Clinical Efficacy and Safety of Neuroendoscopic Surgery for Severe Ventricular Thalamic Hemorrhage

Objective To summarize and analyze the clinical efficacy and safety of neuroendoscopic surgery in the treatment of patients with severe ventricular thalamic hemorrhage. Methods Eight-three patients with severe ventricular thalamic hemorrhage were treated in the Neurosurgery Department of Anqing Hospital Affiliated to Anhui Medical University from July 2019 to August 2021. Of the 83 patients, 41 underwent neuroendoscopic surgery and 42 underwent simple extraventricular drainage. The hospital stay, GCS scores on the 1st and 14th days postoperatively, the incidence of intracranial infections, and the clearance of postoperative hematomas were compared and analyzed between the two groups. The patients were followed up to 6 months. The prognosis was evaluated by the activity of daily living (ADL) score. A head CT or MRI was obtained to determine whether there was hydrocephalus, cerebral infarction, or other related complications. Results The postoperative hospital stay was 17.42±1.53 days, the GCS score was 6.56±0.21 points on day 1 and 10.83±0.36 points on day 14, intracranial infections occurred in three patients (7.31%) and the hematoma clearance rate was 83.6±5.18% in the neuroendoscopy group, all of which were significantly better than the simple extraventricular drainage group (P < 0.05). After 6 months of follow-up, 28 patients (68.29%) had a good prognosis, 5 patients (12.19%) died, and 4 patients(9.75%)had hydrocephalus in the neuroendoscopy group. In the extraventricular drainage group, the prognosis was good in 15 patients (35.71%), death in 12 patients (28.57%), and hydrocephalus in 17 patients (40.47%). The follow-up results showed that the good prognosis, mortality, and incidence of hydrocephalus in the neuroendoscopy group were significantly better than the extraventricular drainage group (P < 0.05). Conclusion Compared with traditional ventricular-puncture drainage, simultaneous endoscopic sinus surgery for severe ventricular thalamic hemorrhage had a higher hematoma clearance rate, fewer intracranial infections, and hydrocephalus, which together improve the clinical prognosis, and is thus recommended for clinical use.

Neuroendoscopic surgery in neonates — indication and results over a 10-year practice

Purpose Neuroendoscopic procedures for treatment of term and preterm newborn infants, such as endoscopic lavage for posthemorrhagic hydrocephalus, are gaining popularity despite sparse data. This single-institution report compiles all neuroendoscopic surgical procedures performed in neonates during a 10-year period. Methods Charts and electronic records were reviewed of all consecutive newborns who underwent a neuroendoscopic procedure before reaching a postmenstrual age of 44 weeks between 09/2010 and 09/2020. Available documentation was reviewed regarding the performed neuroendoscopic procedure, course of disease, complications, and all re-operations throughout the first year of life. Results During the 10-year study period, 116 infants (median gestational age at birth: 29 1/7 weeks) underwent a total of 153 neuroendoscopic procedures (median postmenstrual age at surgery: 35 0/7 weeks). The most common indication at the time of the neuroendoscopic procedures (n = 153) was intraventricular hemorrhage (IVH, n = 119), intraventricular infection (n = 15), congenital malformation (n = 8), isolated 4th ventricle (n = 7), multiloculated hydrocephalus (n = 3), and tumor (n = 1). Thirty-eight of 116 children (32.8%) underwent 43 operative revisions after 153 neuroendoscopic procedure (28.1%). Observed complications requiring surgical revision were secondary infection (n = 11), CSF fistula (n = 9), shunt dysfunction (n = 8), failure of ETV (n = 6), among others. 72 children (62%) of 116 children required permanent CSF diversion via a shunt. The respective shunt rates per diagnosis were 47 of 80 (58.8%) for previously untreated IVH, 11 of 13 (84.6%) for intraventricular infection. Shunt survival rate for the first year of life was 74% for the whole cohort. Conclusion The experience with this large cohort of neonates demonstrates the feasibility of neuroendoscopic technique for the treatment of posthemorrhagic or postinfectious hydrocephalus. Rate and type of complications after neuroendoscopic procedures were within the expected range. Assessing the potential long-term benefits of neuroendoscopic techniques has to await results of ongoing studies.

Application of Endoport-Assisted Neuroendoscopic Techniques in Lateral Ventricular Tumor Surgery

PurposeThe aim of this study was to review the experience of Endoport-assisted neuroendoscopic surgery for lateral ventricular tumors resection, investigate the therapeutic efficiency and discuss the key points. MethodsWe retrospectively reviewed the clinical data of 16 patients suffering from lateral ventricular tumors. All the patients received Endoport-assisted neuroendoscopic surgery from January 2018 to June 2020 in the department of neurosurgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School. ResultsAll the patients received standardized treatment according to the preoperative image data and the postoperative pathology of the tumors. Endoport-assisted Neuroendoscopic surgery achieved complete removal of lateral ventricular tumors in 14 cases (87.5%) and subtotal removal in 2 cases (12.5%, glioma). The perioperative complications were analyzed, 1 acute epidural hematoma occurred during surgery, 1 hemiplegia and 2 obstructive hydrocephalus occurred after surgery. All the complications were managed timely. During the long-time follow up, the patient with glioblastoma died 16 months after surgery, the other patients are still alive with Glasgow outcome scales not less than 4.ConclusionEndoport-assisted neuroendoscopic surgery is suitable for the resection of lateral ventricular tumors. This procedure is simple, effective, minimally invasive, and associated with fast postoperative recovery.

Effect of endoscope flexibility on tissue dissection profile assessed with pulsed water jet device: ensuring safety, efficacy, and handling of thin devices for neuroendoscopic surgery

Objective We developed an actuator-driven pulsed water jet device (ADPJ) for flexible neuroendoscopy to achieve effective tissue dissection with vasculature preservation. Although flexibility is a strong advantage for minimally invasiveness, the effect of the ductile curvature on the dissection profiles remains unknown. The purpose of this study was to clarify the impact of the curvature change of the ADPJ connecting tube on the dissection safety and efficacy. Results Three ADPJ connecting tubes with different inner diameters (1.0, 0.75, 0.5 mm) were used to dissect the brain phantom. They were bent at 3 angles: 0°, 60°, and 120°. The dissection profiles were evaluated using the mean depth and coefficient of variation (CV) for efficacy and safety, respectively.The larger inner diameter connecting tube dissected more deeply. The dissection depth was not changed regardless of the curvature degree in each tube. There was no significant difference in CVs regardless of inner diameter and curvature. The ductile curvature of the flexible neuroendoscope did not affect the efficacy and safety of the ADPJ dissection profile. Among the numerous instruments, tube-formed devices, including suction and injecting devices such as ADPJ, can be used safely and effectively without flexibility-related limitations.

SURG-14. ENDOSCOPIC SURGERY FOR PEDIATRIC INTRAVENTRICULAR TUMOR WITHOUT HYDROCEPHALUS: INDICATION, SURGICAL TECHNIQUE, AVOIDANCE OF COMPLICATION, AND ITS PROSPECT

INTRODUCTION Neuroendoscopic surgery is useful for intraventricular tumors accompanied by ventriculomegaly. However, it is often challenging for cases with small ventricles. Our institution is actively performing surgeries for pediatric intraventricular tumors without frank ventriculomegaly. METHODS Seven cases of intraventricular tumors without ventriculomegaly (5 cases of subependymal giant cell astrocytoma (SEGA) and 2 cases of germ cell tumors (GCTs)) were analyzed. The age ranged between 3 and 14 years (median 5 years). The sizes of SEGA were between 10-27mm, and all the tumors showed an enlargement around the foramen of Monro, which was the indication for surgery. Biopsy and third ventriculostomy were performed for GCTs. For resection, after making a small craniotomy of 2 x 3 cm, ellipse-cone-like sheath with a diameter of 12mm or 17mm was inserted through it to the lateral ventricle, which enabled a wide surgical view. Under a rigid endoscope of 4mm diameter, 2 types of surgical instruments were employed, making the microsurgical procedure like under a microscope, with a wider view, possible. For the cases of tumor resection, septostomy and placement of a drain in the ventricle were performed at the end of surgery. RESULTS The lesions were safely approached in all the cases. For resection, endoscopic microsurgery was possible, and tumor was totally removed in all the cases. No postoperative complication was observed in any of them. CONCLUSIONS Our experience shows that tumor resection can be safely achieved with the aid of endoscope even for cases without ventriculomegaly.

Effect of Endoscope Flexibility on Tissue Dissection Profile Assessed With Pulsed Water Jet Device: Ensuring Safety, Efficacy, and Handling of Thin Devices for Neuroendoscopic Surgery

Objective: We developed an actuator-driven pulsed water jet device (ADPJ) for flexible neuroendoscopy to achieve effective tissue dissection with vasculature preservation. Although flexibility is a strong advantage for minimally invasiveness, the effect of the ductile curvature on the dissection profiles remains unknown. The purpose of this study was to clarify the impact of the curvature change of the ADPJ connecting tube on the dissection safety and efficacy.Results: Three ADPJ connecting tubes with different inner diameters (1.0, 0.75, 0.5 mm) were used to dissect the brain phantom. They were bent at 3 angles: 0 °, 60 °, and 120 °. The dissection profiles were evaluated using the mean depth and coefficient of variation (CV) for efficacy and safety, respectively.The larger inner diameter connecting tube dissected more deeply. The dissection depth was not changed regardless of the curvature degree in each tube. There was no significant difference in CVs regardless of inner diameter and curvature. The ductile curvature of the flexible neuroendoscope did not affect the efficacy and safety of the ADPJ dissection profile. Among the numerous instruments, tube-formed devices, including suction and injecting devices such as ADPJ, can be used safely and effectively without flexibility-related limitations.