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

Abstract

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.

Practical Aspects and Avoidance of Complications in Microendoscopic Spine Surgeries: A Review

“…The endoscope should be retracted when an instrument is introduced to avoid accidental injury to the structures. 17 The side rail of the table, where the endoscope holder is attached, should not be loose. 17 Instruments should fit properly in the working channel of the endoscopic system.…”

“…The tissue to be removed should be moved to the sides (cranial, caudal, medial, or lateral). 17 It should not be pulled toward the endoscope tip to avoid soiling of the lens tip and blinding of vital structures (such as nerve, vessel, dura mater, etc.) in the bed of the tissue.…”

“…A slender instrument with a single limb is better because it occupies less space. 15,17,18 Proper functioning of the instruments should be checked (e.g., scissor should open smoothly without any jerking) before surgery. 15,17 Instrument tip should be slightly curved to allow better visualization.…”

“…Although microendoscopic spine techniques have many advantages, there are also some obstacles that should be recognized and avoided for developing good endoscopic skills and reducing complications. [14][15][16][17][18] This article discusses the practical aspects of microendoscopic techniques and reviews ways to avoid complications in spine surgeries. We also suggest how to manage complications based on the personal experience of 1,574 endoscopic spinal procedures (►Table 1) performed by the senior author and a review of relevant literature.…”

Osthole Enhances the Therapeutic Efficiency of Stem Cell Transplantation in Neuroendoscopy Caused Traumatic Brain Injury

“…For instance the process of applying neuroendoscopy to resect tumor and clean hydrocephalus can damage the central nervous system. 4,5) Intraventricular neuroendoscopy is a technique used primarily in pediatric neurosurgery like endoscopic third ventriculostomy (ETA) a most widely utilized procedure for the treatment of hydrocephalus. In the procedure a metal endoscope is introduced into the lateral ventricle.…”