Endoscopic removal of intraventricular neurocystercercosis.
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ABSTRACT:
SUBMITTER: Carnevale JA
PROVIDER: S-EPMC7881506 | biostudies-literature | 2021
REPOSITORIES: biostudies-literature
Publications
Endoscopic removal of intraventricular neurocystercercosis.
Carnevale Joseph A JA Goldberg Jacob L JL Holland Chloe E CE Souweidane Mark M MM
Surgical neurology international 20210203
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Project description:ObjectiveTo highlight the basic points of brain endoscopic procedure for Thalamic and Intraventricular Hemorrhage to achieve repeatability and reproducibility in the results among the new brain endoscopic surgeons.MethodSharing the experience of 10 years as an endoscopic surgeon to bring out the basic insight into the method, challenges, points which need special attention during the surgery and discussion of recent advancements in the endoscopic equipment for safe surgery.ConclusionProcedure of endoscopic evacuation of brain hematoma is simple with learning curve. In the beginning new endoscopic surgeons should operate in the presence of experience surgeon. They should follow standard technique to achieve the good surgical outcome and uniformity in the result every time they perform the surgery.
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Project description:BackgroundAs intraventricular blood is a strong negative prognostic factor, intraventricular hemorrhage requires prompt and aggressive management to reduce intracranial hypertension.MethodA flexible scope can be used to navigate and to aspirate blood clots from all four ventricles. Complete restoration of CSF pathways from the lateral ventricle to the foramen of Magendie can be obtained.ConclusionFlexible neuroendoscopic aspiration of IVH offers the opportunity to immediately reduce intracranial hypertension, reduce EVD obstruction and replacement rates, and decrease infections and shunt dependency.
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Project description:Intraoperative hemorrhage represents a major risk during endoscopic intraventricular surgery. There are very few publications describing the maintenance of hemostasis during conventional endoscopic intraventricular surgery. Here, we designed a new mini-tubular port to combine intra- and extra-endoscopic techniques for endoscopic intraventricular surgery. With this new methodology, complicated techniques can be performed more efficiently with improved bleeding control. The new mini-tubular port consists of an outer sheath and an obturator. The sheath is a thin-walled transparent cylinder that is 0.35 mm thick, 10 mm in diameter, and 90 mm in length. In this report, we describe the use of the mini-tubular port on 36 patients receiving endoscopic intraventricular surgery. The study enrolled 36 patients, with a median age of 45 years (range: 0-72 years), of which 19 were male and 17 were female. Pure ETV (endoscopic third ventriculostomy) was performed in 20 patients and pure biopsy was performed in 2. ETV and biopsy were performed in five patients, ETV and the removal of cysticerci were performed in five, cyst fenestration was performed in one, ETV and cyst fenestration were performed in two, and ETV and shunt removal were performed in one patient. Two patients received microscopic surgery following endoscopic surgery during the same operation. A total of 17 patients (47%) underwent extra-endoscopic techniques. The median Karnofsky Performance Status (KPS) score of the patients prior to surgery was 50, while the median KPS score of the patients after one month of surgery was 80; these scores were significantly different (P < 0.05), as determined by Wilcoxon's test. In total, 27 patients had a KPS score ≥70% and 75% of patients had a favorable prognosis one month after surgery. None of the patients experienced seizure. The new mini-tubular port can conveniently combine intra- and extra-endoscopic techniques for endoscopic intraventricular surgery. The application of these techniques can efficiently control bleeding during surgery, help improve the confidence of the surgeons involved, and provide a highly efficient approach for performing complicated procedures.
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Project description:IntroductionAn intraventricular cysticercus cyst is observed in 7%-30% patients of neurocysticercosis (NCC). Apart from causing arachnoiditis, intraventricular NCC (IVNCC) can cause sudden death due to acute episodes of hydrocephalus. Various treatment modalities available are external cerebrospinal fluid (CSF) diversion, microsurgical removal, and endoscopic management. There is no consensus regarding the optimal surgical treatment strategy. We are presenting our experience by doing a retrospective analysis of 26 patients having endoscopic removal of IVNCC with a rigid endoscope and angiocatheter.AimThe aim of this study is to evaluate the results of neuroendoscopy in restoring the CSF pathway and removal of the cyst in patients of IVNCC.Materials and methodsRetrospective analysis of clinical record and follow-up of 26 patients of IVNCC who were treated endoscopically between 2010 and 2018 was done. The diagnosis of IVNCC was made based on contrast enhanced magnetic resonance imaging of the brain. Transcranial endoscopy with 0° endoscope was performed through the frontal burr hole. Third ventriculostomy and removal of the cysticercus cyst with angiocatheter were the procedures done.ResultsThe success rate of intraventricular cyst excision, whether complete or partial, was 100% (14/14) in the third ventricular cyst, 62.5% (5/8) in the fourth ventricular cyst and 100% (4/4) in the lateral ventricular cyst. The overall success rate of cyst excision by endoscopy was 88.46%. The overall successful CSF flow pathway was established in 88.46% cases. The mean duration of follow-up was 44 months, and all the patients were found symptom free in the follow-up period.ConclusionNeuroendoscopy, being a single burr hole technique successfully providing internal CSF diversion and cyst removal, is the treatment modality of choice for IVNCC.
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Project description:The development of minimally invasive neuroendoscopy has advanced in recent years. The introduction of the neuroendoscopic ultrasonic aspirator (NUA) broadened the treatment spectrum of neuroendoscopy. We aim to describe our experience with the use of NUA for the resection of intraventricular lesions. Here, we present consecutive retrospective case series of adult and pediatric patients undergoing resection of an intraventricular lesion with a NUA (Endoscopic Neurosurgical Pen, Söring GmbH, Quickborn, Germany) between January 2019 and April 2020. Eight patients between the age of 0.5 and 73 years underwent surgery using NUA and were included in this study. In four patients, an endoscopic assisted (EA) resection of the lesion was undertaken, while in four patients, the lesion was removed using purely endoscopic (PE) resection. In all cases, gross/near total resection was achieved. The average blood loss was 142.5 ± 90.4 mL (range 50-300 mL). Transient morbidity was seen in four patients (50%), while permanent morbidity or mortality did not occur. The NUA seems to be a safe and valuable tool for the minimally invasive resection of intraventricular lesions in selected cases. The type, size, consistency, and vascularization of the lesion limit at times the purely endoscopic use of the NUA.
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Project description:PurposeDeeply embedded corneal foreign bodies and intrastromal foreign body removal can often be a challenge. The aim of this report was to describe the utility of endoscopy in visualization and removal of an embedded corneal bee stinger.MethodsA 44-year-old male patient developed toxic keratopathy after injury from a bee stinger. On examination, the bee stinger was noted to be deeply embedded in the corneal stroma. A superficial keratectomy was initially attempted; however, the stinger was noted to be intrastromal and protruding into the anterior chamber and could not be removed. An Endoscopy-assisted visualization was used to remove the stinger.ResultsThe bee stinger was successfully removed and the patient's vision improved to 20/100 from an initial CFCF (counting fingers close to face) at time of presentation. At the end of 3 months follow-up, there was residual corneal edema along with cataractous changes in the lens as a sequelae of the initial bee sting injury. The patient subsequently underwent an endothelial keratoplasty along with phacoemulsification with intraocular lens implantation and the final BCVA improved to 20/40.ConclusionEndoscopyassisted visualisation of anterior chamber and angle structures can be valuable in removal of retained and deeply embedded corneal or intracameral foreign bodies.
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