Interactive Image-Guided Neuroendoscopy: Development and Early Clinical Experience

Abstract

Technical advances and pioneering surgeons have established neuroendoscopy as an accepted diagnostic and therapeutic tool. The clinical indications for endoscopy, variety of operative techniques and number of endoscopic surgeons continue to increase steadily. However, there are fundamental limits to the scope of freehand endoscopy principally governed by the need for direct vision of anatomical and pathological structures. In addition, whilst the expert neuroendoscopist is only occasionally disorientated by complex distorted anatomy, the rising number of novices are likely to be mislead relatively often. We report the integration of neuroendoscopy with an optical neuronavigation system to provide interactive image-guided neuroendoscopy. This combination both removes the constraining requirement for direct vision and provides accurate localisation to guide the surgeon during surgery. We describe the clinical application of this method to two cases where image-guided endoscopy was essential to the safe completion of the procedure.

The role of neuroendoscopy in the management of brain tumours

“…Similarly, we have yet to be convinced of the value of combining neuroendoscopy with any form of neuronavigation, something which has been advocated by some groups as contributing to safety. 34 Developments in real-time neuronavigation or robotics 35 may alter this position. Although electrodiathermy remains the most useful means of cutting and coagulating tissue the KTP laser (Laserscope, San Jose, CA, USA) has proved very promising in neuroendoscopic procedures with the opportunity for 'no contact' coagulation.…”

Frameless neuronavigation in intracranial endoscopic neurosurgery

“…8,10,15,31,32,35,37 However, the role of image guidance in endoscopic procedures remains to be determined. Based on our experience in 255 intracranial endoscopic procedures, including 148 third ventriculostomies, we found that for most endoscopic procedures in hydrocephalic ventricles, a free-hand approach is adequate.…”

Operative Management of Third Ventriculostomy in Cases of Thickened, Non-Translucent Third Ventricular Floor: Technical Note

“…The endoscopic route from burr hole via the foramen of Monro to the third ventricular floor can be simulated virtually on the screen. Bony structures as target points like the dorsum sellae or the clivus can be used to overcome the potential problem of brain shift due to CSF loss, although it has been shown that, regarding deep midline structures, a relevant distortion must not be expected [24].…”