico Docente "Pedro Agustín Pérez", de provincia Guantánamo. Al interrogatorio, la madre refirió semana de evolución con cefalea y vómitos. Cumplió tratamiento con analgésicos y antieméticos sin resolución de dicho cuadro. El estudio de resonancia magnética nuclear de cráneo informó en T1, corte axial, una lesión ocupativa de espacio, hipointensa, de aspecto quístico de fosa posterior, en hemisferio cerebeloso derecho, que comprimía el IV ventrículo, lo que causó una hidrocefalia obstructiva secundaria. Se realizó ventriculostomía con derivación ventriculoperitoneal y resección macroscópica de lesión con apoyo endoscópico. Se confirmó por estudio histopatológico el diagnóstico de astrocitoma fibrilar cerebeloso.

A seven years old female patient was evaluated at the Hospital Pediátrico Docente "Pedro Agustín Pérez", in Guantánamo, with a history of an apparent health situation. The patient´s mother referred a week with headache and vomiting. Patient underwent an analgesics and antiemetics treatment without resolution of symptoms. A magnetic resonance imaging study of the brain showed in T1 scan, in the axial section, a space-occupying, hypointense, and appearance of posterior fossa cystic lesion, in the right cerebellar hemisphere, which was compressing the IV ventricle, causing obstructive hydrocephalus secondary. Ventriculostomy routing ventriculoperitoneal shunt and macroscopic resection of lesion with endoscopic support included was performed. Cerebellar fibrillary astrocytoma was the diagnosis confirmed by histopathological study.

Paciente do sexo feminino, 7 anos, com histórico aparente de saúde, atendida no Hospital Pediátrico Docente "Pedro Agustín Pérez", na província de Guantánamo. Ao ser questionada, a mãe relatou uma semana de evolução com cefaléia e vômitos. Efetuou tratamento com analgésicos e antieméticos sem resolução dos referidos sintomas. O estudo de ressonância magnética nuclear do crânio relatou em T1, corte axial, lesão hipointensa, expansiva, de aspecto cístico em fossa posterior, no hemisfério cerebelar direito, que comprimia o quarto ventrículo, causando hidrocefalia obstrutiva secundária. Foi realizada ventriculostomia com derivação ventriculoperitoneal e ressecção macroscópica da lesão com suporte endoscópico. O diagnóstico de astrocitoma fibrilar cerebelar foi confirmado pelo estudo histopatológico.

Application value of neuroendoscopic Endoport technique in resection of intracranial lesions involving the interventricular foramen / 中华神经医学杂志

Objective:To explore the application value of neuroendoscopic Endoport technique in resection of intracranial lesions involving the interventricular foramen.Methods:A retrospective analysis was performed; 21 patients with intracranial lesions involving the interventricular foramina accepted treatment by neuroendoscopic Endoport technique in our hospital from January 2018 to August 2020 were chosen. The surgical results and prognoses at follow-up were discussed.Results:In these 21 patients, total removal of the lesions was achieved in 19 patients, and subtotal removal in 2 patients; perioperative complications included 1 patient with postoperative hemorrhage and 1 patient with intracranial infection. During the follow-up of 3-30 months, except for 1 patient lost of follow-up, Karnofsky performance scale scores at the last follow-up were 85.5±3.5, and no signs of tumor recurrence were found during the imaging follow-up.Conclusion:Neuroendoscopic Endoport technique can help to safely and effectively remove intracranial lesions involving the interventricular foramen, and the patients enjoy good prognosis.

Efficacy of neuroendoscopic hematoma removal versus soft channel drainage for chronic subdural hematoma / 中国基层医药

Objective:To investigate the clinical efficacy of neuroendoscopic hematoma removal versus soft channel drainage in the treatment of chronic subdural hematoma (CSDH) and their effects on neurological function and quality of life. Methods:The clinical data of 97 patients with CSDH who received treatment between February 2018 and December 2019 were retrospectively analyzed. These patients were divided into group A ( n = 48, soft channel drainage) and group B ( n = 49, neuroendoscopic hematoma removal) according to different surgical methods. Clinical indicators, neurological function, quality of life, and incidence of complications were compared between groups A and B. Results:Operative time, length of hospital stay, and latency to hematoma disappearance in group B were (31.3 ± 2.18) minutes, (8.16 ± 1.32) days, (7.45 ± 1.49) days, which were significantly shorter than those in group A [(35.15 ± 4.32) minutes, (13.18 ± 1.56) days, (11.32 ± 1.88) days, t = 5.53, 17.12, 11.25, all P < 0.001]. At 3 months after surgery, the score of each dimension of SF-36 in each group was increased. The scores of physiological functioning, bodily pain, mental health, general health perceptions, social role functioning, vitality, role limitations due to emotional health, role limitations due to physical health in group B were (84.94 ± 7.25) points, (84.02 ± 6.29) points, (82.85 ± 8.16) points, (84.36 ± 9.15) points, (83.51 ± 10.39) points, (82.68 ± 8.36) points, (84.93 ± 10.15) points, (86.12 ± 9.13) points, which were significantly higher than those in group A [(62.68 ± 5.47) points, (71.39 ± 7.42) points, (69.51 ± 6.39) points, (72.68 ± 7.36) points, (72.81 ± 8.15) points, (73.12 ± 10.13) points, (77.91 ± 9.52) points, (75.32 ± 7.51) points, t = 19.82, 18.34, 19.75, 16.71, 17.94, 20.57, 18.22, 16.44, all P < 0.001]. At 7 days after surgery, neurotrophic factor, neuron specific enolase, hydrogen sulfide and S100B protein levels in group B were (42.53 ± 6.09) μg/L, (6.52 ± 2.79) μg/L, (203.17 ± 15.03) μmol/L, (0.25 ± 0.05) μg/L, respectively, which were significantly lower than those in group A [(67.38 ± 7.42) μg/L, (9.18 ± 2.27) μg/L, (242.79 ± 14.08) μmol/L, (0.36 ± 0.07) μg/L, t = 17.94, 5.12, 13.33, 8.86, all P < 0.001]. There was no significant difference in the incidence of complications between group B and group A [8.16% (4/49) vs. 18.75% (9/48), χ2 = 2.22, P = 0.136]. Conclusion:Compared with soft channel drainage, neuroendoscopic hematoma removal can better improve clinical indicators, neurological function, and quality of life in patients with CSDH, and is highly safe Neuroendoscopic hematoma removal is of certain clinical application value and innovation.

Tercer ventriculostomía endoscópica en la hidrocefalia de presión normal idiopática / Endoscopic third ventriculostomy in idiopathic normal pressure hydrocephalus

RESUMEN Introducción: La hidrocefalia de presión normal idiopática es un complejo sintomático caracterizado por afectación de la marcha, incontinencia urinaria y deterioro del estado mental. En la actualidad no existe un esquema diagnóstico estandarizado. La tercer ventriculostomía endoscópica se comenzó a utilizar hace unos años ante la elevada tasa de complicaciones de los sistemas derivativos pero aún no se definen con claridad los factores pronósticos de su éxito y se cuestiona su indicación. Objetivo: Describir el rol de la tercer ventriculostomía endoscópica en la hidrocefalia de presión normal idiopática. Métodos: Se realizó la revisión de la literatura en bases de datos PUBMED, además de literatura gris en los servidores de preprints BioRxiv, MedRxiv y preprint.org. Se seleccionaron los artículos de los últimos 15 años sin aplicación de filtros idiomáticos. Se usaron los siguientes descriptores Normal pressure hydrocephalus AND Endoscopic third ventriculostomy. Fueron seleccionados solo aquellos artículos con texto completo disponible. Resultados: Se identificaron un total de 430 artículos. Se analizaron 10 investigaciones sobre tercer ventriculostomía endoscópica en la hidrocefalia de presión normal idiopática, ocho fueron estudios retrospectivos con el 62,5 % de los mismos con una muestra inferior a 15 pacientes, además de dos estudios de cohorte. Conclusiones: La tercer ventriculostomía endoscópica ha tenido relativo éxito en el tratamiento de pacientes cuidadosamente seleccionados con hidrocefalia de presión normal idiopática. Es un procedimiento seguro y efectivo, encaminado a mejorar la compliance intracraneal a través de la restauración de la pulsatilidad cerebral, y la influencia de la misma en la dinámica del líquido cerebroespinal.

ABSTRACT Introduction: Idiopathic normal pressure hydrocephalus is a clinical complex characterized by impaired gait, urinary incontinence and deterioration of mental status. Currently, there is not a standardized diagnostic scheme. The endoscopic third ventriculostomy began to be used a few years ago due to the high rate of complications of the derivative systems, but the prognostic factors of its success have not yet been clearly defined, and its indication is questioned. Objective: To describe role of endoscopic third ventriculostomy in idiopathic normal pressure hydrocephalus. Methods: A literature review was performed in PUBMED and preprint servers BioRxiv, MedRxiv and preprint.org. Articles from the last 15 years were selected without the application of language filters. The following descriptors Normal pressure hydrocephalus AND Endoscopic third ventriculostomy were used. Only those articles with the full text available were selected. Results: A total of 430 articles were identified. Ten investigations about endoscopic third ventriculostomy in idiopathic normal pressure hydrocephalus were analyzed, 8 were retrospective studies with 62.5% of them with a sample of less than 15 patients, in addition to two cohort studies. Conclusions: Endoscopic third ventriculostomy has been relatively successful in treating carefully selected patients with idiopathic normal pressure hydrocephalus. It is a safe and effective procedure, aimed at improving intracranial compliance through the restoration of cerebral pulsatility, and its influence on the dynamics of cerebrospinal fluid.

Therapeutic effects of hematoma removal by neuroendoscopy or craniotomy on thalamic hemorrhage / 中华神经医学杂志

Objective:To explore the effects of hematoma removal by neuroendoscopy or craniotomy on thalamic hemorrhage.Methods:Eighty-three patients with thalamic hemorrhage, admitted to our hospital from September 2016 to March 2019, were chosen in our study; 44 patients accepted hematoma removal by neuroendoscopy and 39 patients accepted hematoma removal by craniotomy under microscope. These patients were divided into severe type ( n=55) and mild type ( n=28) according to Glasgow coma scale scores at admission. The efficacy and safety of the two procedures were compared. Patients were followed up until one year after onset, and their recovery was assessed by Glasgow outcome scale (GOS). Results:As compared with those in the craniotomy group, patients in the neuroendoscopy group had significantly small volume of intraoperative blood loss ([284.90±31.74] mL vs. [45.70±6.94] mL), significantly shorter hospital stays ([18.40±2.75] d vs. [14.70±2.13] d), and statistically lower incidence of epilepsy (15.4% vs. 2.3%, P<0.05). In critical survived patients, the GOS scores in the endoscopic group were 4.99±0.48 until one year after onset, which were significantly higher than those in the craniotomy group (2.64±0.41, P<0.05). Conclusion:As compared with hematoma removal by craniotomy, that by neuroendoscopy has the advantages of minimal invasion, good visual field, and high efficiency in the treatment of thalamic hemorrhage.

Selection of surgical methods for different sites of symptomatic Rathke's cleft cyst and clinical efficacies of these patients / 中华神经医学杂志

Objective:To explore the selection of surgical methods for different sites of symptomatic Rathke's cleft cyst (RCC) and the clinical efficacies of these patients.Methods:Forty-seven patients with symptomatic RCC, admitted to our hospital from January 2016 to December 2019, were chosen in our study; 21 patients with intrasellar symptomatic RCC accepted surgery via unilateral nasal approach at the right side, 19 patients with intra-suprasellar symptomatic RCC accepted surgery via bilateral nasal approach, 3 patients with suprasellar symptomatic RCC accepted endonasal transsphenoidal surgery under endoscope, and 4 patients with suprasellar symptomatic RCC accepted craniotomy via pterion approach. The clinical efficacies and complications of patients accepted different surgical methods were compared. All patients were followed up for 3-36 months to observe the recurrence.Results:The postoperative symptoms of the patients were effectively improved, including headache relief ratio of 27/31, vision loss improvement ratio of 5/5, high prolactin relief ratio of 11/13, pituitary function improvement ratio of 9/18. Complications occurred in 6 patients, presenting as diabetes insipidus. Four patients recurred during follow-up.Conclusion:Intrasellar and intra-suprasellar symptomatic RCC accepted surgery via endoscopic transnasal transsphenoidal approach are safe and effective; selection of surgical methods for suprasellar symptomatic RCC should be determined according to the sizes and growth directions of cysts.

Comparison of efficacies of surgeries via frontal keyhole approach assisted by endoscope and via temporal keyhole approach assisted by microscope in treatment of basal ganglia cerebral hemorrhage / 中华神经医学杂志

Objective:To compare the clinical efficacy and safety of surgeries via frontal keyhole approach assisted by neuro-endoscope and via temporal keyhole approach assisted by microscope in cerebral basal ganglia hemorrhage. Methods:One hundred and five patients with basal ganglia cerebral hemorrhage admitted to our hospital from January 2017 to January 2020 were chosen in our study; 51 patients underwent surgeries via frontal keyhole approach assisted by neuro-endoscope (neuro-endoscopy group) and 54 patients underwent surgeries via temporal keyhole approach assisted by microscope (microscopy group). The clinical data of these patients were retrospectively analyzed; and the differences of hematoma clearance rate, intraoperative blood loss, duration of surgery, length of hospital stays, Glasgow Coma Scale (GCS) scores one week after surgery, incidence of postoperative complications, and activity of daily living (ADL) scores 6 months after surgery were compared between the 2 groups. Results:There were no significant differences in hematoma clearance rate and length of hospital stays between the 2 groups ( P>0.05). As compared with the microscopy group, the neuro-endoscopy group had significantly lower intraoperative blood loss, significantly shorter duration of surgery, and statistically higher GCS scores one week after surgery ( P<0.05). There were no significant differences in incidence of postoperative complications and ADL scores 6 months after surgery between 2 groups ( P>0.05). Conclusion:Both surgeries via frontal keyhole approach assisted by neuro-endoscope and via temporal keyhole approach assisted by microscope can effectively clear the intracranial hematoma in patients with cerebral hemorrhage in the basal ganglia and protect neurological function; however, surgeries via frontal keyhole approach assisted by neuro-endoscope has advantages of shorter duration of surgery and lower intraoperative blood loss, and earlier neurological function recovery.

Tratamiento endoscópico de lesiones quísticas supratentoriales en pediatría / Endoscopic treatment of supratentorial cystic lesions in pediatrics

Introducción: La endoscopía neuroquirúrgica es una técnica mínimamente invasiva, utilizada desde principios del siglo XX para dar solución a las patologías localizadas en el sistema ventricular. En la actualidad las indicaciones de esta técnica se han ampliado notablemente. El objetivo de este trabajo consiste en presentar el tratamiento endoscópico de quistes cerebrales supratentoriales de diferentes etiologías en pediatría. Materiales y métodos: Se realizó un estudio transversal retrospectivo, desde enero de 2016 hasta diciembre de 2019, de pacientes pediátricos con lesiones quísticas supratentoriales tratados endoscópicamente en el Hospital de Niños de La Plata. Para definir el éxito se utilizó la clasificación en 5 grados de Ross et al. Resultados: Se practicaron 14 procedimientos en 12 pacientes, con edades comprendidas entre los 2 meses y los 9 años. Del total, 6 fueron quistes intraventriculares, 3 quistes de línea media, 5 quistes paraventriculares. Todos presentaban algún signo o síntoma al momento de la consulta, predominando entre ellos la alteración del estado neurológico y los vómitos. Luego de practicarse la fenestración endoscópica, presentaron una evolución clínica favorable en 12 de los 14 procedimientos y una mejoría en al menos un criterio imagenológico en 10 del total de los procedimientos.Basados en la categorización de Ross et al. se obtuvo un grado I en el 57% de los casos, lo que implica una mejoría completa permanente. La tasa de complicación global fue del 7%, presentando en solo un caso infección post endoscopia. Conclusión: La neuroendoscopía debería ser considerada como una opción de primera línea para el tratamiento en las lesiones quísticas supratentoriales. Demostró ser un método poco invasivo, con el cual se obtuvieron buenos resultados y una baja tasa de complicaciones.

Introduction: Neurosurgical endoscopy is a minimally invasive technique, used since the beginning of the 20th century to solve pathologies localized in the ventricular system. Currently the indications for this technique have been greatly expanded. The objective of this work is to present the endoscopic treatment of supratentorial brain cysts of different etiologies in pediatrics. Material and methods: We carried out a retrospective cross-sectional study, from January 2016 to December 2019, of pediatric patients with supratentorial cystic lesions treated endoscopically at the Hospital de Niños of La Plata City. To define success, we used the 5-degree classification of Ross et al. Results: 14 procedures were performed in 12 patients, aged between 2 months and 9 years. Of the total, 6 were intraventricular cysts, 3 midline cysts, 5 paraventricular cysts. All presented any signs or symptoms at the time of the consultation, prevailing among them the alteration of the neurological state and vomiting. After endoscopic fenestration was performed, they presented a favorable clinical evolution in 12 of the 14 procedures and an improvement in at least one imaging criterion in 10 of all procedures. Based on the categorization of Ross et al. we obtained a grade I in 57% of the cases, which implies a permanent complete improvement. The overall complication rate was 7%, presenting post-endoscopy infection in only one case. Conclusion: Neuroendoscopy should be considered as a first-line option for the treatment of supratentorial cystic lesions. It proved to be a non-invasive method, with which we obtained good results and a low complication rate

Quiste aracnoideo intraventricular asintomático: reporte de un caso / Asymptomatic intraventricular arachnoid cyst: a case report

Introducción: Los Quistes Aracnoideos son colecciones benignas de líquido cefalorraquídeo que representan el 1% de lesiones ocupantes de espacios intracraneales. Se detecta frecuentemente antes de los 20 años, entre 60 a 90% de los casos. La prevalencia estimada es de 1,4% en adultos, siendo la menos frecuente la ubicación intraventricular. Caso Clínico: Mujer de 60 años de edad, consultó por cefalea holocraneana de larga data y ocasionales mareos. Sin alteraciones al examen físico neurológico. Se le realizó tomografía axial computarizada donde llamó la atención una leve alteración de la densidad intraventricular por lo que se procedió a realizar resonancia magnética nuclear que demostró imágenes quísticas en atrio de ventrículos laterales, bilateral. No se requirió de una intervención quirúrgica debido a que la paciente no presentaba sintomatología significativa. Discusión: El tratamiento quirúrgico es recomendado en pacientes sintomáticos, en quistes de gran extensión y en los que cursan con complicaciones. Para los pacientes que cursen sólo con dolor de cabeza, sin hidrocefalia secundaria o un aumento evidente de la presión intracraneal se recomienda la observación con o sin repetición de las imágenes.

Introduction: Arachnoid cysts are benign collections of cerebrospinal fluid that represents 1% of lesions occupying intracranial spaces. It is frequently detected before the age of 20, between 60 to 90% of cases. The estimated prevalence is 1.4% in adults, the least frequent being intraventricular location. Clinical Case: A 60-year-old woman attended for a long-standing holocranial headache and occasional dizziness. No alteration in the neurological physical examination. A computerized axial tomography was performed, where a slight alteration in the intraventricular density drew attention, for which a nuclear magnetic resonance was carried out, which showed cystic images in the atrium of bilateral lateral ventricles. No surgical intervention was required because the patient did not present a significant symptomatology. Discussion: Surgical treatment is recommended in symptomatic patients, in cysts of great extension and in those with complications. For patients with only headache, without secondary hydrocephalus or an obvious increase in intracranial pressure, observation with or without repetition of the images is recommended.

Pure Endoscopic Excision of Parenchymal Brain Tumors: Feasibilty, Risks, Advantages and Realities - A Beginners Perspective

Background Neuroendoscopy is gaining popularity and is reaching new realms. Young neurosurgeons are exploring the various possibilities associated with the use of neuroendoscopy. Neuroendoscopy in excision of parenchymal brain tumors is less explored, and young neurosurgeons should be aware of the realities. The present article is an approach to put forward the difficulties faced by a young neurosurgeon and the lessons learnt. Objective To report the experience of surgical excision of parenchymal brain tumors, in selected cases, using pure endoscopic approach and to discuss its feasibility, technical benefits, risks and comparison with conventional microscopic excision. Method Eight patients of variable age group with parenchymal brain tumors were operated upon by a single surgeon and followed up for a period varying from6months to 2 years. Data regarding operating time, illumination, clarity of the field, size of craniotomy, blood loss and course of recovery was evaluated. All of the tumors were resected using rigid high definition zero and 30° endoscope. Results Out of eight cases, seven had lesions in the supratentorial and one in the infratentorial location. The age group ranged from 27 to 74 years old. Near to gross total resection was achieved in all except two cases. All of the patients recovered well without any significant morbidity or mortality. Hospital stay was reduced by 1 day on average. Conclusion Excision of parenchymal brain tumors via pure endoscopic method is a safe and efficient procedure. Although there is an initial period of learning curve, it is not steep for those already practicing neuroendoscopy, but the approach has its advantages.

Microsurgical and Endoscopic Anatomy of the Cavernous Sinus

Objective To describe the endoscopic and microsurgical anatomy of the cavernous sinus (CS) with focus on the surgical landmarks in microsurgical anatomy. Materials and methods Ten formalin-fixed central skull base specimens (20 CSs) with silicone-injected carotid arteries were examined through an extended endoscopic transsphenoidal approach. Fifteen formalin-fixed heads were dissected to simulate the surgical position in CS approaches. Results Endoscopic access enables identification of the anterior and posterior surgical corridors. Structures within the CS and on its lateral wall could be visualized and studied, but none of the triangular areas relevant to the transcranial microsurgical anatomy were fully visible through the endoscopic approach. Conclusion The endoscopic approach to the CS is an important surgical technique for the treatment of pathological conditions that affect this region. Correlating endoscopic findings with the conventional (transcranial)microsurgical anatomy is a useful way of applying the established knowledge into a more recent operative technique. Endoscope can provide access to the CS and to the structures it harbors.

Electromagnetic navigation technique in removal of hematoma under neuroendoscope / 中华神经医学杂志

Objective:To explore the application value of electromagnetic navigation technique in the removal of hematoma under neuroendoscope.Methods:Forty-three patients with supratentorial spontaneous cerebral hemorrhage, accepted removal of hematoma under neuroendoscope in our hospital from October 2015 to February 2019, were chosen in our study; 22 patients (navigation group) were performed the removal under the guide of real-time electromagnetic navigation, and 21 (non-navigation group) were performed the removal under neuroendoscope only. The amount of cerebral hemorrhage, operation time, residual amount of hematoma and hematoma clearance rate were compared between the two groups. Fugl-Meyer Assessment (FMA) was used to evaluate the motor function of the affected limbs two weeks after surgery. The anisotropy fraction (FA) values of fibers of affected pyramidal tracts and contralateral pyramidal tracts were examined by diffusion tensor imaging (DTI), and the relative FA (rFA) value (FA values of affected side/contralateral side) was calculated. Barthel index was used to evaluate the basic daily activities of the patients 6 months after surgery.Results:There was no significant difference between the navigation group and the non-navigation group in the amount of cerebral hemorrhage before surgery, amount of residual hematoma after surgery, hematoma clearance rate, and operation time ( P>0.05). FMA scores of upper and lower limbs, FA and rFA values of the affected side in the navigation group were significantly higher than those in the non-navigation group two weeks after surgery ( P<0.05). Barthel index of patients in the navigation group was statistically higher than that of the non-navigation group 6 months after surgery ( P<0.05). Conclusion:Electromagnetic navigation technique can guide endoscopy to effectively clear the supratentorial hypertensive cerebral hemorrhage without obviously increasing the operation time; effective protection of pyramidal fibers can improve the prognoses of patients.