Flexible endoscopy for management of intraventricular brain tumors in patients with small ventricles

Ogiwara, Hideki; Morota, Nobuhito

doi:10.3171/2014.7.peds13648

Cited by 9 publications

(7 citation statements)

References 31 publications

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“…The steady improvements in flexible endoscopic resolution stand to enhance visual guidance during these procedures. An additional advantage of the flexible endoscope is that it can be used in cases of intraventricular brain tumors for patients who have small ventricles, M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 6 such as in pediatric populations, for whom contemporary rigid endoscopes may not be safely deployed (13). Furthermore, while the cost of the device is likely to be higher than that of rigid rod-lens endoscopes, the flexible HD endoscope, which is fully sterilizable, could offer a more affordable and practical option for intraventricular procedures compared to comprehensive surgical systems that rely on extensive technological development with significant overhead cost (5,19).…”

Section: Beyond Improved Intraoperative Visualization and Precision mentioning

confidence: 99%

Initial Experience with High-Definition Camera-On-a-Chip Flexible Endoscopy for Intraventricular Neurosurgery

et al. 2015

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Section: Beyond Improved Intraoperative Visualization and Precision mentioning

confidence: 99%

Initial Experience with High-Definition Camera-On-a-Chip Flexible Endoscopy for Intraventricular Neurosurgery

et al. 2015

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“…The combined use of a flexible and a rigid endoscope may be helpful, particularly in complicated cases. Endoscopic tumor biopsies typically yield a definitive diagnosis rate between 43% and 100%, whereas ETV has a success rate of between 64% and 100%13,36,39,44,49).…”

Section: Tumor Biopsymentioning

confidence: 99%

“…Significant complications occur in 0 to 18% of patients2,13,39,44,49), which can include bleeding (10%), forniceal contusion, massa intermedia disruption (3.1%), and vegetative state (3.1%). The incidence of significant hemorrhage is between 2.3% and 3.5%13,30,39,44,49). To prevent hemorrhagic complications, precisely visualizing the biopsy site and obtaining meticulous hemostasis after the biopsy procedure are essential13).…”

Section: Tumor Biopsymentioning

confidence: 99%

“…Recently, the application of endoscopic surgery has extended into various diseases relevant to the neurosurgical field, including transcortical intraventricular lesions, such as arachnoid cyst intraventricular extensions17,40), colloid cysts22,26,54), and intraventricular cysticercosis24,53). New applications include biopsies13,39,44,49,52) and intraventricular brain tumor removal6,50). In this article, we will discuss the management of all transcortical intraventricular lesions, with the exceptions of ETV and complicated hydrocephalus.…”

Section: Introductionmentioning

confidence: 99%

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Transcortical Endoscopic Surgery for Intraventricular Lesions

Kim

2017

J Korean Neurosurg Soc

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To review recent advances in endoscopic techniques for treating intraventricular lesions via transcortical passage. Articles in PubMed published since 2000 were searched using the keywords ‘endoscopy,’ ‘endoscopic,’ and ‘neuroendoscopic.’ Of these articles, those describing intraventricular lesions were reviewed. Suprasellar arachnoid cysts (SACs) can be treated with ventriculo-cystostomy (VC) or ventriculo-cysto-cisternostomy (VCC). VCC showed better results compared to VC. Procedure type, fenestration size, stent placement, and aqueductal patency may affect SAC prognosis. Colloid cysts can be managed using a transforaminal approach (TA) or a transforaminal-transchoroidal approach (TTA). However, TTA may result in better exposure compared to TA. Intraventricular cysticercosis can be cured with an endoscopic procedure alone, but if pericystic inflammation and/or ependymal reaction are seen, third ventriculostomy may be recommended. Tumor biopsies have yielded successful diagnosis rates of up to 100%, but tumor location, total specimen size, endoscope type, and vigorous coagulation on the tumor surface may affect diagnostic accuracy. An ideal indication for tumor excision is a small tumor with friable consistency and little vascularity. Tumor size, composition, and vascularity may influence a complete resection. SACs and intraventricular cysticercosis can be treated successfully using endoscopic procedures. Endoscopic procedures may represent an alternative to surgical options for colloid cyst removal. Solid tumors can be safely biopsied using endoscopic techniques, but endoscopy for tumor resection still results in considerable challenges.

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“…These instruments are used by fewer surgeons and involve additional skills training to hold the tip position; to maneuver thinner, flexible instruments; and, above all, to avoid disorientation during zoomed-in views. 14,58,98 …”

mentioning

confidence: 99%

A multiport MR-compatible neuroendoscope: spanning the gap between rigid and flexible scopes

Manjila

Mencattelli

Rosa

et al. 2016

FOC

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OBJECTIVE Rigid endoscopes enable minimally invasive access to the ventricular system; however, the operative field is limited to the instrument tip, necessitating rotation of the entire instrument and causing consequent tissue compression while reaching around corners. Although flexible endoscopes offer tip steerability to address this limitation, they are more difficult to control and provide fewer and smaller working channels. A middle ground between these instruments—a rigid endoscope that possesses multiple instrument ports (for example, one at the tip and one on the side)—is proposed in this article, and a prototype device is evaluated in the context of a third ventricular colloid cyst resection combined with septostomy. METHODS A prototype neuroendoscope was designed and fabricated to include 2 optical ports, one located at the instrument tip and one located laterally. Each optical port includes its own complementary metal-oxide semiconductor (CMOS) chip camera, light-emitting diode (LED) illumination, and working channels. The tip port incorporates a clear silicone optical window that provides 2 additional features. First, for enhanced safety during tool insertion, instruments can be initially seen inside the window before they extend from the scope tip. Second, the compliant tip can be pressed against tissue to enable visualization even in a blood-filled field. These capabilities were tested in fresh porcine brains. The image quality of the multiport endoscope was evaluated using test targets positioned at clinically relevant distances from each imaging port, comparing it with those of clinical rigid and flexible neuroendoscopes. Human cadaver testing was used to demonstrate third ventricular colloid cyst phantom resection through the tip port and a septostomy performed through the lateral port. To extend its utility in the treatment of periventricular tumors using MR-guided laser therapy, the device was designed to be MR compatible. Its functionality and compatibility inside a 3-T clinical scanner were also tested in a brain from a freshly euthanized female pig. RESULTS Testing in porcine brains confirmed the multiport endoscope's ability to visualize tissue in a blood-filled field and to operate inside a 3-T MRI scanner. Cadaver testing confirmed the device's utility in operating through both of its ports and performing combined third ventricular colloid cyst resection and septostomy with an endoscope rotation of less than 5°. CONCLUSIONS The proposed design provides freedom in selecting both the number and orientation of imaging and instrument ports, which can be customized for each ventricular pathological entity. The lightweight, easily manipulated device can provide added steerability while reducing the potential for the serious brain distortion that happens with rigid endoscope navigation. This capability would be particularly valuable in treating hydrocephalus, both primary and secondary (due to tumors, cysts, and so forth). Magnetic resonance compatibility can aid in endoscope-assisted ventricular aqueductal plasty and stenting, the management of multiloculated complex hydrocephalus, and postinflammatory hydrocephalus in which scarring obscures the ventricular anatomy.

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Flexible endoscopy for management of intraventricular brain tumors in patients with small ventricles

Cited by 9 publications

References 31 publications

Initial Experience with High-Definition Camera-On-a-Chip Flexible Endoscopy for Intraventricular Neurosurgery

Initial Experience with High-Definition Camera-On-a-Chip Flexible Endoscopy for Intraventricular Neurosurgery

Transcortical Endoscopic Surgery for Intraventricular Lesions

A multiport MR-compatible neuroendoscope: spanning the gap between rigid and flexible scopes

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