Ahead of Print: Indocyanine Green Angiography in Endoscopic Third Ventriculostomy

Background: Endoscopic third ventriculostomy (ETV) has become a well-established method for the treatment of non-communicating hydrocephalus with a high success and relatively low morbidity rate. However, vessel injury has been repeatedly reported, often with fatal outcome. Vessel injury is considered to be the most threatening complication. The use of indocyanine green (ICG) angiography has become an established tool in vascular microneurosurgery.

Objective: We report our initial experience with endoscopic ICG angiography in ETV for intraoperative visualization of the basilar artery and its perforators to reduce the risk of vascular injury.

Methods: Eleven patients with non-communicating hydrocephalus underwent ETV. Prior to opening of the third ventricular floor, ICG angiography was performed using a prototype neuroendoscope for intraoperative visualization of ICG fluorescence.

Free Editor Choice: July Phenomenon in Neurosurgery

Background: The evidence of or against the presence of a July phenomenon in resident teaching hospitals has been inconsistent. Moreover, there are limited data on the “July phenomenon” in the field of neurosurgery.

Objective: To determine whether a “July phenomenon” exists for neurosurgical mortality or complications.

Methods: A search of the National Inpatient Sample database from 1998 to 2008 was performed for all admissions for International Classification of Diseases, 9th Revision codes corresponding to nontraumatic hemorrhage, central nervous system (CNS) trauma, CNS tumor, and hydrocephalus. Generalized linear mixed-model analysis was performed, adjusted for patient demographics and hospital characteristics, for the outcomes of mortality and complications for the month of July compared with all other months in teaching hospitals.

Ahead of Print: The “July Phenomenon” in Teaching Hospitals

Background: The evidence for or against the presence of a ‘July Phenomenon’ in resident teaching hospitals has been inconsistent. Moreover, there are limited data on the “July Phenomenon” in the field of Neurosurgery.

Objective: To determine if a July phenomenon exists for neurosurgical mortality or complications.

Methods: A search of the National Inpatient Sample (NIS) database from 1998-2008 was performed for all admissions for ICD-9 codes corresponding to non-traumatic hemorrhage, central nervous system (CNS) trauma, CNS tumor, and hydrocephalus. Generalized linear mixed model analysis was performed, adjusted for patient demographics and hospital characteristics, for the outcomes: 1) mortality, and 2) complications for the month of July compared to all other months in teaching hospitals.

Editor Choice: Antibiotic-Impregnated vs Standard Extraventricular Drainage Devices Trial

Background: External ventricular drainage (EVD) catheters provide reliable and accurate means of monitoring intracranial pressure and alleviating elevated pressures via drainage of cerebrospinal fluid (CSF). CSF infections occur in approximately 9% of patients. Antibiotic-impregnated (AI) EVD catheters were developed with the goal of reducing the occurrence of EVD catheter-related CSF infections and their associated complications.

Objective: To present an international, prospective, randomized, open-label trial to evaluate infection incidence of AI vs standard EVD catheters.

Methods: Infection was defined as (1) proven infection, positive CSF culture and positive Gram stain or (2) suspected infection: (A) positive CSF culture with no organisms identified on initial Gram stain; (B) negative CSF culture with a gram-positive or -negative stain; (C) CSF leukocytosis with a white blood cell/red blood cell count >0.02.

Video: Endoscopic Transventricular Lamina Terminalis Fenestration Video 1

Intraoperative endoscopic video of the lamina terminalis fenestration procedure. The video starts with a standard endoscopic third ventriculostomy and exploration of the basal cisterns. Very limited space for adequate CSF flow within the cisterns was noted. Proceeding with the LT fenestration, the tip of the flexible neuroendoscope is bent ventraly. The optic chiasm is identified. Utilizing a closed grasping forceps for the initial fenestration, the lamina terminalis is perforated. The ostomy is slowly enlarged with the neuroendoscope itself. The anterior communicating artery complex is identified. The ostomy is further enlarged if necessary.