Value of the Application of Neuroendoscope in the Treatment of Ventriculoperitoneal Shunt Blockage.

OBJECTIVE: To explore the value of the application of neuroendoscopy techniques in the treatment of ventriculoperitoneal (VP) shunt blockage. METHODS: Our study included 3 plans for revision surgeries for VP shunt blockage. In plan A, the choroid plexus or ependyma growing inside the ventricular catheter was completely removed. In plan B, the terminal part of the ventricular catheter was clipped and removed. In plan C, the ventricular catheter was carefully extracted with the aid of neuroendoscopy, and the tissues blocking the catheter were removed. The ventricular catheter was then reinserted into the lateral ventricle. RESULTS: The side holes of the tube may be blocked by cerebral tissue, granulation tissue, newly formed blood vessels, choroid plexus, or ependyma. Five patients successfully underwent plan A revision surgery, 8 patients underwent plan B revision surgery, and the remaining 22 patients underwent plan C revision surgery. After the operation, 34 patients experienced relief of symptoms of elevated intracranial pressure. In all patients, the shunt obstruction was resolved. CONCLUSIONS: Neuroendoscopy techniques can be used to reveal the various causes of shunt obstruction. Any attempt to extract the tube should be performed with the aid of a neuroendoscope. The 3 surgical revision strategies for a blocked catheter are described for the first time in the literature. These approaches can reduce the operation time, the incidence of intraventricular hemorrhage, and the risk of infection.

Does the Simultaneous Use of a Neuroendoscope Influence the Incidence of Ventriculoperitoneal Shunt Infection?

BACKGROUND: The relationship between the use of an endoscope during ventriculoperitoneal shunt (VPS) procedures and infection remains poorly defined. In this study, we sought to analyze whether the simultaneous use of an endoscope could in fact increase the infection rate associated with VPS procedures. METHODS: This study included 438 VPS procedures, 49 in which an endoscope was used (11.2%) and 389 in which an endoscope was not used (88.8%). The infection rates in these 2 main groups were calculated and compared. Subsequently, 4 new groups were created, composed of patients with a shunt inserted for the first time (groups 1A and 1B) and patients with a shunt reviewed or inserted for a second time (groups 2A and 2B). Groups 1A and 2A comprised patients in whom an endoscope was used simultaneously with VPS surgery, and groups 1B and 2B comprised patients in whom an endoscope was not used. These groups were compared to determine the infection rate. RESULTS: The overall infection rate was 18.5%, including 22.4% in the groups in which an endoscope was used and 18% in those in which an endoscope was not used (P = 0.449). Groups 1A and 1B and groups 2A and 2B were matched for possible intervening risk factors. The infection rate was 28.6% in group 1A and 16.2% in group 1B (P = 0.27), and 20% in group 2A and 19.8% in group 2B (P = 0.977). CONCLUSIONS: In the present study, the use of an endoscope during VPS procedures did not increase the risk of surgical infection.

Required Reading: The Most Impactful Articles in Endoscopic Endonasal Skull Base Surgery.

OBJECTIVE: Endoscopic endonasal skull base surgery has become widely accepted in neurosurgery and otolaryngology over the last 15 years. However, there has yet to be a formal curation of the most impactful articles for an introductory curriculum to its technical evolution. METHODS: The Science Citation Index Expanded was used to generate a citation rank list (October 2015) on articles relevant to endoscopic skull base surgery. The top 35 cited articles overall, as well as the top 15 since 2009, were identified. Journal, year, author, study population, article format, and level of evidence were compiled. Additional surgeon experts were polled and made recommendations for significant contributions to the literature. RESULTS: The top 35 publications ranged from 98 to 467 citations and were published in 10 different journals. Four articles had more than 250 citations. A period of frequent contribution occurred between 2005 and 2009, when 21/35 reports were published. 18/35 articles were case series, and 13/35 were technical reports. There were 11/35 articles focused primarily on pituitary surgery and 10/35 on extrasellar lesions. The top 15 articles since 2009 had 8/15 articles focused on extrasellar lesions. Polled surgeons consistently identified the most prominently cited articles, and their recommendations drew attention to cerebrospinal fluid leak as well as extrasellar management. CONCLUSIONS: Identification of the most cited works within endoscopic endonasal skull base surgery shows greater anatomic access and safety over the last 2 decades. These articles can serve as an educational tool for novices or midlevel practitioners wishing to obtain a greater understanding of the field.

[Shifting paradigm in skull base surgery: Roots, current state of the art and future trends of endonasal endoscopic approaches]. / Chirurgie endoscopique endonasale des tumeurs de la base du crane : historique, état de l'art et perspectives d'avenir.

During the last two decades, endoscopic endonasal approach has completed the minimally invasive skull base surgery armamentarium. Endoscopic endonasal skull base surgery (EESBS) was initially developed in the field of pituitary adenomas, and gained an increasing place for the treatment of a wide variety of skull base pathologies, extending on the midline from crista galli process to the occipitocervical junction and laterally to the parasellar areas and petroclival apex. Until now, most studies are retrospective and lack sufficient methodological quality to confirm whether the endoscopic endonasal pituitary surgery has better results than the microsurgical trans-sphenoidal classical approach. The impressions of the expert teams show a trend toward better results for some pituitary adenomas with the endoscopic endonasal route, in terms of gross total resection rate and probably more comfortable postoperative course for the patient. Excepting intra- and suprasellar pituitary adenomas, EESBS seems useful for selected lesions extending onto the cavernous sinus and Meckel's cave but also for clival pathologies. Nevertheless, this infatuation toward endoscopic endonasal approaches has to be balanced with the critical issue of cerebrospinal fluid leaks, which constitutes actually the main limit of this approach. Through their experience and a review of the literature, the authors aim to present the state of the art of this approach as well as its limits.

German neuroendoscopy above the skull base.

Endoscopy plays an important part in current minimally invasive neurosurgery. The concepts, indications, and standards of current neuroendoscopy were developed in the beginning of the 1990s by several groups of neurosurgeons. Several factors contributed to its success and acceptance, including technical development, influence of other disciplines, and adaptation to neurosurgical requirements. This historical survey focuses on the period when this technique initially emerged, including the scientific discussions of each group as well as the arguments and reasons that led to present intraventricular neuroendoscopy. Interestingly, despite the almost independent development of neuroendoscopic systems and techniques, the available systems and techniques applied these days grossly correspond. Rigid rod-lens endoscopes are generally accepted as the best option among the various available instrument sets. Nevertheless, frameless as well as frame-based stereotactic endoscopy and flexible steerable endoscopes might have their applications as well.