Single burr hole endoscopic biopsy with third ventriculostomy—measurements and computer-assisted planning

Knaus, H; Schumacher, Matthias; Koch, Arend; Thomale, Ulrich-Wilhelm

doi:10.1007/s00381-011-1405-1

Cited by 49 publications

(28 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This compromised entry site enables good access to both targets with a reduced movement relative to the actual entry trajectory. 15,[20][21][22]26 The compromised location of the bur hole will impose some (but probably of limited clinical importance) pressure on the fornix (when performing the ETV) and on the posterior border of the foramen of Monro (when performing the EBX). In this technique, a rigid endoscope is used.…”

Section: Discussionmentioning

confidence: 99%

“…Various techniques have been suggested to combine an ETV with an EBX, including 1) performing 1 bur hole, between both ideal entry points and using a rigid endoscope (Fig. 1A); 15,[20][21][22]26 2) performing 2 separate bur holes: one in an "ideal" location for an ETV and the second more anteriorly in an "ideal" location for a biopsy (Fig. 1B); 3,6,13,14,25,27 and 3) using a flexible endoscope through a single bur hole.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Combined rigid and flexible endoscopy for tumors in the posterior third ventricle

Roth

Constantini

2015

JNS

View full text Add to dashboard Cite

T umors leading to occlusion of the sylvian aqueduct include those of pineal, thalamic, and tectal origins. These tumors frequently cause obstructive hydrocephalus and thus necessitate a CSF diversion procedure, such as an endoscopic third ventriculostomy (ETV).The histopathological differential diagnosis of tumors leading to aqueductal occlusion includes germ cell tumors, ependymomas, and astrocytomas. As the treatment paradigm may change according to pathology (and grade), a tumor biopsy is often indicated. Thus, in many cases a dual procedure is recommended: an ETV combined with an endoscopic biopsy (EBX). 17The trajectory for an ETV is pointed more anteriorly than the optimal trajectory for an EBX of a posterior third ventricular tumor. 17 The foramen of Monro limits the trajectory both anteriorly (avoiding injury to the fornix) and posteriorly (avoiding injury to the venous angle and genu of the internal capsule). Various techniques have been suggested to combine an ETV with an EBX, including 1) performing 1 bur hole, between both ideal entry points and using a rigid endoscope (Fig. 1A); 15,[20][21][22]26 2) performing 2 separate bur holes: one in an "ideal" location for an ETV and the second more anteriorly in an "ideal" location for a biopsy (Fig. 1B); 3,6,13,14,25,27 and 3) using a flexible endoscope through a single bur hole. 2,[8][9][10]20,23 The limitations of these options are a compromise for both the ETV and for the EBX when using a single bur hole and rigid endoscope, the need for 2 entry points and trajectories in the second option, and compromised visual quality and technical limitations using only a flexible endoscope. To overcome abbreviatioNs EBX = endoscopic biopsy; ETV = endoscopic third ventriculostomy; IVH = intraventricular hemorrhage. obJect Tumors leading to occlusion of the sylvian aqueduct include those of pineal, thalamic, and tectal origins. These tumors cause obstructive hydrocephalus and thus necessitate a CSF diversion procedure such as an endoscopic third ventriculostomy (ETV), often coupled with an endoscopic biopsy (EBX). Lesions located posterior to the massa intermedia pose a technical challenge, as the use of a rigid endoscope for performing both an ETV and EBX is limited. The authors describe their experience using a combined rigid and flexible endoscopic procedure through a single bur hole for both procedures in patients with posterior third ventricular tumors. methods Since January 2012, patients with posterior third ventricular tumors causing hydrocephalus underwent dual ETV and EBX procedures using the combined rigid-flexible endoscopic technique. Following institutional review board approval, data from clinical, radiological, surgical, and pathological records were retrospectively collected. results Six patients 3.5-53 years of age were included. Lesion locations included pineal (n = 3), fourth ventricle (n = 1), aqueduct (n = 1), and tectum (n = 1). The ETV and EBX were successful in all cases. Pathologies included pilocytic astrocytoma, pineoblastoma, ependymoma G...

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Combined rigid and flexible endoscopy for tumors in the posterior third ventricle

Roth

Constantini

2015

JNS

View full text Add to dashboard Cite

show abstract

“…Such variance in the lateral and third ventricle dimensions will translate into different relations between the third ventricle floor and the foramen of Monro causing a shift in the locations of the optimal ETV entry point. Supporting this observation (as discussed above), a high variability has been noted for the location of the optimal ETV entry point by multiple studies [9,10,[15][16][17]. Although neuronavigation allows preoperative planning and individualization of ETV approaches to match these variations, the infrastructure for this may not be available in all centers.…”

Section: Etv Planning Aid With the Incorporation Of Ventricle Sizementioning

confidence: 88%

“…The optimal trajectory for a right-sided ETV was defined as the line connecting the floor of the third ventricle with the center of the foramen of Monro [8,10,16,17] (Fig. 2a and b).…”

Section: Assessment Of Optimal Etv Entry Points and Trajectorymentioning

confidence: 99%

“…Radioanatomical data has been used to compare variants of the transpetrosal approach confirming the expected increments of working areas and angle with progressive bone removal [23]. The extent of tissue displacement in ETVs has been quantified by several investigators using intraoperative neuronavigation and paralleled with clinical safety of the procedure [14,16,17,24]. Furthermore, several studies advocate surgical simulation that uses virtual platforms or physical heads as adjunct models of surgical training as well as preoperative planning [25][26][27].…”

Section: Radioanatomical Simulations Of Surgical Approachesmentioning

confidence: 99%

See 1 more Smart Citation

Operative planning aid for optimal endoscopic third ventriculostomy entry points in pediatric cases

et al. 2017

View full text Add to dashboard Cite

Object Endoscopic third ventriculostomy (ETV) uses anatomical spaces of the ventricular system to reach the third ventricle floor and create an alternative pathway for cerebrospinal fluid flow. Optimal ETV trajectories have been previously proposed in the literature, designed to grant access to the third ventricle floor without a displacement of eloquent periventricular structures. However, in hydrocephalus, there is a significant variability to the configuration of the ventricular system, implying that the optimal ETV trajectory and cranial entry point needs to be planned on a case-by-case basis. In the current study, we created a mathematical model, which tailors the optimal ETV entry point to the individual case by incorporating the ventricle dimensions. Methods We retrospectively reviewed the imaging of 30 consecutive pediatric patients with varying degrees of ventriculomegaly. Three dimensional radioanatomical models were created using preoperative MRI scans to simulate the optimal ETV trajectory and entry point for each case. The surface location of cranial entry points for individual ETV trajectories was recorded as Cartesian coordinates centered at Bregma. The distance from the Bregma in the coronal plane represented as Bx^, and the distance from the coronal suture in the sagittal plane represented as By^. The correlation between the ventricle dimensions and the x, y coordinates were tested using linear regression models. Results The distance of the optimal ETV entry point from the Bregma in the coronal plane (Bx^) and from the coronal suture in the sagittal plane (By^) correlated well with the frontal horn ratio (FHR). The coordinates for x and y were fitted along the following linear equations: x = 85.8 FHR−13.3 (r 2 = 0.84, p < 0.001) and y = −69.6 FHR + 16.7 (r 2 = 0.83, p < 0.001). Conclusion The surface location of the optimal cranial ETV entry point correlates well with the ventricle size. We provide the first model that can be used as a surgical planning aid for a case specific ETV entry site with the incorporation of the ventricle size.

show abstract

Hydrocephalus and Surgical Solutions for It

Thomale

2023

Pediatric Neurosurgery Board Review

View full text Add to dashboard Cite

Single burr hole endoscopic biopsy with third ventriculostomy—measurements and computer-assisted planning

Abstract: Performing ETV in parallel to target paraventricular lesions causing a hydrocephalus is feasible via a single burr hole by using computer-assisted planning and performing a navigated endoscopic procedure.

Cited by 49 publications

References 43 publications

Combined rigid and flexible endoscopy for tumors in the posterior third ventricle

Combined rigid and flexible endoscopy for tumors in the posterior third ventricle

Operative planning aid for optimal endoscopic third ventriculostomy entry points in pediatric cases

Hydrocephalus and Surgical Solutions for It

Contact Info

Product

Resources

About