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1.
World Neurosurg ; 136: e578-e585, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31958589

RESUMO

OBJECTIVE: To determine the rate and anatomical location of dural tears associated with spinal surgery using a percutaneous biportal endoscopic surgery (PBES) technique. We investigated the relationship between dural tears and the type of procedure and type of instrument used. METHODS: We retrospectively analyzed 643 PBES cases by reviewing the medical records, operative records, and operative videos. Incidental durotomy was identified in 29 cases. We analyzed the size and anatomical location of the dural tears, the surgical instrument that caused the tear, and the technique used to seal the tear. RESULTS: The dural tear incidence was 4.5% (29 of 643 cases). Tears in the exiting nerve area (2 cases; 6.9%) had mainly been caused by curettage, tears in the thecal sac area (18 cases; 62.1%) were associated with electric drill and forceps use; and tears in the traversing nerve area were associated with the use of a Kerrison punch (9 cases; 31%). Of the 29 cases of dural tear, 12 were treated with in-hospital monitoring and bed rest, 14 were treated with a fibrin sealant, 2 were treated with a nonpenetrating titanium clip, and 1 was converted to microscopic surgery. One case of postoperative meningocele after conservative treatment required endoscopic revision surgery to close the dural tear. CONCLUSIONS: Most cases of incidental dural tear during PBES were treated with an endoscopic procedure. The incidence of dural tear was no greater than that associated with microscopic surgery. Our management strategy for incidental dural tears during PBES has been shown to be safe and effective.


Assuntos
Dura-Máter/lesões , Neuroendoscopia/efeitos adversos , Coluna Vertebral/cirurgia , Dura-Máter/cirurgia , Feminino , Adesivo Tecidual de Fibrina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/instrumentação , Duração da Cirurgia , Estudos Retrospectivos , Instrumentos Cirúrgicos , Adesivos Teciduais/uso terapêutico
2.
World Neurosurg ; 133: e356-e368, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31521759

RESUMO

BACKGROUND: Intracranial aneurysms (IAs) located in the midline region represent formidable challenge owing to their deep location. The objective of this study was to assess feasibility and identify the limitations of endoscopic endonasal clipping of IAs. We further aimed to describe the locations and characteristics of aneurysms that may be amenable for endoscopic endonasal clipping; thus outlining the indications of these approaches. METHODS: Fifteen latex-injected cadaveric heads were used for endoscopic endonasal exposure of anterior and posterior cerebral circulations. An aneurysm simulator model with 2 different sizes was used at the common sites for IAs to emulate a real surgery. Key measured parameters included "exposure of vessels and their respective perforators," "ability to gain proximal/distal control," and "possibility of clip placement" according to the size, direction, and location of the aneurysm model. Maneuverability of instruments and the need for pituitary gland transposition were assessed and recorded as well. RESULTS: Exposure of the anterior communicating artery complex and the common sites of posterior circulation aneurysms were feasible. The size, location, and direction of the aneurysm model had an impact on obtaining proximal and/or distal control, and the ability of clip placement. CONCLUSIONS: Clipping of midline aneurysms of the posterior circulation is feasible via endoscopic endonasal approach. Small-sized ventrally and medially directed aneurysm models carried a better probability of getting proximal and/or distal control, as well as better overall ability to place a clip. The endonasal route seems to provide a limited condition for proper management of anterior circulation aneurysms.


Assuntos
Artérias Cerebrais/anatomia & histologia , Aneurisma Intracraniano/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Neuroendoscopia/métodos , Cadáver , Circulação Cerebrovascular , Estudos de Viabilidade , Humanos , Modelos Anatômicos , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural/instrumentação , Neuroendoscopia/instrumentação
3.
Neurosurg Clin N Am ; 30(4): 401-412, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31471047

RESUMO

Tumor recurrence in pituitary adenomas is as high as 20% after surgery. Conventional neuronavigation and white light visualization are not sufficiently accurate in detecting residual neoplastic tissue. Fluorescence-guided surgery offers accurate, real-time visualization of neoplastic tissue. The authors' group has explored the use of near-infrared imaging, which is superior to visible-light fluorescence in both signal contrast and tissue penetration, in transsphenoidal endoscopic surgeries for pituitary adenomas using 2 techniques: second window indocyanine green, in which indocyanine green passively accumulates in the tumor, and OTL38, which actively targets folate receptors on adenoma cells. This work establishes the foundation of intraoperative near-infrared imaging for fluorescence-guided neurosurgery.


Assuntos
Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Neuroendoscopia/métodos , Neuronavegação/métodos , Imagem Óptica/métodos , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Corantes Fluorescentes/administração & dosagem , Humanos , Processamento de Imagem Assistida por Computador , Verde de Indocianina/administração & dosagem , Período Intraoperatório , Neuroendoscopia/instrumentação , Resultado do Tratamento
4.
World Neurosurg ; 129: 24-27, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31426253

RESUMO

OBJECTIVE: Pediatric endoscopic endonasal surgery represents a still-growing discipline to approach complex skull base lesions and is characterized by unfavorable anatomical conditions. Children have very small nostrils and narrow rhinosinusal corridors, which could lead more easily to accidental injury to the nasal structures. We describe the use of a peel-away catheter introducer sheath as an innovative and minimally invasive technique to further reduce surgical trauma to the nasal mucosa and structures in pediatric rhinoneurosurgery. METHODS: From January 2009 to December 2018, the peel-away sheath technique was used in 6 pediatric endoscopic procedures for biopsy and/or removal of skull base tumors. RESULTS: The endoscopic technique with the use of the peel-away catheter allowed clear visualization of the surgical field during the whole course of the procedure and good surgical maneuverability. The use of the peel-away sheath did not prolong the surgical operation time and provided a good working channel. No intraoperative or postoperative major complications were observed. No nasal short-term complications were registered in all patients. CONCLUSIONS: The use of a peel-away catheter introducer sheath technique represents a valid adjunct in the endoscopic pediatric skull base surgery repertoire. It can help in avoiding inadvertent surgical traumas to the sinonasal structures, especially by residents and junior surgeons. This could potentially reduce postoperative nasal morbidity.


Assuntos
Neuroendoscopia/instrumentação , Neoplasias da Base do Crânio/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural/instrumentação
5.
World Neurosurg ; 130: 77-83, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31279105

RESUMO

BACKGROUND: Neurocysticercosis, caused by the larval form of the tapeworm Taenia solium, is the most common parasitic disease affecting the human central nervous system. The incidence of spinal neurocysticercosis in endemic regions ranges from 0.25% to 5.85%. Surgery is preferred when medical treatment fails to achieve control of the symptoms or when multiple cysts are present. METHODS: We describe the use of spinal flexible endoscopy for patients with spinal neurocysticercosis who failed to achieve control with standard treatment. Three patients with limb weakness and pain underwent a midline interspinous approach at the L5-S1 level to access the lumbar cistern. The flexible endoscope was introduced, the subarachnoid space was inspected, and the cysticerci were extracted. In 1 patient with cervical subarachnoid blockage, a 3-cm suboccipital craniotomy and removal of the posterior arch of C1 were performed to place a subarachnoid-to-subarachnoid catheter going from the craniocervical junction to the thoracic region. RESULTS: Removal of the cysticerci was possible in all cases. No complications related to the surgery were observed. All patients received medical treatment for 2-3 months, and all symptoms were solved. CONCLUSIONS: Flexible spinal endoscopy is a feasible and valuable tool in patients with spinal neurocysticercosis that do not respond adequately to standard treatment. It helps restore cerebrospinal fluid dynamics and can be used to place shunt catheters under guided vision. Longer endoscopes are needed to explore the entire spinal subarachnoid space with a single approach, and more research in this area is needed.


Assuntos
Neurocisticercose/diagnóstico por imagem , Neurocisticercose/cirurgia , Neuroendoscopia/métodos , Maleabilidade , Medula Espinal/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Neuroendoscopia/instrumentação , Adulto Jovem
6.
World Neurosurg ; 131: 339-345, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31284061

RESUMO

Cylindrical tubular ports are among the most innovative dynamic tools added to the neurosurgery armamentarium. The rationale behind the use of tubular systems lies in the knowledge that damage to surrounding tissues is minimized with the equal pressure exerted by the walls of the cylinder. A microscope or an endoscope is used for visualization in the tubular ports. Neuronavigation is an essential adjuvant to ensure avoiding injury to essential brain tracts and parenchyma. In the present report, we focused on 3 commonly used cylindrical retractor systems, including the ViewSite, BrainPath, and syringe port. The custom-made syringe port system is used by us and is cost effective. It costs only the price of a syringe. The efficacy and safety of tubular port systems have been shown in limited studies. The complications associated with the port system have been minimal, and injury to the brain has been reduced by the equal pressure exerted by the walls of the port.


Assuntos
Encefalopatias/cirurgia , Neuroendoscopia/instrumentação , Remoção de Dispositivo/métodos , Humanos , Imagem por Ressonância Magnética , Microcirurgia/instrumentação , Microcirurgia/métodos , Neuroendoscópios , Neuroendoscopia/métodos , Neuronavegação/instrumentação , Instrumentos Cirúrgicos , Seringas
7.
World Neurosurg ; 130: 98-105, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31226461

RESUMO

OBJECTIVE: To technically review and explore long-term follow-up results of aqueductoplasty and stenting under flexible neuroendoscopy in infantile obstructive hydrocephalus. METHODS: The clinical data, surgical techniques, and long-term effects in 14 infants with obstructive hydrocephalus treated by flexible neuroendoscopic aqueductoplasty and stenting between 2008 and 2010 were analyzed retrospectively. RESULTS: The 14 infants had a mean age of 5.71 ± 3.10 months (range, 2-11 months) and a mean duration of follow-up of 62.64 ± 34.52 months (range, 9-121 months). Subdural effusion was observed in 4 infants (28.6%) after surgery. There were no deaths or serious complications related to intracranial stent placement. Three infants (21.4%) failed, 2 due to proximal aqueduct occlusion from a short stent length and 1 due to intraluminal ependymal adhesion obstruction. One case was abandoned when a second surgical adjustment stent was unsuccessful, and the other 2 cases went to shunt surgery. CONCLUSIONS: Aqueductoplasty with stenting is a feasible and safe surgical procedure for treating infants with midbrain aqueduct stenosis or occlusion. However, the optimal stent material and definitive outcomes after this procedure require additional long-term follow-up studies in large numbers of infants.


Assuntos
Aqueduto do Mesencéfalo/cirurgia , Hidrocefalia/cirurgia , Neuroendoscopia/métodos , Maleabilidade , Stents , Aqueduto do Mesencéfalo/diagnóstico por imagem , Estudos de Coortes , Feminino , Seguimentos , Humanos , Hidrocefalia/diagnóstico por imagem , Lactente , Masculino , Neuroendoscopia/instrumentação , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
8.
World J Emerg Surg ; 14: 21, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31080494

RESUMO

Background: Minimally invasive endoscopic hematoma evacuation is widely used in the treatment of intracerebral hemorrhage. However, this technique still has room for improvement. The intra-neuroendoscopic technique (INET) is a modified minimally invasive technique, and we report its safety and efficacy in evacuating brain parenchyma hematomas by comparing it with cranial puncture and drainage operation (CPDO). Methods: The frontal, temporal, or occipital approaches were used according to the site of bleeding. The preoperative and postoperative hematoma volumes, Glasgow Coma Scale (GCS) score, Cerebral State Index (CSI), hematoma evacuation rate, operation time, complications, and 30-day mortality and Glasgow Outcome Scale (GOS) were retrospectively compared between the two groups. Results: A total of 98 patients were enrolled. The evacuation rate (84 ± 7.1% versus 51.0 ± 8.4%, p = 0.00), 7-day GCS (11.8 ± 1.2 versus 10.4 ± 1.5, p = 0.01), and CSI (87.1 ± 8.7 versus 80.6 ± 10.2, p = 0.02) were higher, and the 30-day mortality rate (1.9% versus 15.6%, p = 0.036) was lower in the INET group. However, the operation time was longer in the INET group than in the control group (65.2 ± 12.5 min versus 45.6 ± 10.9 min, p = 0.000). Multivariable logistic regression showed that a good medium-term outcome (GOS scores 4-5) was significantly associated with INET (odds ratio (OR) 3.514, 95% confidence interval (CI) 1.463-8.440, p = 0.005), age under 65 years (OR 1.402, 95% CI, 1.041-1.888, p = 0.026), and hematoma volume less than 50 ml (OR 1.974, 95% CI 1.302-2.993, p = 0.001). Conclusions: INET surgery for brain parenchyma hematoma evacuation is a safe and efficient modified technique. This technique is minimally invasive, has less complications, and may be helpful in providing optimal outcomes for selected patients. Trial registration: ClinicalTrials.gov, NCT02515903. Registered on 5 August 2015.


Assuntos
Hemorragia Cerebral/cirurgia , Neuroendoscopia/métodos , Idoso , Encéfalo/fisiopatologia , Encéfalo/cirurgia , Drenagem/métodos , Drenagem/tendências , Feminino , Escala de Coma de Glasgow/estatística & dados numéricos , Hematoma/cirurgia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Neuroendoscópios , Neuroendoscopia/instrumentação , Neuroendoscopia/tendências , Resultado do Tratamento
9.
World Neurosurg ; 129: e35-e39, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31042595

RESUMO

BACKGROUND: Spontaneous intracranial hemorrhage (ICH) of the cerebellum can be life threatening because of mass effect on the brainstem and fourth ventricle. Suboccipital craniectomy is currently the treatment of choice for cerebellar ICH evacuation. Minimally invasive surgery (MIS) is currently being investigated for the treatment of supratentorial ICH. However, its utility for cerebellar ICH is unknown. The aim of this multicenter, retrospective cohort study is to evaluate the outcomes of MIS for cerebellar ICH. METHODS: We retrospectively reviewed the records of all patients with cerebellar ICH who underwent MIS using either the Apollo or Artemis Neuro Evacuation Device (Penumbra Inc., Alameda, California, USA) at 3 institutions from May 2015 to July 2018. Data from each contributing center were deidentified and pooled for analysis. RESULTS: The study cohort comprised 6 patients with a median age of 62.5 years. The median pre- and postoperative Glasgow Coma Scale scores were 10.5 and 15, respectively. The median degree of hematoma evacuation was 97.5% (range, 79%-100%). There were no procedural complications, but 1 patient required subsequent craniectomy (retreatment rate 17%). The median discharge modified Rankin scale score was 4, including 3 patients who improved to functional independence at follow-up durations of 3 months. Two patients died from medical complications (mortality rate 33%). CONCLUSIONS: MIS could represent a reasonable alternative to conventional surgery for the treatment of appropriately selected patients with cerebellar ICH. However, further studies are needed to clarify the perioperative and long-term risk to benefit profiles of this technique.


Assuntos
Doenças Cerebelares/cirurgia , Drenagem/instrumentação , Hemorragias Intracranianas/cirurgia , Neuroendoscopia/instrumentação , Idoso , Cerebelo/cirurgia , Estudos de Coortes , Drenagem/métodos , Feminino , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/métodos , Neuronavegação/métodos , Estudos Retrospectivos
10.
World Neurosurg ; 127: 146-149, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30954749

RESUMO

BACKGROUND: We describe a modified endoscopic diving technique with an alternative irrigation system different than the one used by Locatelli et al. (CLEARVISION II, Karl Storz and Co., Tuttlingen, Germany). METHODS: From January 2016 to October 2018, our senior surgeon performed the modified endoscopic diving technique in 76 endoscopic surgical procedures. Diving surgery was performed in all procedures to check the completeness of tumor resection, thus allowing for the removal of any residual tumor tissue. RESULTS: In the modified endoscopic diving technique, the optic system and the irrigation source are separated into 2 independent tools, allowing surgeons to point the flow on a selected structure, whereas the endoscope can be pointed in the same direction or not. Moreover, the optic system and the irrigation source can be placed at different distances. Surgeons can control the infusion pressure and the entity of the flow. CONCLUSIONS: The use of the modified endoscopic diving technique allows surgeons to have more settings that could be controlled and also bypasses any compatibility issues between different endoscopic systems. In addition, the reproducibility of this technique, together with the low cost of the instrumentation, could allow an easier application of the diving technique.


Assuntos
Neuroendoscopia/instrumentação , Neuroendoscopia/métodos , Base do Crânio/cirurgia , Humanos , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/métodos , Base do Crânio/diagnóstico por imagem , Irrigação Terapêutica/instrumentação , Irrigação Terapêutica/métodos
11.
World Neurosurg ; 126: e1302-e1308, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30898754

RESUMO

BACKGROUND: Entrapment neuropathies include a wide field of locations. In most cases, the microsurgical decompression is still the therapy of choice. However, the role of venous stasis and ischemia is still discussed controversially. Here the authors evaluated the visualization of microvessels and the microperfusion at peripheral nerves with a contact endoscope during the surgical decompression for the first time. METHODS: Eight patients were subjected to endoscopic or endoscopically assisted peripheral nerve decompression. In 3 patients with nerve tumors, the tumor carrying nerve was inspected endoscopically proximal and distal to the tumor site before and after resection. Microcirculation was assessed by a contact endoscope, allowing a 150-fold magnification, at superficial areas proximal and distal to the compression site. The electronically stored records were analyzed retrospectively using image processing software. Vessel diameter, red blood cell velocity, and blood flow, before and after decompression, were extracted. RESULTS: The contact endoscope was easy to handle intraoperatively without problems. All minimally invasive procedures were performed without complications. In the offline computer-assisted analysis, single arterioles and veins were visualized showing decreased red blood cell velocity prior to decompression. After surgical treatment, a statistically significant increase of blood flow was observed. CONCLUSIONS: Basically, the application of a contact endoscope for visualization of peripheral nerves' microcirculation is feasible. The observed effect of increased blood flow after decompression should be compared with the clinical outcome in a further prospective randomized study.


Assuntos
Síndromes de Compressão Nervosa/cirurgia , Neuroendoscopia/instrumentação , Neuroendoscopia/métodos , Nervos Periféricos/irrigação sanguínea , Adulto , Idoso , Descompressão Cirúrgica/instrumentação , Descompressão Cirúrgica/métodos , Endoscópios , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Nervos Periféricos/cirurgia
12.
World Neurosurg ; 125: e978-e983, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30763750

RESUMO

OBJECTIVE: Three-dimensional (3D), high-definition (HD) endoscopy has been recently introduced in neurosurgery, and its value has been discussed extensively in endonasal skull base surgery. Because there has been no reported clinical series on the use of a recent 3D-HD ventriculoscope, the aim of this study was to describe our initial experience with this novel device. METHODS: Patients consecutively operated on from June 2016 to June 2018 with a 3D-HD ventriculoscope were prospectively collected. The system is a 6-mm, 0-degree optic with a 105-degree field of view, with a central working channel of 2.2-mm diameter and 2 side channels of 1.3-mm diameter. Patients' demographic data, preoperative symptoms, and neurologic status; neuroradiologic data; type of surgery; operative time; intraoperative and postoperative complications, and follow-up data were prospectively recorded and retrospectively reviewed. RESULTS: Twenty-four patients (age range: 3-84 years) underwent 25 procedures including endoscopic third ventriculocisternostomy, biopsy, and cyst fenestration. The technical goal of surgery was obtained in all patients. There were no intraoperative complications, expect for 1 intraoperative epileptic seizure. Postoperative complications included asymptomatic subdural collections in 2 patients, infection, and delayed endoscopic third ventriculocisternostomy closure in 1 patient each. Relative limits of the system are its size and the availability of only a 0-degree optic. Image quality appeared satisfactory in all procedures. The lack of a dedicated introducer was resolved, exploiting a vascular "peel-away" system. CONCLUSIONS: 3D-HD technology seems to provide potential advantages in ventricular surgery. This initial experience is promising but must be confirmed by larger series.


Assuntos
Ventrículos Cerebrais/cirurgia , Imageamento Tridimensional/instrumentação , Imageamento Tridimensional/métodos , Neuroendoscopia/instrumentação , Neuroendoscopia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
13.
World Neurosurg ; 126: 647-655.e7, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30776512

RESUMO

OBJECTIVE: The aim of this study was to compare the efficacy and safety of endoscopic microvascular decompression (E-MVD) and microscopic microvascular decompression (M-MVD) for the treatment for cranial nerve syndrome caused by vascular compression, including primary trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia. METHODS: A systematic search of the online databases, including PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, China Biology Medicine disc, and China National Knowledge Infrastructure, was performed from January 1966 to March 2018. The language of the included literature was not limited. Relevant outcomes of perioperative safety and postoperative efficacy were considered for meta-analysis. Single-arm and cumulative meta-analyses were also conducted. All the outcomes were calculated as odds ratios (ORs) with 95% confidence intervals using R language. RESULTS: A total of 9 studies involving 1093 (E-MVD [543] vs. M-MVD [550]) patients were included for analysis in our study. The recent remission rate (92% vs. 86%; OR, 1.71; P = 0.0089), offending vessel discovery rate (99% vs. 95%; OR 2.76, P = 0.0061), and long-term remission rate (97% vs. 87%; OR 4.59, P = 0.0036) were significantly higher in patients who underwent E-MVD than in those who underwent M-MVD, whereas perioperative complications (23% vs. 35%; OR 0.56, P < 0.0001) were significantly lower in patients who underwent E-MVD. CONCLUSIONS: This meta-analysis confirms that E-MVD is superior to M-MVD both in perioperative and postoperative efficacy (short- and long-term), and therefore it should be considered as an appropriate treatment choice for patients with neuralgia and hemifacial spasm.


Assuntos
Doenças dos Nervos Cranianos/cirurgia , Microcirurgia/métodos , Cirurgia de Descompressão Microvascular/métodos , Síndromes de Compressão Nervosa/cirurgia , Neuroendoscopia/métodos , Doenças do Nervo Glossofaríngeo/cirurgia , Espasmo Hemifacial/cirurgia , Humanos , Microcirurgia/instrumentação , Cirurgia de Descompressão Microvascular/instrumentação , Neuroendoscopia/instrumentação , Resultado do Tratamento , Neuralgia do Trigêmeo/cirurgia
14.
World Neurosurg ; 125: e361-e371, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30703594

RESUMO

OBJECTIVE: For effective minimally invasive lumbar decompression, we changed the routine of segmental decompression. Using a high-speed drill or an ultrasound knife, we created a working channel, starting at the base of the spinous process of the upper vertebra slightly above the disc level, to target and decompress the contralateral recess, and termed it the translaminar crossover decompression (TCD). We evaluated the feasibility and compared the outcomes of a navigation-guided endoscopic translaminar crossover approach for segmental decompression (eTCD) in elderly patients with microscopic decompression using the same approach (mTCD). METHODS: A total of 740 elderly patients were enrolled in a prospective cohort study. Of the 740 patients, 297, who had undergone mTCD, and 253, who had undergone eTCD, completed a 1-year follow-up visit. In addition to the surgical data, numerical rating scales (NRSs) for back and leg pain, the Core Outcome Measures Index and Oswestry Disability Index were recorded preoperatively and 3, 6, and 12 months after surgery. The MacNab criteria were supplemented by qualitative assessment of the patients' postoperative pain-free walking distance. RESULTS: A comparison of the preoperative and postoperative clinical scores showed significant improvement after TCD in both cohorts (P < 0.01): Oswestry Disability Index, from 50.3% ± 12.6% to 15.5% ± 7.43%; NRS (back), from 6.9 ± 1.9 to 2.5 ± 1.3; NRS (leg), from 8.0 ± 0.85 to 1.6 ± 0.33; Core Outcome Measures Index (back), from 7.8 ± 2.0 to 2.7 ± 1.5. No statistically significant differences were found in the outcomes between the 2 cohorts. CONCLUSIONS: TCD inherently eliminated central stenosis and facilitated decompression of both recesses via mutual undercutting, with preservation of facet joint integrity.


Assuntos
Descompressão Cirúrgica/métodos , Neuroendoscopia/métodos , Estenose Espinal/cirurgia , Idoso , Dor nas Costas/etiologia , Dor nas Costas/cirurgia , Descompressão Cirúrgica/instrumentação , Avaliação da Deficiência , Desenho de Equipamento , Feminino , Humanos , Claudicação Intermitente/etiologia , Claudicação Intermitente/cirurgia , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética , Masculino , Microcirurgia/instrumentação , Microcirurgia/métodos , Neuroendoscopia/instrumentação , Neuronavegação/instrumentação , Neuronavegação/métodos , Estudos Prospectivos , Tomografia Computadorizada por Raios X
15.
World Neurosurg ; 126: e208-e218, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30797910

RESUMO

OBJECTIVE: Frame-based stereotaxy represents the gold standard for biopsy of deep-seated lesions. Visual control of possible bleeding in these lesions is not possible. Neuroendoscopic biopsy represents an alternative procedure for tissue sampling in deep-seated intraventricular lesions. The authors present a technique for transventricular-navigated endoscopic biopsy of lesions that are located in the paraventricular region. METHODS: Biopsy of paraventricular pathologies was performed in 6 male and 6 female patients between March 2013 and September 2018. The patient age ranged from 18 to 82 years. All patients underwent a pure endoscopic procedure over a burr hole trepanation supported by frameless navigation of the sedan probe. RESULTS: Histologic diagnoses were established in all biopsies. In all patients, a direct control of the biopsy area was feasible, and hemostasis could be obtained. In 5 patients, endoscopic third ventriculostomy was performed first due to obstructive hydrocephalus. In 1 patient suffering from obstructive hydrocephalus, a pellucidotomy was performed. In 9 cases, the initial postoperative course was uneventful. Three patients suffered from persistent hydrocephalus and had to be treated with ventriculoperitoneal shunt insertion. CONCLUSIONS: Endoscopically conducted biopsies with the aid of navigated tracking of the probe represent a possible additional technique in selected paraventricular intraparenchymal pathologies. The endoscopic approach enables the direct visualization of the intraventricular surface and its vessels. In contrast to standard stereotactic biopsy, direct visual control of hemostasis can be obtained even in paraventricular tumors.


Assuntos
Biópsia por Agulha/métodos , Neoplasias do Ventrículo Cerebral/patologia , Neuroendoscopia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/instrumentação , Neoplasias do Ventrículo Cerebral/diagnóstico , Feminino , Humanos , Hidrocefalia/patologia , Hidrocefalia/cirurgia , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/instrumentação , Neuronavegação/instrumentação , Neuronavegação/métodos , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/métodos , Técnicas Estereotáxicas , Terceiro Ventrículo/patologia , Terceiro Ventrículo/cirurgia , Trepanação , Derivação Ventriculoperitoneal , Ventriculostomia , Adulto Jovem
16.
Acta Neurochir Suppl ; 125: 165-169, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30610318

RESUMO

The far lateral approach (FLA) is a technique performed nowadays to gain access to and remove intradural lesions located ventrolaterally to the brainstem and to the craniovertebral junction (CVJ).


Assuntos
Tronco Encefálico/cirurgia , Neuroendoscopia , Neuronavegação , Cadáver , Vértebras Cervicais/cirurgia , Humanos , Neuroendoscopia/instrumentação , Crânio/cirurgia
17.
World Neurosurg ; 122: 638-647, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30481620

RESUMO

BACKGROUND: Although the incidence of intracerebral hemorrhage (ICH) has appeared to be increasing over the years, its prognosis remains dismal. No consensus has yet been reached regarding the management of ICH; however, minimally invasive surgery should limit, if not avoid, intraoperative parenchymal damage. Therefore, we have presented a novel, modified "homemade" approach aimed to shorten the operative time and minimize the corticectomy and brain manipulation. METHODS: From 2008 to 2017, 53 patients (32 men and 21 women; mean age, 63.8 years) were admitted to our neurosurgery department and surgically treated for a lobar ICH. A modified suction tube, coupled with the endoscope light source, was used. Clot evacuation was performed under loupe magnification without the use of the microscope or endoscope. The light source of the latter was only used to provide light in the working cavity. RESULTS: The mean hematoma volume was 69.2 mL (range, 40-100) preoperatively and 12.1 mL (range, 0-20) postoperatively, with a mean clot evacuation of 84.3% (range, 60%-100%). The mean postoperative Glasgow coma scale score was 11.6, with an improvement of 14% from the admission score (mean, 9.2). CONCLUSIONS: The results from our clinical series have shown the effectiveness of endoscopic clot evacuation in surgical ICH. In addition, we have demonstrated an efficient technique that can be used in urgent cases and in less-developed areas owing to its reduced demand on resources and its shorter learning curve. The outcomes were good and comparable to those with the classical endoscopic approach.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/cirurgia , Gerenciamento Clínico , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Neuroendoscopia/métodos , Idoso , Pessoas Famosas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Neuroendoscopia/instrumentação
18.
World Neurosurg ; 122: e81-e88, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30244186

RESUMO

OBJECTIVE: To present the clinical experience of 2 neurosurgical centers with the use of a 2-micron continuous-wave laser (2µ-cwL) system as standard tool in neuroendoscopic procedures and to discuss the safety and efficacy of this system. METHODS: In total, 469 patients underwent neuroendoscopic procedures using 2µ-cwL between September 2009 and January 2015. All patient data were retrospectively reviewed. In total, 241 (51%) patients were children and 228 (49%) adults. Mean age was 27.5 years (range: 3 days to 83 years). Intraoperative ultrasonography or neuronavigation were used to guide ventricular or cyst puncture and for intraventricular or intracystic orientation if necessary. RESULTS: A total of 524 neuroendoscopic procedures using 2µ-cwL were performed. Laser-assisted endoscopic third ventriculostomy was the most common procedure in 302 (64%) patients. Cyst fenestration was performed in 124 (26%), septostomy in 45, tumor biopsy in 41, tumor resection in 8, and choroid plexus coagulation in 3 patients. There was no intraoperative complication directly attributable to the use of laser and an overall procedural complication rate of 4.8%. CONCLUSIONS: This large series of 2µ-cwL as a routine tool in neuroendoscopic procedures demonstrates that 2µ-cwL is safe for endoscopic third ventriculostomy, septostomy, cyst fenestration, and intraventricular tumor biopsy or resection. As a cutting and coagulation tool, it combines the action of mechanical tools like forceps, balloons, and scissors plus those of electric tools. It therefore renders neuroendoscopic procedures more straightforward with a minimum need to change tools.


Assuntos
Terapia a Laser/instrumentação , Neuroendoscopia/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Lasers , Masculino , Pessoa de Meia-Idade , Neuronavegação , Estudos Retrospectivos , Ultrassonografia de Intervenção , Adulto Jovem
19.
Neurosurg Rev ; 42(4): 973-982, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30019320

RESUMO

Surgery for intraventricular tumors remains a controversial and evolving field, with endoscopic resection becoming more popular. We present a series of nine consecutive cases of purely endoscopic resection of intraventricular tumors with the aid of an ultrasonic aspirator specific for neuroendoscopy. Nine patients (five men, four women) aged 18-74 years (mean 43.7) underwent surgery. The most common symptom was headache. In all cases, magnetic resonance imaging showed single supratentorial intraventricular lesions (five lateral ventricle, four third ventricle). The average maximum diameter was 20.5 mm (range 11-42). Associated hydrocephalus was found in eight cases at diagnosis. Five patients underwent complete macroscopic resection. Three underwent subtotal resection and one underwent partial resection (two thirds of the tumor). The mean endoscopic procedure time was 70 min (37-209). The eight patients with associated hydrocephalus also underwent endoscopic septostomy to improve cerebral spinal fluid circulation, with one patient additionally requiring endoscopic third ventriculostomy and another requiring Monro foraminoplasty. One patient required ventriculoperitoneal shunting. The mean post-operative follow-up was 15.1 months (range 2-33). At the time of analysis, no patient showed recurrence or regrowth of the operated lesion. The histological diagnoses and degree of resection were three subependymomas with complete resection, three colloid cysts with two complete and one subtotal resection, one pilocytic astrocytoma with partial resection (approximately two thirds of the lesion), one epidermoid tumor with subtotal resection, and one central neurocytoma with subtotal resection. The endoscopic ultrasonic surgical aspirator can be a safe and effective tool for the removal of intraventricular tumors, even in firmer solid lesions.


Assuntos
Astrocitoma/terapia , Neoplasias do Ventrículo Cerebral/cirurgia , Cistos Coloides/cirurgia , Neuroendoscopia/instrumentação , Procedimentos Cirúrgicos Ultrassônicos/instrumentação , Ventriculostomia/instrumentação , Adolescente , Adulto , Idoso , Astrocitoma/patologia , Estudos de Coortes , Feminino , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/métodos , Terceiro Ventrículo/cirurgia , Ventriculostomia/métodos , Adulto Jovem
20.
Brain Inj ; 32(9): 1142-1148, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29889578

RESUMO

BACKGROUND: Minimally invasive endoscopic haematoma evacuation is widely used in the treatment of intraventricular haemorrhage. However, its technique still has room for improvement. A new modified neuroendoscope technology (MNT) was used in this study and we explored its safety and efficacy in the treatment of severe acute intraventricular haemorrhage by comparing it with extraventricular drainage plus urokinase thrombolytic (EVD + UT) therapy. METHODS: The following parameters were compared between the MNT group and the control group: incision design, operation time, ICU monitoring time, ventricular drainage tube (VDT) placement time, post-operative drainage tube obstruction (PDTO) rate, post-operative complications rate, 6-month mortality and Glasgow Outcome Scale (GOS). RESULTS: A total of 85 patients were enrolled. The ICU monitoring times, VDT placement times, PDTO rate were shorter in the MNT group. Multivariable logistic regression identified that good medium-term outcome (GOS scores 4-5) was significantly associated with MNT applied (OR 1.017, 95% CI 1.005-1.029, p = 0.008), age under 65 years (OR 4.223, 95% CI, 1.322-17.109, p = 0.034) and pre-operation GCS scores more than 10 (OR 3.427, 95% CI 1.048-11.205, p = 0.040). CONCLUSION: MNT surgery for severe intraventricular haematoma evacuation is a safe and efficient new surgical option. This technique is minimally invasive and may be helpful to provide good outcomes for selected patients.


Assuntos
Hemorragia Cerebral Intraventricular/cirurgia , Neuroendoscopia/métodos , Adolescente , Adulto , Idoso , Hemorragia Cerebral Intraventricular/diagnóstico por imagem , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/instrumentação , Neuroimagem , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
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