Percutaneous intraspinal navigation for access to the subarachnoid space: use of another natural conduit for neurosurgical procedures

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The purpose of this paper was to demonstrate the usefulness of various fiberoptic endoscopes for percutaneous intraspinal navigation of the spinal canal, posterior fossa, and ventricular system.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Fresh, unembalmed cadavers were used, in which lumbar punctures were made for access to the sub-arachnoid space (in the case of larger [3.8- and 5-mm-diameter] endoscopes, small laminotomies were performed). Static and video images of pertinent structures were acquired for comparison among devices. Endoscopes were compared for their maneuverability, durability, field of view, and image quality. Seven sizes and types of endoscopes were considered.</jats:p> <jats:p>Overall, the devices offering a tip-deflecting mechanism were superior in maneuverability. Endoscopes in which a charged couple display chip was used at the tip of the scope for image acquisition offered improved image quality and field of view. Larger scopes, although more durable, were more rigid and may be limited in application. Multiple images from multiple devices are presented.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Percutaneous intraspinal navigation offers a promising neurosurgical approach to the spinal canal, the posterior fossa, and the ventricular system. Concerns regarding safety, management of complications, and the lack of adjunctive tools for intervention through the endoscopes or for use under fluoroscopic guidance represent areas that warrant further investigation and development.</jats:p></jats:sec>

Ablation of porcine ligamentum flavum with Ho:YAG, q‐switched Ho:YAG, and quadrupled Nd:YAG lasers

“…Navigating a laser‐fiber‐coupled system to the site of ligamentum flavum hypertrophy within the spinal canal is a fundamental design challenge for a laser‐driven minimally invasive system. However, advances in percutaneous endoscopic navigation of the spinal canal have already been demonstrated using flexible endoscopes introduced through a small opening in the base of the sacrum called the sacral hiatus . Through this access corridor, the spinal canal can be directly and safely entered through no more than a 2–3 mm incision and without the need for muscle or bony removal.…”

Microrobots for Minimally Invasive Medicine

“…Therefore, it may be possible to insert a microrobot at that site and navigate to the brain for intervention, leaving the skull intact. This principle of using percutaneous intraspinal navigation was recently applied in brain surgery through the use of catheters (37).…”

A new approach for observing cerebral cisterns and ventricles via a percutaneous lumbosacral route by using fine, flexible fiberscopes

“…With regard to the safe limit in fiberscope diameter, Stefanov et al 18 have reported that in > 100 human cadavers the subarachnoid space seems to be large enough for coaxial exploration from the spinal subarachnoid space through the cerebral aqueduct by using a 3.0-5.0-mm-diameter fiberscope. Fujimoto and colleagues 4 and Purdy et al 13 have also demonstrated that the spinal canal, posterior fossa, and ventricular system can be approached even with 3.8-5.0-mm-diameter fiberscopes and that a stent can be passed across the third ventricle through a lumbar puncture in cadavers. 6 Further improvements based on clinical experience may also allow routine placement of the fiberscope tip at an intended site in the brainstem subarachnoid space.…”