Near-Infrared Fluorescence Imaging Sensor with Laser Diffuser for Visualizing Photoimmunotherapy Effects under Endoscopy.

The drug efficacy evaluation of tumor-selective photosensitive substances was expected to be enabled by imaging the fluorescence intensity in the tumor area. However, fluorescence observation is difficult during treatments that are performed during gastrointestinal endoscopy because of the challenges associated with including the fluorescence filter in the camera part. To address this issue, this study developed a device that integrates a narrow camera and a laser diffuser to enable fluorescence imaging through a forceps port. This device was employed to demonstrate that a laser diffuser with an NIR fluorescence imaging sensor could be delivered through a 3.2 mm diameter port. In addition, fluorescence images of Cetuximab-IR700 were successfully observed in two mice, and the fluorescence intensity confirmed that the fluorescence decayed within 330 s. This device is expected to have practical application as a tool to identify the optimal irradiation dose for tumor-selective photosensitive substances under endoscopy.

Sprayable tissue adhesive microparticle-magnetic nanoparticle composites for local cancer hyperthermia.

Incomplete removal of early-stage gastrointestinal cancers by endoscopic treatments often leads to recurrence induced by residual cancer cells. To completely remove or kill cancer tissues and cells and prevent recurrence, chemotherapy, radiotherapy, and hyperthermia using biomaterials with drugs or nanomaterials are usually administered following endoscopic treatments. However, there are few biomaterials that can be applied using endoscopic devices to locally kill cancer tissues and cells. We previously reported that decyl group-modified Alaska pollock gelatin-based microparticles (denoted C10MPs) can adhere to gastrointestinal tissues under wet conditions through the formation of a colloidal gel driven by hydrophobic interactions. In this study, we combined C10MPs with superparamagnetic iron oxide nanoparticles (SPIONs) to develop a sprayable heat-generating nanomaterial (denoted SP/C10MP) for local hyperthermia of gastrointestinal cancers. The rheological property, tissue adhesion strength, burst strength, and underwater stability of SP/C10MP were improved through decyl group modification and SPION addition. Moreover, SP/C10MP that adhered to gastrointestinal tissues formed a colloidal gel, which locally generated heat in response to an alternating magnetic field. SP/C10MP successfully killed cancer tissues and cells in colon cancer-bearing mouse models in vitro and in vivo. Therefore, SP/C10MP has the potential to locally kill residual cancer tissues and cells after endoscopic treatments.

Cortical spreading depression induces propagating activation of the thalamus ventral posteromedial nucleus in awake mice.

BACKGROUND: As the relay centre for processing sensory information, the thalamus may involve in the abnormal sensory procedure caused by cortical spreading depression (CSD). However, few studies have focused on the transient response of thalamus during CSD. Our study aimed to investigate the neuronal activity of mouse thalamus ventral posteromedial nucleus (VPM) during CSD by in vivo micro-endoscopic fluorescence imaging of the genetic calcium probe GCaMP6s expressed in excitatory glutamatergic neurons. METHODS: Thirty-four transgenic VGluT2-GCaMP6s mice were used in the experiments. An endoscope was inserted into the VPM for image acquisition. CSD was induced by KCl topically applied unilaterally on the cranial dura. Data were acquired in awake (ipsilateral or contralateral VPM, saline instead of KCl, MK-801 treatment) and anaesthetized (isoflurane, pentobarbital) states. Statistical analysis was performed using analysis of variance (ANOVA) by SPSS. RESULTS: We found that after CSD induced in ipsilateral motor cortex, the neuronal activity increased and propagated from the posterior-lateral to the anterior-medial part of the VPM with an average speed of 3.47 mm/min. When CSD was induced in visual cortex, the response propagated in opposite direction, from the anterior-medial to the posterior-lateral part of the VPM. Aanaesthetics resulted in the suppression of VPM activation induced by CSD. No significant VPM activation was detected when CSD was induced in contralateral cortex or KCl was replaced by saline. When 5 mM MK-801 was applied to the dura, the electrode failed to record the DC shift of CSD, and there was no significant VPM activation after KCl application. CONCLUSION: CSD induced propagating activation of the ipsilateral VPM in awake mice. The response might correlate to the cortical location where CSD was induced and might be affected by anaesthetics. No significant VPM activation was detected in saline and mk801 experiment results indicated that this VPM activation is due to CSD rather than mouse motion or direct effect of the KCl applying to the intact dura. This finding suggests the potential involvement of thalamus in the migraine auras.

The effect of intranasal irrigation with epinephrine solution on intraoperative visualization and bleeding during FESS.

PURPOSE: Bleeding during Functional endoscopic sinus surgery (FESS) can have adverse effect on surgical outcomes. This study evaluates if there is any benefit of adding epinephrine to the saline nasal irrigation in patients undergoing elective FESS for chronic rhinosinusitis. METHODS: A prospective, randomized, double-blinded study was performed. Fifty ASA I or II patients undergoing FESS were randomized to have irrigation either with normal saline or (1:100,000) epinephrine in normal saline during surgery. Outcomes measure included the Boezaart grading scale to assess the intraoperative surgical field, surgeon's satisfaction with field visualization and bleeding which was evaluated in a 10 cm visual analog scale, estimated blood loss as well as hemodynamic parameters changes. RESULTS: There was no statistically significant difference in the studied variables between both groups. However in patients with higher than 12 Lund-Mackay score the volume of blood loss was significantly less in the epinephrine group. All surgical procedures were completed and there were no operative complications or any reported perioperative cardiovascular events. CONCLUSIONS: Intraoperative irrigation with saline-epinephrine solution at a concentration of (1:100,000) is safe and does not change heart rate or blood pressure but is unlikely to improve the setting of intraoperative surgical field except for decreasing the volume of blood loss in patients with high Lund-Mackay score.

Screening and Preponderance of Peptic Ulcer and its Contributing Risk Factors Among Basrah City Residents in Iraq.

BACKGROUND: With the recent widespread use of over-the-counter drugs, there has been a noticeable increase in the occurrence of gastrointestinal discomfort and peptic ulcer disease. However, peptic ulcer is a highly complex disorder resulting from an imbalance between gastric destructive and protective factors. OBJECTIVE: To identify the risk factors of peptic ulcer disease. METHODS: This study was organized at Al-Basra teaching hospital and Al Sader teaching hospital in Basrah city, Iraq. Medical records and questionnaires were filled by patients undergoing diagnostic and therapeutic upper gastrointestinal endoscopies following their gastric discomfort complaints. Information related to patients, disease history, and medication history for six months prior to endoscopy procedures was collected. RESULTS: A total of 476 patients were identified, including 246 (51.7%) patients with endoscopically diagnosed peptic ulcers and 230 (48.3%) patients without peptic ulcers. The population was predominately male and there were significant differences between age groups. Smoking correlated with high relative risk; however, alcohol drinking had no significant role as a causative factor. The most extensively used drugs by patients who complained of peptic ulcers include NSAIDs, iron supplements, corticosteroids, and anti-platelet agents. A small number of patients were treated for hypertension and diabetes, which were correlated with peptic ulcer risks. The presence of H-pylori infections was significantly associated with peptic ulcer diagnosis. CONCLUSION: The risk of peptic ulcer disease appeared to increase with chronic medication use and smoking, which aggravate the contributing risk by H-pylori infections.

Endoscope-Assisted Contralateral Perimedian Supracerebellar Suprapineal Approach to Third Ventricle Surface of the Thalamus: 3-Dimensional Operative Video.

In managing thalamic gliomas, total surgical removal is the most effective way of increasing overall survival. However, the thalamus is a difficult target because of surrounding neurovascular structures. According to the lesion's size/location/growth pattern, relation to neighboring structures, and surgeon's experience, most thalamic lesions can be reached through one of the 4 free surfaces: lateral ventricle, velar, cisternal, and third ventricle surfaces of the thalamus (3VsT).1-3 Approaching the thalamic lesions through the lateral side disrupts the integrity of internal capsule and corona radiata; thus, we never prefer this approach. For the removal of the lesions on the 3VsT, a transcallosal approach can be considered, but with this approach, we cannot reach 3VsT without harming the velar surface. In this 3-dimensional video, we demonstrate an endoscope-assisted contralateral perimedian supracerebellar suprapineal (CPeSS) approach to a glioma on the 3VsT. The patient, a 49-yr-old man, had progressive dizziness for a month. With the patient in a semisitting position, total resection was achieved via the endoscope-assisted CPeSS approach. This approach is entirely transcisternal-transventricular and is a natural route to the 3VsT. Although the route is longer than the ipsilateral approach, it requires no retraction and provides more direct and wider visualization. It allows complete visualization of the lateral border of the lesion. A perimedian approach also avoids the major tentorial bridging veins, which are mostly at the midline. High-definition neuroendoscope was a great adjunct that helped to visualize residual tumors at hidden corners. We suggest this approach for thalamic lesions on the third ventricle surface of the thalamus. The patient consented to the publication of his images and a written consent was obtained.

[Auxiliary analgesic effect of wrist-ankle acupuncture on patients undergoing transforaminal endoscope surgery].

OBJECTIVE: To observe the auxiliary analgesic effect of wrist-ankle acupuncture on patients undergoing transforaminal endoscope surgery. METHODS: A total of 64 patients with lumbar disc herniation who underwent percutaneous lateral transforaminal endoscope surgery were randomly divided into an observation group and a control group, 32 cases in each group. The patients in the control group were treated with injection of 1% lidocaine for routine local infiltration anesthesia. The patients in the observation group were treated with wrist-ankle acupuncture at lower 5 area and lower 6 area for 30 min, 5 min before routine local infiltration anesthesia; immediately, 15 min, 30 min after insertion the left-right technique, up-down technique, and rotation technique were applied for six times, respectively. The mean arterial pressure (MAP), heart rate (HR), blood oxygen saturation (SpO2) and pain visual analogue scale (VAS) were compared between the two groups at the time points of intraoperative puncture (T1), circular saw grinding (T2), and placement of working channel (T3). The intention of reoperation was recorded immediately after operation and 24 h after operation. The expectation and treatment credibility scale (ETCS) was used to evaluate the relationship between patients' expectation and efficacy 5 min before operation and immediately after operation. RESULTS: At T2 and T3 during the operation, the MAP and HR in the obserrvation group were lower than those in the control group, while SpO2 was higher than that in the control group (P<0.05). At T1, there was no significant difference of MAP, HR and SpO2 between the two groups (P>0.05). At T2, the peak VAS and average VAS in the observation group were lower than those in the control group (P<0.05), but there was no significant difference at T1 and T3 (P>0.05). The intention of reoperation in the observation group was higher than that in the control group both immediately after operation and 24 h after operation (P<0.05). In the observation group, the scores of each item in ETCS immediately after operation were higher than those 5 min before operation (P<0.05), while in the control group there was no significant difference between immediately after operation and 5 min before operation (P>0.05). The scores of ETCS1, ETCS2 and ETCS3 immediately after operation in the observation group were higher than those in the control group (P<0.05). CONCLUSION: The wrist-ankle acupuncture has positive auxiliary analgesic effect on lumbago during transforaminal endoscope surgery, and strengthens the patients' confidence on the operation effect.

Auxiliary analgesic effect of wrist-ankle acupuncture on patients undergoing transforaminal endoscope surgery / 中国针灸

OBJECTIVE@#To observe the auxiliary analgesic effect of wrist-ankle acupuncture on patients undergoing transforaminal endoscope surgery.@*METHODS@#A total of 64 patients with lumbar disc herniation who underwent percutaneous lateral transforaminal endoscope surgery were randomly divided into an observation group and a control group, 32 cases in each group. The patients in the control group were treated with injection of 1% lidocaine for routine local infiltration anesthesia. The patients in the observation group were treated with wrist-ankle acupuncture at lower 5 area and lower 6 area for 30 min, 5 min before routine local infiltration anesthesia; immediately, 15 min, 30 min after insertion the left-right technique, up-down technique, and rotation technique were applied for six times, respectively. The mean arterial pressure (MAP), heart rate (HR), blood oxygen saturation (SpO) and pain visual analogue scale (VAS) were compared between the two groups at the time points of intraoperative puncture (T), circular saw grinding (T), and placement of working channel (T). The intention of reoperation was recorded immediately after operation and 24 h after operation. The expectation and treatment credibility scale (ETCS) was used to evaluate the relationship between patients' expectation and efficacy 5 min before operation and immediately after operation.@*RESULTS@#At T and T during the operation, the MAP and HR in the obserrvation group were lower than those in the control group, while SpO was higher than that in the control group (0.05). At T, the peak VAS and average VAS in the observation group were lower than those in the control group (0.05). The intention of reoperation in the observation group was higher than that in the control group both immediately after operation and 24 h after operation (0.05). The scores of ETCS1, ETCS2 and ETCS3 immediately after operation in the observation group were higher than those in the control group (<0.05).@*CONCLUSION@#The wrist-ankle acupuncture has positive auxiliary analgesic effect on lumbago during transforaminal endoscope surgery, and strengthens the patients' confidence on the operation effect.

Surgical Approaches to the Thalamus in Relation to the White Matter Tracts of the Cerebrum.

BACKGROUND: Approaching the thalamus from any angle remains a challenge because of its deep-seated location and intimate relations with adjacent important neurovascular structures and functions such as relaying sensory and motor signals and cognition. Our aim was to explore the relationship of the white matter tracts of the cerebrum to the thalamus using a fiber dissection technique, to delineate anatomic principles of approaches to the thalamus, and to discuss the tracts at risk in relation to each approach. METHODS: The thalamus was subdivided into 6 different regions and 13 approaches were examined in an attempt to describe a surgical road map. RESULTS: To reach the anteroinferior, medial, and lateral parts of the thalamus, the anterior and middle group approaches were used, and to reach the posterosuperior and posteroinferior thalamus, posterior and middle group approaches were used. The anteroinferior zone was the most difficult site to be accessed and the posterosuperior thalamus had the maximum number of alternative approaches. The distal transsylvian approach to the posterosuperior thalamus and the supracarotid infrafrontal approach to the anteroinferior thalamus had the highest number of neural structures severed within the surgical corridor. The infratentorial approaches and the suboccipital transtentorial approach preserve most of the white matter tracts en route to the posterosuperior and medial posteroinferior parts of the thalamus. CONCLUSIONS: When the surgical approaches for thalamic lesions are defined, white matter tracts along the surgical route should be taken into consideration.

Choice of timing and methods of treatment for congenital nasolacrimal duct obstruction / 国际眼科杂志(Guoji Yanke Zazhi)

@#Congenital nasolacrimal duct obstruction(CNLDO)is one of the most common ocular disorders in infants, and the main feature is a membranous obstruction of the distal end of the nasolacrimal duct. Methods are considered to treat with CNLDO, including lacrimal sac massage, probing, silicone intubation, balloon dacryocystoplasty, and dacryohynostomy. Recently, the combination use of lacrimal endoscopes may increase the success rate of surgery. Because many CNLDOs can resolve spontaneously, there are still some controversies in the timing of surgery and the choice of treatment options. The aim of the review is to provide a reference for the treatment of CNLDO.

[Percutaneous transforaminal endoscopic discectomy via lateral position assisted with local anesthesia for lumbar disc herniation in elder with systemic diseases].

OBJECTIVE: To explore the clinical effect of percutaneous transforaminal endoscopic discectomy via lateral position assisted with local anesthesia for lumbar disc herniation in elder with systemic diseases. METHODS: The clinical data of 44 elder patients with lumbar disc herniation and systemic diseases treated from June 2013 to June 2017 were retrospectively analyzed. Including 26 males and 18 females, aged 70 to 86 years old with an average of(77.5±3.5) years, course of disease was 3 weeks to 6 months. Percutaneous transforaminal endoscopic discectomy via lateral position assisted with local anesthesia was performed in the patients. Postoperative straight leg-raising degree change and Nakai criteria were used to evaluate the operative effect. Visual analogue scale(VAS) and JOA scoring system were used to compare the symptom improvement between preoperative and postoperative. RESULTS: No serious complications occurred during and after the operation, and the coexisting medical diseases were not aggravated. All patients safely survived the perioperative period. All the 44 cases were followed up from 6 to 30 months with an average of 20 months. Postoperative straight leg raising angle was obviously improved. At final follow-up, according to Nakai standard, 41 cases got excellent results, 3 good. VAS scores were significantly decreased and JOA scores were significantly increased in final follow-up(P<0.01). CONCLUSIONS: Percutaneous transforaminal endoscopic discectomy via lateral position assisted with local anesthesia is a safe, effective, less invasive technique for the treatment of lumbar disc herniation in elder with systemic diseases. Multidisciplinary collaboration and perioperative well controlled disease are essential for early rehabilitation of such patients.

Endoscope-assisted (with robotic guidance and using a hybrid technique) interhemispheric transcallosal hemispherotomy: a comparative study with open hemispherotomy to evaluate efficacy, complications, and outcome.

OBJECTIVEEndoscope-assisted hemispherotomy (EH) has emerged as a good alternative option for hemispheric pathologies with drug-resistant epilepsy.METHODSThis was a prospective observational study. Parameters measured included primary outcome measures (frequency, severity of seizures) and secondary outcomes (cognition, behavior, and quality of life). Blood loss, operating time, complications, and hospital stay were also taken into account. A comparison was made between the open hemispherotomy (OH) and endoscopic techniques performed by the senior author.RESULTSOf 59 cases (42 males), 27 underwent OH (8 periinsular, the rest vertical) and 32 received EH. The mean age was 8.65 ± 5.41 years (EH: 8.6 ± 5.3 years; OH: 8.6 ± 5.7 years). Seizure frequency per day was 7 ± 5.9 (EH: 7.3 ± 4.6; OH: 15.0 ± 6.2). Duration of disease (years since first episode) was 3.92 ± 1.24 years (EH: 5.2 ± 4.3; OH: 5.8 ± 4.5 years). Number of antiepileptic drugs per patient was 3.9 ± 1.2 (EH: 4.2 ± 1.2; OH: 3.8 ± 0.98). Values for the foregoing variables are expressed as the mean ± SD. Pathologies included the following: postinfarct encephalomalacia in 19 (EH: 11); Rasmussen's syndrome in 14 (EH: 7); hemimegalencephaly in 12 (EH: 7); hemispheric cortical dysplasia in 7 (EH: 4); postencephalitis sequelae in 6 (EH: 2); and Sturge-Weber syndrome in 1 (EH: 1). The mean follow-up was 40.16 ± 17.3 months. Thirty-nine of 49 (79.6%) had favorable outcomes (International League Against Epilepsy class I and II): in EH the total was 19/23 (82.6%) and in OH it was 20/26 (76.9%). There was no difference in the primary outcome between EH and OH (p = 0.15). Significant improvement was seen in the behavioral/quality of life performance, but not in IQ scores in both EH and OH (p < 0.01, no intergroup difference). Blood loss (p = 0.02) and hospital stay (p = 0.049) were less in EH.CONCLUSIONSEH was as effective as the open procedure in terms of primary and secondary outcomes. It also resulted in less blood loss and a shorter postoperative hospital stay.

Endoscopic near infrared photoimmunotherapy using a fiber optic diffuser for peritoneal dissemination of gastric cancer.

Near infrared photoimmunotherapy (NIR-PIT) is a highly selective tumor treatment that employs an antibody-photo-absorber conjugate (APC) which is activated by near infrared light. Here, we describe the efficacy of endoscopic NIR-PIT using the APC trastuzumab-IR700DX (tra-IR700) in the setting of human epidermal growth factor 2 positive (HER2 + ) gastric carcinoma with peritoneal disseminations. In this in vivo study, fluorescence endoscopy showed high tumor accumulation of tra-IR700 within disseminated peritoneal implants. Mice with disseminated peritoneal gastric cancer were separated into 4 groups: (i) control (no treatment); (ii) tra-IR700 i.v. only; (iii) NIR light only; and (iv) endoscopic NIR-PIT. NIR light irradiation was carried out through a fiber optic diffuser under endoscopic guidance. In vivo bioluminescence images showed significantly greater therapeutic effect in the endoscopic NIR-PIT group than that in the control groups (P < .01 vs other control groups). Histological analysis showed diffuse cancer cell death in NIR-PIT-treated tumors. In conclusion, NIR-PIT with NIR light delivered via an endoscopic fiber optic diffuser is a promising method for the treatment of peritoneal dissemination of gastric cancer. Moreover, this technique could be readily used in other types of cancers with peritoneal dissemination provided that suitable antibodies could be found.

Flexible endoscopically assisted evacuation of acute and subacute subdural hematoma through a small craniotomy: preliminary results.

BACKGROUND: The first choice to treat acute subdural hematoma (SDH) is a large craniotomy under general anesthesia. However, increasing age or comorbid burden of the patients may render invasive treatment strategy inappropriate. These medically frail patients with SDH may benefit from a combination of small craniotomy and endoscopic hematoma removal, which is less invasive and even available under local anesthesia. Although hematoma evacuation with a rigid endoscope for acute or subacute SDHs has been reported in the literature, use of a flexible endoscope may have distinct advantages. In this article, we attempted to clarify the utility of small craniotomy evacuation with a flexible endoscope for acute and subacute SDH in the elderly patients. METHOD: Between November 2013 and September 2016, a total of 17 patients with acute SDH (15 patients), subacute SDH (1 patient), or acute aggravation of chronic SDH (1 patient) underwent hematoma evacuation with a flexible endoscope at our hospital and were enrolled in this retrospective study. Either under local or general anesthesia, the SDH was removed with a flexible suction tube with the aid of the flexible endoscope through the small craniotomy (3 × 4 cm). Hematoma evacuation rate, improvement of clinical symptoms, and procedure-related complications were evaluated. RESULTS: Hematoma evacuation rate was satisfactory, and statistically significant clinical improvement was observed in postoperative Glasgow Coma Scale in all cases compared to the preoperative assessment. No procedure-related hemorrhagic complications were observed. CONCLUSIONS: The results reported here suggest that small craniotomy evacuation with a flexible endoscope is a safe, effective, and minimally invasive treatment for acute and subacute SDH in selected cases.

Percutaneous transforaminal endoscopic discectomy via lateral position assisted with local anesthesia for lumbar disc herniation in elder with systemic diseases / 中国骨伤

OBJECTIVE@#To explore the clinical effect of percutaneous transforaminal endoscopic discectomy via lateral position assisted with local anesthesia for lumbar disc herniation in elder with systemic diseases.@*METHODS@#The clinical data of 44 elder patients with lumbar disc herniation and systemic diseases treated from June 2013 to June 2017 were retrospectively analyzed. Including 26 males and 18 females, aged 70 to 86 years old with an average of(77.5±3.5) years, course of disease was 3 weeks to 6 months. Percutaneous transforaminal endoscopic discectomy via lateral position assisted with local anesthesia was performed in the patients. Postoperative straight leg-raising degree change and Nakai criteria were used to evaluate the operative effect. Visual analogue scale(VAS) and JOA scoring system were used to compare the symptom improvement between preoperative and postoperative.@*RESULTS@#No serious complications occurred during and after the operation, and the coexisting medical diseases were not aggravated. All patients safely survived the perioperative period. All the 44 cases were followed up from 6 to 30 months with an average of 20 months. Postoperative straight leg raising angle was obviously improved. At final follow-up, according to Nakai standard, 41 cases got excellent results, 3 good. VAS scores were significantly decreased and JOA scores were significantly increased in final follow-up(<0.01).@*CONCLUSIONS@#Percutaneous transforaminal endoscopic discectomy via lateral position assisted with local anesthesia is a safe, effective, less invasive technique for the treatment of lumbar disc herniation in elder with systemic diseases. Multidisciplinary collaboration and perioperative well controlled disease are essential for early rehabilitation of such patients.

Endonasal endoscopic reoperation for residual or recurrent craniopharyngiomas.

OBJECTIVE Craniopharyngiomas can be difficult to remove completely based on their intimate relationship with surrounding visual and endocrine structures. Reoperations are not uncommon but have been associated with higher rates of complications and lower extents of resection. So radiation is often offered as an alternative to reoperation. The endonasal endoscopic transsphenoidal approach has been used in recent years for craniopharyngiomas previously removed with craniotomy. The impact of this approach on reoperations has not been widely investigated. METHODS The authors reviewed a prospectively acquired database of endonasal endoscopic resections of craniopharyngiomas over 11 years at Weill Cornell Medical College, NewYork-Presbyterian Hospital, performed by the senior authors. Reoperations were separated from first operations. Pre- and postoperative visual and endocrine function, tumor size, body mass index (BMI), quality of life (QOL), extent of resection (EOR), impact of prior radiation, and complications were compared between groups. EOR was divided into gross-total resection (GTR, 100%), near-total resection (NTR, > 95%), and subtotal resection (STR, < 95%). Univariate and multivariate analyses were performed. RESULTS Of the total 57 endonasal surgical procedures, 22 (39%) were reoperations. First-time operations and reoperations did not differ in tumor volume, radiological configuration, or patients' BMI. Hypopituitarism and diabetes insipidus (DI) were more common before reoperations (82% and 55%, respectively) compared with first operations (60% and 8.6%, respectively; p < 0.001). For the 46 patients in whom GTR was intended, rates of GTR and GTR+NTR were not significantly different between first operations (90% and 97%, respectively) and reoperations (80% and 100%, respectively). For reoperations, prior radiation and larger tumor volume had lower rates of GTR. Vision improved equally in first operations (80%) compared with reoperations (73%). New anterior pituitary deficits were more common in first operations compared with reoperations (51% vs 23%, respectively; p = 0.08), while new DI was more common in reoperations compared with first-time operations (80% vs 47%, respectively; p = 0.08). Nonendocrine complications occurred in 2 (3.6%) first-time operations and no reoperations. Tumor regrowth occurred in 6 patients (11%) over a median follow-up of 46 months and was not different between first versus reoperations, but was associated with STR (33%) compared with GTR+NTR (4%; p = 0.02) and with not receiving radiation after STR (67% vs 22%; p = 0.08). The overall BMI increased significantly from 28.7 to 34.8 kg/m2 over 10 years. Six months after surgery, there was a significant improvement in QOL, which was similar between first-time operations and reoperations, and negatively correlated with STR. CONCLUSIONS Endonasal endoscopic transsphenoidal reoperation results in similar EOR, visual outcome, and improvement in QOL as first-time operations, with no significant increase in complications. EOR is more impacted by tumor volume and prior radiation. Reoperations should be offered to patients with recurrent craniopharyngiomas and may be preferable to radiation in patients in whom GTR or NTR can be achieved.

A multiport MR-compatible neuroendoscope: spanning the gap between rigid and flexible scopes.

OBJECTIVE Rigid endoscopes enable minimally invasive access to the ventricular system; however, the operative field is limited to the instrument tip, necessitating rotation of the entire instrument and causing consequent tissue compression while reaching around corners. Although flexible endoscopes offer tip steerability to address this limitation, they are more difficult to control and provide fewer and smaller working channels. A middle ground between these instruments-a rigid endoscope that possesses multiple instrument ports (for example, one at the tip and one on the side)-is proposed in this article, and a prototype device is evaluated in the context of a third ventricular colloid cyst resection combined with septostomy. METHODS A prototype neuroendoscope was designed and fabricated to include 2 optical ports, one located at the instrument tip and one located laterally. Each optical port includes its own complementary metal-oxide semiconductor (CMOS) chip camera, light-emitting diode (LED) illumination, and working channels. The tip port incorporates a clear silicone optical window that provides 2 additional features. First, for enhanced safety during tool insertion, instruments can be initially seen inside the window before they extend from the scope tip. Second, the compliant tip can be pressed against tissue to enable visualization even in a blood-filled field. These capabilities were tested in fresh porcine brains. The image quality of the multiport endoscope was evaluated using test targets positioned at clinically relevant distances from each imaging port, comparing it with those of clinical rigid and flexible neuroendoscopes. Human cadaver testing was used to demonstrate third ventricular colloid cyst phantom resection through the tip port and a septostomy performed through the lateral port. To extend its utility in the treatment of periventricular tumors using MR-guided laser therapy, the device was designed to be MR compatible. Its functionality and compatibility inside a 3-T clinical scanner were also tested in a brain from a freshly euthanized female pig. RESULTS Testing in porcine brains confirmed the multiport endoscope's ability to visualize tissue in a blood-filled field and to operate inside a 3-T MRI scanner. Cadaver testing confirmed the device's utility in operating through both of its ports and performing combined third ventricular colloid cyst resection and septostomy with an endoscope rotation of less than 5°. CONCLUSIONS The proposed design provides freedom in selecting both the number and orientation of imaging and instrument ports, which can be customized for each ventricular pathological entity. The lightweight, easily manipulated device can provide added steerability while reducing the potential for the serious brain distortion that happens with rigid endoscope navigation. This capability would be particularly valuable in treating hydrocephalus, both primary and secondary (due to tumors, cysts, and so forth). Magnetic resonance compatibility can aid in endoscope-assisted ventricular aqueductal plasty and stenting, the management of multiloculated complex hydrocephalus, and postinflammatory hydrocephalus in which scarring obscures the ventricular anatomy.

Flexible Endoscopic Aspiration for Intraventricular Casting Hematoma.

BACKGROUND: Conventionally, patients suffering a massive intraventricular hemorrhage have undergone external ventricular drainage. However, long-term or repeated drainage increases the risk of complications due to infections or shunt dependency. Neuroendoscopic surgery may offer some advantages over more conventional procedures. METHODS: Thirteen patients suffering intraventricular hematoma associated with intracerebral hemorrhage, treated in our hospital between April 2011 and March 2014, were reviewed retrospectively. Casting hematomas in the ventricles were manually aspirated using a flexible endoscope. The timing of the operation, period of post-endoscopic ventricular drainage, additional internal shunt surgery, 3-month post-surgical outcome, and critical complications were evaluated. RESULTS: Two patients (treated during our earliest use of endoscope) who underwent surgery on the 7th and 16th day post-onset required subsequent cerebrospinal shunt surgery. In contrast, of the 11 patients who underwent endoscopic surgery on the day of onset, only 1 patient required an additional, third ventriculostomy due to a secondary obstruction of the aqueduct by adhesive fibrous membranes. After 3 months, all six patients with mRS scores of 2-3 satisfied all the following criteria: initial Glasgow Coma Scale scores higher than 8, flexible endoscopic surgeries performed on the day of onset, and period of ventricular drainage of less than 4 days. CONCLUSIONS: Early surgical intervention using a flexible endoscope and short period of post-surgical drainage can be highly effective for patients suffering from casting intraventricular hematomas associated with intracerebral hemorrhage. The advantages of this treatment may be a less invasive procedure, ICP control in the acute phase, breaking away from ventricular drainage in the early stage, and prevention of hydrocephalus or intracranial infectious complications in the long term.

Estalishing a new system of extended Chinese pattern differetiation method by endoscope / 国际中医中药杂志

The aim of extended Chinese pattern differetiation method by endoscope is to establish the new system of five methods for clinical Chinese pattern differetiation system. There were two modes of the new system: the first mode is a purely Chinese pattern differentiation of inspectioin of the mucosa by endoscope, and the other mode combines the TCM four methods (inspection, listening and smelling, interrogation, pulse feeling and palpation) with endoscopic inspection method to establish the extended Chinese pattern differentiation mode by endoscope. Key technology was that: (1) how to compare the traditional four methods with the new five methods in clinic; (2) how to set up the criteria and classification of extended Chinese pattern differentiation by endoscope mode; (3) How to improve the new system with the feedback of effect of extended Chinese pattern differentiation by endoscope mode. The new system was regarded as innovative in the fields of clinical practice, TCM theory and application, and it was believed that it would promote TCM in the process of modernaization.

Catheter-free method is sufficient for preparation for transnasal endoscopy: randomized controlled trial.

BACKGROUND AND AIM: Although transnasal endoscopy (TNE) is generally a comfortable and safe procedure, it has some disadvantages, such as complicated preprocessing and occasional repulsion reaction during catheterization. In an attempt to simplify the preprocessing method, the efficacy of a catheter-free method in which a catheter is not inserted into the nasal cavity was assessed. METHODS: The present study was a prospective, open-label, single-center, randomized controlled study with parallel assignment allocation 1:1. Between March 2009 and August 2009, a total of 93 TNE-naïve patients were enrolled and randomized. Patients were prospectively randomized into two groups (catheter-free vs catheter-insertion method). Patients who prepared according to the catheter-free method and who were unsuccessful underwent the catheter-insertion method. Clinical characteristics, success rate, complications, vital signs, acceptability, and tolerability were assessed and compared. RESULTS: Success rates of the catheter-free and catheter-insertion methods were 88% (n=44) and 88% (n=38) (P>0.05), respectively. Causes of failure in the catheter-free method included severe rhinalgia (n=1, 2%) and narrowing of the nasal cavity (n=5, 10%). Causes of failure in the catheter-insertion method included narrowing of the nasal cavity (n=5, 11%). Six patients whose TNE failed with the catheter-free method also experienced failed TNE with the catheter-insertion method. There were no statistical differences in vital signs, acceptability, and tolerability. CONCLUSION: The catheter-free method is sufficient for preparation for TNE. The success rate of TNE depends more on the structure of the nasal cavity than the preprocessing method.