ABSTRACT
OBJECTIVE: To explore the therapeutic efficacies of endoscope for fourth ventricular outlet obstruction (FVOO). METHODS: Endoscopic third ventriculostomy (ETV) was performed for 30 cases. The circumstances of third ventricular floor and basal cistern were observed and recorded intra-operatively. Meanwhile the fourth ventricular exploration and fistulation were performed across enlarged aqueduct. And the velocity and flow rate of aqueduct, fourth ventricular outlet and stoma were evaluated post-operatively with Cine-MR (magnetic resonance). RESULTS: Standard ETV was performed successfully in 28 patients. Fourth ventricular exploration (n = 6) and outlet membrane fistulation (n = 2) were carried out. The mean follow-up period was 2.3 years (range: 0.5 - 4.0). The overall success rate was 78.6%. CONCLUSION: ETV is a viable therapeutic option for FVOO patients. The therapeutic effects of outlet membrane fistulation require further observations.
Subject(s)
Brain Diseases/surgery , Endoscopy , Fourth Ventricle , Ventriculostomy/methods , Adolescent , Child , Child, Preschool , Fourth Ventricle/pathology , Humans , Infant , Neurosurgical Procedures/methods , Treatment OutcomeABSTRACT
OBJECTIVE: To evaluate the method, strategy and efficacy of treating different types of quadrigeminal cistern arachnoid cysts (QCAC) with neuroendoscope. METHODS: A retrospective analysis was conducted for 12 QCAC patients with obstructive hydrocephalus. They were classified into 3 types and underwent neuroendoscopic operation at our hospital between November 2005 and November 2009. Their surgical approaches, complications and efficacy were analyzed. The mean age of first diagnosis was 3.7 years old. There were 7 type II cases and 5 type III cases with a varying level of symptoms. The follow-up period was 6 - 24 months. Cine-MRI (magnetic resonance imaging) examination was performed both preoperatively and post-operatively. RESULTS: Among them, 12 patients recovered well without any occurrence of hemorrhage, paralysis, lower cranial nerve injury, cerebrospinal fluid leakage, infection or death. Subdural effusion occurred in 3 cases, but disappeared within 6 months. Seven feverish cases recovered after a symptomatic treatment. The shapes of cysts and ventricles almost returned to a normal level in 8 cases. Three cases of arachnoid cyst had a slight change. CONCLUSION: In accordance with the QCAC patient types, different neuroendoscopic approaches can fully reconstruct the cerebrospinal fluid circulation. And the use of frameless navigation makes it more precise and safe.
Subject(s)
Arachnoid Cysts/classification , Arachnoid Cysts/surgery , Neuroendoscopy/methods , Adolescent , Child , Child, Preschool , Craniotomy/methods , Female , Humans , Infant , Male , Retrospective Studies , Tectum MesencephaliABSTRACT
OBJECTIVE: To explore the feasibility, operating technique and precautions of endoscopic microvascular decompression for trigeminal neuralgia. METHODS: A retrospective analysis was conducted for 21 patients with primary trigeminal neuralgia. All underwent neuroendoscopic microvascular decompression for trigeminal nerves. RESULTS: The pains disappeared upon awaking post-anesthesia in 19 patients. In 2 patients, pains became significantly alleviated and disappeared after taking carbamazepine for 1 - 3 months. No patient suffered the injuries of trigeminal nerve and other cranial nerves. None had cerebellum edema or death. During the follow-up period, there was no recurrence of pains. CONCLUSION: Neuroendoscopic surgery may accomplish microvascular decompression for trigeminal nerve independently. As a minimally invasive and effective technique, it offers a clearer vision of local anatomy and decreases the probability of damaging nerves and vessels. There is no need for pulling cerebellum. It brings minimal damage to normal brain tissue compared with microsurgery. Further popularization is warranted.
