The use of waterjet dissection in endoscopic neurosurgery

Oertel, Joachim; Gen, Michail; Krauss, Joachim K.; Zumkeller, M.; Gaab, M. R.

doi:10.3171/jns.2006.105.6.928

Cited by 43 publications

(31 citation statements)

References 14 publications

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“…1,2,15,16,[35][36][37][38]43,44 In brief, all procedures were performed with the patient supine and in a state of general anesthesia with the head slightly anteflexed in Mayfield 3-pin fixation or fixed with bandages only in infants ≤ 2 years old. Antibiotic medications were not routinely prescribed.…”

Section: Endoscopic Surgical Techniquementioning

confidence: 99%

Endoscopic options in children: experience with 134 procedures

Oertel

Baldauf

Schroeder

et al. 2009

PED

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106

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Object There are frequent applications for endoscopy in neurosurgery. However, endoscopic surgery in children has peculiar characteristics and is associated with different rates of success. In this study, the authors report on their experience with 134 consecutive endoscopy procedures performed in 126 patients < 18 years of age. Methods Between April 1993 and October 2007, 134 endoscopic procedures were performed in 126 children. Indications for surgery included brain tumors in 48 children, cystic lesions in 24, aqueductal stenosis in 23, various malformations in 20, hemorrhage and infarction in 6, and isolated ventricles in 5 children. In this long-term followup study, data were analyzed with respect to clinical and radiological success rates, as well as shunt dependence both in relation to lesion origin, and to the type of endoscopic procedure performed (endoscopic third ventriculostomy [ETV], septostomy, aqueductoplasty, or cystocisternostomy). Finally, the influence of patient age on the success rate was evaluated. Results In 114 patients, restoration of CSF circulation was the goal of endoscopy, but in 2 patients only ventriculoscopy was performed followed by ventriculoperitoneal shunt placement. In 12 of 114 patients, tumor biopsy sampling or resection was performed simultaneously with shunt placement. In another 12 patients, only endoscopic tumor resection without CSF circulation restoration was done. The follow-up period ranged from 1 to 6 years. Thirteen tumor biopsies, 7 partial tumor resections, and 4 endoscopically complete tumor resections were performed. An intraoperative switch to microsurgery was made in 2 patients because of recurrent hemorrhage and an overly time-consuming endoscopic surgery. Cerebrospinal fluid circulation was successfully restored in 81 (72%) of 112 patients, with the use of endoscopy in the setting of tumor-related hydrocephalus providing the best results (86% success rate). However, of the various endoscopic procedures, cyst openings (cystocisternostomy, cystoventriculostomy, and ventriculocystocisternostomy) provided the best results—superior even to ETV—with a success rate of 77% and no complications. In contrast, endoscopic aqueductoplasty had a high failure and complication rate. Patients < 6 months old who underwent ETV, septostomy, or aqueductoplasty had poor results and became more frequently shunt dependent than older children. Conclusions Overall, endoscopy can be considered safe and effective in children. Based on the authors' data, acute hydrocephalus cases such as those caused by tumors are the best candidates for endoscopic CSF flow restoration. Interestingly, cyst openings to the ventricles or cisterns were the most successful endoscopic techniques with the lowest complication rate. Aqueductoplasty should be reserved for selected cases. Finally, the success rate of endoscopic techniques remains poor in infants < 6 months of age; this was not only true of ETV, but also other techniques such as septostomy and aqueductoplasty.

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Section: Endoscopic Surgical Techniquementioning

confidence: 99%

Endoscopic options in children: experience with 134 procedures

Oertel

Baldauf

Schroeder

et al. 2009

PED

Self Cite

106

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“…5 Thus, our group even applied the waterjet for opening the floor of the third ventricle under preservation of the basilar artery tip. 9 High precision waterjet use is not only requested for neurosurgical use. There is also a need for maximum continuous reliability for all surgeons of all disciplines, without change of depth, of waterjet direction, of waterjet pressures or of flow-through volume.…”

Section: Discussionmentioning

confidence: 99%

“…Since the mid-1990s, a group of authors picked up this technique for further experimental 3-7 and clinical [8][9][10][11][12][13][14][15] studies. After the Helix Hydro-Jet waterjet system was approved for human surgery, they demonstrated the intraoperative safety.…”

Section: Introductionmentioning

confidence: 99%

New applicator improves waterjet dissection quality

Tschan

Krauss

et al. 2010

British Journal of Neurosurgery

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“…If the hematoma is too hard, it can be carefully removed using a vacuum aspirator under observation by a rigid endoscope. Water jet or ultrasound dissection[2930] may be useful for ICH but are not suitable for IVH. Surgery should be performed before the hematoma hardens.…”

Section: Discussionmentioning

confidence: 99%

Neuroendoscopic evacuation of intraventricular hematoma associated with thalamic hemorrhage to shorten the duration of external ventricular drainage

Nomura

Ishihara²,

Yanagawa³

et al. 2010

Surg Neurol Int

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Background:We report neuroendoscopic evacuation of an intraventricular hematoma (IVH) in 13 patients with thalamic hemorrhage. We discuss strategies to improve the outcome and to shorten the management period by using external ventricular drainage (EVD).Methods:Patients were classified into fair (modified Rankin scale [mRS] grade 4 or less) and poor (mRS grade 5) outcome groups, and depending on the duration of EVD, into short (7 days or shorter) and long EVD (8 days or longer) groups.Results:The postoperative residual IVH, graded using the Graeb score, was better for the fair outcome group than for the poor outcome group (3.9 [1.2] vs. 5.7 [1.0], P < 0.05). The postoperative Graeb score was significantly better for the short EVD group than for the long EVD group (3.6 [0.8] vs. 6.0 [0.6], P < 0.01). The duration of EVD was not correlated with the IVH at the fourth ventricle, but it was correlated with the IVH at the foramen of Monro (P < 0.05) and the third ventricle (P < 0.01). Reduction in the volume of thalamic hemorrhage had no effect on the neurological outcome or duration of EVD.Conclusion:Neuroendoscopic evacuation of the IVH at the foramen of Monro and the third ventricle shortened the duration of EVD for hydrocephalus caused by thalamic hemorrhage with IVH involvement. Removal of the thalamic hemorrhage and IVH at the fourth ventricle was not necessary.

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The use of waterjet dissection in endoscopic neurosurgery

Cited by 43 publications

References 14 publications

Endoscopic options in children: experience with 134 procedures

Endoscopic options in children: experience with 134 procedures

New applicator improves waterjet dissection quality

Neuroendoscopic evacuation of intraventricular hematoma associated with thalamic hemorrhage to shorten the duration of external ventricular drainage

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