Complication avoidance and its management in endoscopic neurosurgery

Yadav, Yad Ram; Parihar, Vijay; Kher, Yatin

doi:10.4103/0028-3886.115051

Cited by 31 publications

(62 citation statements)

References 11 publications

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“…Intra-ventricular bleeding can be caused by excessive side movements, removing the flexible scope in curved tip position, wrong entry in the lateral ventricle, injuries due to repeated introduction of endoscope without the use of the peel-away sheath or other sheath, direct ventricular access by the telescope, and the use of a sharp-edged sheath, etc. (59). Rarely blood might trickle from the burr-hole site into the ventricle.…”

Section: Intra-ventricular Bleedingmentioning

confidence: 99%

Management of colloid cyst of third ventricle

Yadav

Yadav²,

Parihar³

et al. 2014

Turkish Neurosurgery

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Colloid cysts are usually located in third ventricle and are believed to be derived from either primitive neuroepithelium or endoderm. Patients may remain asymptomatic for long time while some can present with paroxysmal headache, gait disturbance, nausea, vomiting, behavioral changes, weaknesses of lower limbs, impaired memory, new learning disability and sudden death. Computed tomography usually reveals a well-defined round or oval nonenhancing lesion. Although magnetic resonance imaging (MRI) signal intensity of colloid cysts is variable, the most common appearance is hyperintensity in T1-weighted sequences and iso to hypointensity in T2-weighted sequences. Observation, stereotactic aspiration, microscopic or endoscopic approaches and shunt surgery are various management options. Transcallosal and transcortical microscopic (with or without tubular retractor) approaches are mainly useful in normal-sized and dilated ventricles respectively. Endoscopic technique is an effective alternative to microsurgical technique but total resection and long-term recurrence remains a concern. Utilization of two instruments, the bi port technique and tubular retractor can be helpful in selected patients to overcome limitations. Although total excision should be aimed, subtotal excision and coagulation of residual cyst wall usually results in good long-term results without any growth of remnant wall. Conversion to an open procedure may be required in some patients.KEywords: Central nervous system cyst, Central nervous system neoplasm, Colloid cyst, Nervous system diseases, Third ventricle ÖZKolloid kistler genellikle üçüncü ventrikülde bulunur ve primitif nöroepitel veya endodermden köken aldıklarına inanılmaktadır. Hastalar uzun süre belirtisiz kalabilirler veya durum paroksismal baş ağrısı, yürüme bozukluğu, bulantı, kusma, davranış değişiklikleri, alt ekstremitelerde kuvvetsizlik, hafıza kaybı, yeni şeyler öğrenme zorluğu ve ani ölümle ortaya çıkabilir. Bilgisayarlı tomografi genellikle iyi tanımlanmış yuvarlak veya oval, kontrast tutmayan bir lezyon gösterir. Kolloid kistlerin manyetik rezonans görüntüleme (MRG) sinyal şiddeti değişkendir ama en sık rastlanan görünüm T1 ağırlıklı dizilerde hiperintens ve T2 ağırlıklı dizilerde izo ila hipointenstir. Gözlem, stereotaktik aspirasyon, mikroskopik veya endoskopik yaklaşımlar ve şant cerrahisi çeşitli tedavi seçenekleridir. Transkallosal ve transkortikal mikroskopik (tübüler retraktörle veya olmadan) yaklaşımlar temel olarak sırasıyla normal büyüklükte ve dilate ventriküllerde faydalıdır. Endoskopik teknik, mikrocerrahi tekniğe etkin bir alternatiftir ama total rezeksiyon imkanı ve uzun dönemde nüks olasılığı endişe yaratmaya devam etmektedir. İki alet kullanımı, iki portlu teknik ve tübüler retraktör bazı hastalarda sınırlamaları aşmak açısından faydalı olabilir. Total eksizyon hedeflenmelidir ama subtotal eksizyon ve kalan kist duvarının eksizyonu genellikle kalan duvarda bir büyüme olmadan uzun dönemli iyi sonuçlar verir. Bazı hastalarda açık cerrahiye dönmek de gerek...

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Section: Intra-ventricular Bleedingmentioning

confidence: 99%

Management of colloid cyst of third ventricle

Yadav

Yadav²,

Parihar³

et al. 2014

Turkish Neurosurgery

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“…During neuroendoscopy more often reported events are: Injury to the fornix, intraventricular hemorrhage, basilar artery injury, cardiac arrhythmias or respiratory arrest and failed ETV [28][29][30]. Our study reported the following complications: there were 4 cases of fever and meningeal irritation.…”

Section: Discussionmentioning

confidence: 71%

Neuroendoscopy Sway in the Treatment of Posterior Fossa Tumours associated Hydrocephalus in Children

Rami¹,

Khasawneh²,

Feras³

et al. 2017

JNSK

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IntroductionBrain tumors are of the most devastating forms of human disorders, particularly when they arise in the posterior fossa. The proximity of these lesions to the brainstem and fourth ventricle explains the common presentation of these patients. Obstructive hydrocephalus is described in about 80% of the cases, it can lead to herniation and death if left untreated [1][2][3][4][5][6][7].The best way to handle obstructive hydrocephalus secondary to posterior fossa tumor is still subject to debate. Approaches include preoperative insertion of a cerebrospinal fluid shunt or external ventricular drainage followed by surgical resection of the tumor [1,2,4,[6][7][8][9]. Others recommend treatment with corticosteroids and direct approach to the posterior fossa pathology, when possible [10][11][12][13][14][15][16][17].Endoscopy capitulates on improved visualization and permits effective surgical therapy of lesions in the nadirs of the brain with minimal collateral interruption of eloquent parenchyma. It is currently established popularity emulates the diversity of increasing applications, which are also reflective of integral challenges. Based on recent reports [6,7,13,18,19]. Neuroendoscopic treatment of hydrocephalus (endoscopic third ventriculostomy) is the most recent approach for management. In our center, we adopted the policy of performing a preoperative endoscopic third ventriculostomy (ETV) in cases of symptomatic hydrocephalus. Methods AbstractBackground: Brain neuroendoscopy has been introduced to our neurosurgical department since January 2000. Neuroendoscope was used to treat hydrocephalus secondary to posterior fossa tumours. In this study we expand on our previously published data to reassess and present our experience over the last sixteen years.

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“…Camera, light source and image quality of the endoscopes needs to be checked before induction of anesthesia (26). Every single detail should be checked including side rod of table for holder attachment.…”

Section: █ Discussionmentioning

confidence: 99%

Practical aspects in neuroendoscopic techniques and complication avoidance: a systematic review.

Yadav

Bajaj²,

Parihar³

et al. 2016

Turkish Neurosurgery

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Although endoscopic techniques have many advantages including improved visualization and magnification, they are also associated with limitations. The objective of this review is to discuss the practical aspects that can reduce complications after endoscopic procedures, and their management. The review is based on the personal experience of more than 2000 neuroendoscopic procedures performed by the senior author. Topic search was made on PubMed using Neuroendoscopy, complications and neuroendoscopy, complication avoidance and neuroendoscopy, endoscopic neurosurgery, and minimally invasive neurosurgery. Relevant articles were selected after analyzing abstracts and/or topics. Endoscopic procedures are also associated with limitations such as obstruction in instruments manipulation, steep learning curve, blind area, difficulty in visualization, disorientation, loss of stereoscopic image and others. Neuroendoscopy is distinct from microsurgery and the surgeon has to learn endoscopic skills in addition to microsurgical techniques. Difficulties in controlling bleeding, working in a limited area, higher complication rate during the initial learning curve and longer operative time are some of the limitations. Attending live workshops, practicing on models, and hands on cadaveric workshops can reduce the learning curve. Proper case selection, multidisciplinary team approach, watching operative video, visiting other departments, observing a skillful endoscopic surgeon, lab training, and simulators can improve results and shorten the learning curve. Limitations of this review are that the search is limited to the English literature and personal experience of a single surgeon that may create some bias. Although neuroendoscopic techniques are associated with improved results in some indications, they have many limitations. Neuroendoscopic skills need to be learned to improve results.

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Complication avoidance and its management in endoscopic neurosurgery

Cited by 31 publications

References 11 publications

Management of colloid cyst of third ventricle

Management of colloid cyst of third ventricle

Neuroendoscopy Sway in the Treatment of Posterior Fossa Tumours associated Hydrocephalus in Children

Practical aspects in neuroendoscopic techniques and complication avoidance: a systematic review.

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