Microsurgical Third Ventriculostomy with Stenting in Intrinsic Brain Tumors Involving Anterior Third Ventricle

Pitskhelauri, D I; Konovalov, Alexander N.; Kopachev, D N; Samborsky, Dmitry I.; Melnikova-Pitskhelauri, T.V.

doi:10.1016/j.wneu.2011.03.049

Cited by 12 publications

(11 citation statements)

References 31 publications

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“…In the study of Pitskhelauri et al, microsurgical resection via the anterior transcallosal route and fenestration to the third ventricular floor were performed for brain tumors extending to the anterior of the third ventricle. One end of the 6-to 7-cmlong silicone catheter with holes on both ends was leaned against the upper wall of the lateral ventricle, the other end was placed between the basilar artery and the clivus in the prepontine cisterna, and a cuff close to this end was supported by Liliequist's membrane to prevent caudal dislocation (14).…”

Section: █ Resultsmentioning

confidence: 99%

Evaluation of the usefulness of an expandable stent for establishing patency in endoscopic third ventriculostomy: a fresh cadaveric study

Aydöseli

Ünal²,

Dolaş³

et al. 2022

Turkish Neurosurgery

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AIM:To demonstrate the feasibility of stent application to the third ventricular floor during endoscopic third ventriculostomy (ETV). MATERIAL and METHODS:We performed the ETV procedure on four fresh cadavers not exposed to head trauma. The neuroendoscope was introduced into the third ventricle under ultrasonography guidance. The stoma was opened with a neuroballoon in the third ventricular floor in three cases and with the catheter carrying the stent in the remaining case. The balloon-expandable stent was 8 mm in length and 4 and 4.5 mm in diameter. The distal end of the stent was placed in the prepontine cistern, without contact with the vascular structures in the cistern, and the proximal end was placed in the stoma, with its proximal end in the third ventricle. RESULTS:In all the cases, the stent was fixed in the targeted position. Then, the head cavity was opened. The brain was extracted from the skull for pathological analysis. The stents were placed in front of the mamillary bodies in all four cases, fixed around the stoma, which was opened previously. No significant compression on the structures around the prepontine cisterna and on the basilar artery was observed.CONCLUSION: Expandable stents may be useful and technically safe in creating and maintaining the stomal opening in ETV.

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Section: █ Resultsmentioning

confidence: 99%

Evaluation of the usefulness of an expandable stent for establishing patency in endoscopic third ventriculostomy: a fresh cadaveric study

Aydöseli

Ünal²,

Dolaş³

et al. 2022

Turkish Neurosurgery

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“…As an extension of this application, our new scope can provide a better bird’s eye view of the subependymal spread of disseminated ventricular tumors and even offer transtumoral stent placement for CSF diversion, for example, third ventricular and aqueductal stents in craniopharyngiomas and tectal tumors, respectively. 66 …”

Section: Discussionmentioning

confidence: 99%

“…The same technology can be effectively used for intraventricular stent procedures (aqueductoplasty and stenting), as well as intratumoral stenting (in craniopharyngiomas sealing off the prior ETV or in a posterior third ventricular region tumor occluding the aqueduct). 3,9, 21,29,33,49,66,69,83 Magnetic resonance compatibility can be helpful in treating intraventricular neurocysticercosis as well as juxtaventricular parenchymal cystic changes such as tumefactive enlargement of thalamopeduncular Virchow-Robin spaces. 3,24 …”

Section: Discussionmentioning

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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“…The performed sETV was sufficient to clinically control hydrocephalus in all patients with a thickened third ventricular floor as a risk factor for conventional ETV failure and in the one adult with membranous aqueductal stenosis and previous failure of a conventional ETV. The approach to place a stent through an endoscopically achieved opening of the third ventricular floor has not been reported yet, but in a series of 9 microsurgically treated patients, Pitskhelauri et al report simultaneous placement of a stent through the floor of the third ventricle simultaneously with resection of a deep-seated tumor [23], where none of the patients required a shunt after this procedure.…”

Section: Discussionmentioning

confidence: 99%

Stented endoscopic third ventriculostomy—indications and results

2015

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Microsurgical Third Ventriculostomy with Stenting in Intrinsic Brain Tumors Involving Anterior Third Ventricle

Cited by 12 publications

References 31 publications

Evaluation of the usefulness of an expandable stent for establishing patency in endoscopic third ventriculostomy: a fresh cadaveric study

Evaluation of the usefulness of an expandable stent for establishing patency in endoscopic third ventriculostomy: a fresh cadaveric study

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

Stented endoscopic third ventriculostomy—indications and results

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