Posts Tagged ‘endoscopy’
Background: A virtual reality (VR) neurosurgical simulator with haptic feedback may provide the best model for training and perfecting surgical techniques for transsphenoidal approaches to the sella turcica and cranial base. Currently there are 2 commercially available simulators: NeuroTouch (Cranio and Endo) developed by the National Research Council of Canada in collaboration with surgeons at teaching hospitals in Canada, and the Immersive Touch. Work in progress on other simulators at additional institutions is currently unpublished.
Objective: This article describes a newly developed application of the NeuroTouch simulator that facilitates the performance and assessment of technical skills for endoscopic endonasal transsphenoidal surgical procedures as well as plans for collecting metrics during its early use.
Methods: The main components of the NeuroTouch-Endo VR neurosurgical simulator are a stereovision system, bimanual haptic tool manipulators, and high-end computers. The software engine continues to evolve, allowing additional surgical tasks to be performed in the VR environment. Device utility for efficient practice and performance metrics continue to be developed by its originators in collaboration with neurosurgeons at several teaching hospitals in the United States. Training tasks are being developed for teaching 1- and 2-nostril endonasal transsphenoidal approaches. Practice sessions benefit from anatomic labeling of normal structures along the surgical approach and inclusion (for avoidance) of critical structures, such as the internal carotid arteries and optic nerves.
Background and Importance: Meningiomas of the lateral ventricles are commonly located in the atria. Surgical access to such tumors is challenging because of their deep location and proximity to critical neurovascular structures, particularly if situated on the dominant side. Although a number of approaches have been described in the literature, most carry the risk of post-operative neuropsychological, visual or speech deficits, especially when operating on the dominant hemisphere. The supracerebellar transtentorial transcollateral sulcus (STTCS) approach offers the potential to circumvent functionally important structures, reducing the risk of these approach-related neurological deficits.
Clinical Presentation: Two patients with dominant hemisphere trigonal meningiomas underwent surgical resection utilizing the STTCS approach. Neuronavigation was used to carefully plan the incision, craniotomy and exposure, and also intra-operatively to orientate the operating surgeon at key steps, particularly when raising the tentorial flap in-line with the tumor. Endoscopy was used to provide increased light intensity, an extended viewing angle, and higher magnification when compared to a microscope. Specially designed tube-shaft instruments were also employed to assist with manipulation through the narrow surgical corridor. In both cases the tumors were fully resected without approach-related morbidity.
Background: The absence of ventriculomegaly has been considered an overt or relative contraindication to the endoscopic resection of colloid cysts. In the past, endoscopic removal of colloid cysts in the absence of ventriculomegaly has been considered ill advised. Reports of successful endoscopic surgery in small ventricles are surfacing
Objective: We examined the combined experience of 2 high-volume endoscopic centers to characterize the outcomes of patients undergoing endoscopic removal of colloid cysts in small ventricles.
Methods: We retrospectively reviewed all endoscopic colloid cyst removal procedures by the 2 senior authors (PN, CT) performed at the Barrow Neurological Institute over an 8-year period. Radiographic, clinical, and interview data were recorded and analyzed. The age-adjusted relative bicaudate index was used to define “small ventricles.”
Objective: To evaluate the benefit of endoscopic application during microsurgical procedures in a retrospective study.
Methods: One hundred eighty aneurysms were microsurgically treated in 124 operations. Three different applications of endoscopic visualization were used, depending on the respective requirements: inspection before clipping, clipping under endoscopic view, and postclipping evaluation.
Background: Reconstruction of the skull base is essential to prevent postoperative leakage of cerebrospinal fluid (CSF). However, a reliable method of reconstructing the middle cranial fossa via a subtemporal keyhole is not available.
Objective: To determine whether less invasive reconstruction of the middle cranial fossa under endoscopic guidance using a pedicled deep temporal fascia approach via a subtemporal keyhole is feasible and useful.
Methods: The middle cranial fossa in four fresh cadaver heads was reconstructed using a 4-mm 0[degrees] rigid endoscope.