Novel devices for intraoperative visualization in neurosurgical procedures: current state and prospect of using the exoscope

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Editorial "pituitary apoplexy-are visual deficits the only indication for emergent surgical intervention?"

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The minimally invasive transventricular endoscopic approach to third ventricular lesions in pediatric patients-all-rounder with limitations?

Introduction The surgical management of third ventricular lesions poses unique challenges, requiring careful consideration of various approaches and techniques. This study focuses on the transventricular transforaminal endoscopic approach and aims to provide insights into its indications, limitations, technical nuances, and potential complications in pediatric patients. Methods A retrospective analysis was conducted using data from a 13-year period on pediatric patients who were subjected to transforaminal endoscopic surgery for third ventricular lesions. The study utilized a prospectively maintained internal database, extracting demographic data, preoperative assessment, surgical details, and postoperative follow-up information. The surgical technique is presented in detail, and exemplary case reports highlight relevant surgical considerations. Results Out of 578 endoscopic transforaminal procedures, 24 surgeries were performed on pediatric patients with third ventricular lesions. Performed procedures consisted of cyst resection (13 cases), solid tumor resection (4 cases), and tumor biopsies with CSF pathway restoration (7 cases). The mean age at the time of surgery was 7.6 years. Postoperatively, 14 patients showed transient nausea and vomiting (58.3%); 10 patients showed pneumocephalus on postoperative MRI (41.7%). No emergency postoperative re-interventions nor perioperative mortality were observed. Conclusion The endoscopic transventricular transforaminal approach is a safe approach for lesion resection, CSF pathway restoration, and tumor biopsy in pediatric patients with third ventricle lesions. The author’s results support the use of this minimally invasive technique as an alternative to more extensive approaches, particularly to the interforniceal interhemispheric approach. However, surgical success is highly dependent to the individual surgeon’s experience and moreover to a suitable indication setting. Careful preoperative planning and knowledge of the approaches’ pro and cons is mandatory for successful application of this approach

Considerations on surgical strategies and associated risk profiles for endoscopic tumor biopsies within the third ventricle and periaqueductal region

Introduction Neuroendoscopic techniques have proven to be a successful and minimally-invasive technique for tumor biopsies within the third ventricle in pediatric patients. However, a comprehensive assessment of associated surgical strategies, techniques, and morbidity is essential to optimize patient outcomes. Methods This retrospective study analyzed full endoscopic tumor biopsies in pediatric patients with tumors in the third ventricle and periaqueductal region. Data from 1995 to 2022 were collected from medical records, imaging, and intraoperative video documentation. Results In this study, 16 shear endoscopic tumor biopsies were performed using the transventricular transforaminal approach. Tumors were located in the anterior or mid part of the third ventricle (50%) or in the periaqueductal and pineal recess region (50%). Preoperative hydrocephalus was seen in 81.25%. Tumor biopsies were harvested successfully in all cases. Simultaneous ETV was performed in 12 (75%) cases and additional septostomy in 3 (18.75%). Significant intraoperative bleeding occurred in 3 cases (18.75%). All bleeding situations could be successfully managed with continuous irrigation. Histopathology revealed astrocytoma as the predominant diagnosis (75%). No new neurologic deficits were observed, except for one case of transient oculomotor nerve paralysis after ETV. Hydrocephalus persisted in 18.6% of all cases with the need of urgent ventriculoperitoneal shunting in two patients. Conclusion In conclusion, neuroendoscopy emerges as an efective technique for tumor biopsies within the third ventricle in pediatric patients, ofering the added advantage of simultaneous treatment of obstructive hydrocephalus. However, it is essential to acknowledge the specifc intra- and postoperative risks associated with various surgical strategies. The safe management and achievement of favorable clinical results demand extensive experience and expertise

Presentation of the Success Rate of ETV in Distinct Indication Cases of Hydrocephalus

Endoscopic third ventriculostomy (ETV) is an endoscopic fenestration between the floor of the third ventricle and subarachnoid space. It is the procedure of choice for obstructive hydrocephalus (HC). The indication includes obstructive HC caused by aqueduct stenosis, tumors, brain infarction, cystic lesions, hematoma, postinfectious and posthemorrhagic HC, malformation of the fourth ventricle, and further uncommon indications. In this chapter, surgical techniques and the success rate of ETV in distinct indications will be presented and discussed. The overall success rate of ETV is reported at 60–90%. The outcome of the procedure depends highly on the underlying pathology and age. A very favorable outcome is reported in case of aqueduct stenosis (67–93.5%). High success rate is observed in case of cerebellar infarction (86%), tumors (56–81%), and intraventricular cysts (56–95%). In case of intraventricular hemorrhage (43–73%), infection (60–64%), anatomical aberration (21–80%), and communicating HC (65–72%), a significantly inferior success rate is reported. It is well known that ETV has a lower success rate in children (68–71%) compared to adults (70–90%). The overall high clinical success rate in short-term and long-term follow-up confirms that ETV is the gold standard for treatment of occlusive HC. It is effective, safe, and simple

Skull Base Endoscopic-Assisted Surgery

Endoscopic-assisted surgery is becoming a more and more important tool in the neurosurgical armamentarium. This chapter provides a broad overview of the role of this technique in various skull base procedures. It starts with a historical perspective followed by a thorough exploration of the various principles and techniques for different indications. Additionally, the topics of “minimally invasive” techniques using “key hole” approaches are explained. At the end of this chapter, advantages and pitfalls with endoscopic assisted techniques are discussed

Management of severe intraoperative hemorrhage during intraventricular neuroendoscopic procedures: the dry field technique

Objective Neuroendoscopic procedures inside the ventricular system always bear the risk for an unexpected intraoperative hemorrhage with potentially devastating consequences. The authors present here their experience, and a stage-to-stage guide for the endoscopic management of intraoperative hemorrhages. Methods A step-by-step guide for the management to gain control of and stop the bleeding is described including a grading system. More advanced techniques are presented in cases examples. Conclusion Most of intraoperative hemorrhages can be controlled by constant irrigation and coagulation. More advanced techniques can be applied quickly and easily to ensure control of the hemorrhages and avoid the need for a microsurgical conversion

There is more to NPH than lower body Parkinsonism

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Benefits and obstacles of telemetric ICP monitoring

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Motor skills, cognitive impairment, and quality of life in normal pressure hydrocephalus: early effects of shunt placement

Background Traditionally, clinical fndings of normal pressure hydrocephalus are mainly characterized by the Hakim triad. The aim of this study is to evaluate the performance of patients sufering from idiopathic normal pressure hydrocephalus (iNPH) in a more holistic manner regarding motor skills, cognitive impairment, and quality of life. Methods In total, 30 individuals diagnosed with iNPH as well as a reference group with another 30 individuals were included. The iNPH patients and the reference group were age, educational, and morbidity matched. A standardized test battery for psychomotor skills, gait, neuropsychological abilities as well as questionnaires for quality of life was applied. The iNPH group was tested prior to surgery, at 6 weeks, and 3 months postoperatively. The reference group was tested once. Results Patients showed a signifcant improved performance in various items of the test battery during the frst 3 months postoperatively. This included neuropsychological evaluation, motor skills including gait and upper motor function as well as the quality of life of the patients. Compared to reference individuals, neuropsychological aspects and quality of life of iNPH patients improved in some parts nearly to normal values. Conclusion Our fndings underline that shunt surgery does not only improve the symptoms in iNPH patients but also ame liorates the quality of life to a great extent close to those of age and comorbidity matched reference individuals. This data enables an optimized counseling of iNPH patients regarding the expectable outcome after shunt surgery especially regarding cognitive performance, motor skills as well as life quality