RESUMEN
In 30 cases, an analysis of the transoral transpharyngeal approach to the ventral brain stem was made. All preparations were performed in situ using microscopic and endoscopic methods. Modern imaging techniques and computer-assisted approach planning were also applied and discussed. To show the subarachnoidal cisterns and receive a realistic impression of the tissue, the preparation was performed 26 times in non-fixed cases. To use currently available equipment safely, it is important to take anatomical details into account when determining the size and type of the clivus window to be used. Preparation of the preclival tissue is the most difficult step. It requires a precise approach plan to ensure safe closure. This selective approach gives the best access to the lower ventral brainstem, without any of the problems associated with other approaches to the same region. The transoral transpharyngeal approach is described here within the context of minimally invasive techniques, in particular endoscopy, modern imaging methods, and computer-assisted approach planning.
Asunto(s)
Encéfalo/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos , Neurocirugia/métodos , Articulación Atlantooccipital , Tejido Conectivo/anatomía & histología , Disección/métodos , Endoscopía , Humanos , Procesamiento de Imagen Asistido por Computador , Ilustración Médica , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Modelos Teóricos , Boca/cirugía , Músculo Esquelético/anatomía & histología , Cuello , Neurocirugia/instrumentación , Faringe/cirugía , Cráneo/anatomía & histología , Terapia Asistida por Computador , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: Endoscopic third ventriculostomy (ETV) has been shown to be a sufficient alternative in the surgical treatment of occlusive hydrocephalus. To elucidate the ongoing discussion of timing, indication, and surgical technique, a retrospective analysis of 100 consecutive ETVs was conducted. METHODS: One hundred ETVs were performed in 95 patients (43 female and 52 male patients). Their age ranged from 3 weeks to 77 years (mean age, 36 yr). Hydrocephalus was caused by aqueductal stenosis in 40 patients, space-occupying lesions in 42, and intraventricular or subarachnoid hemorrhage in 8. One patient had postinflammatory hydrocephalus, and four patients had occlusive hydrocephalus of unknown origin. In 33 cases, surgery was performed using stereotactic guidance. RESULTS: ETV was accomplished in 98 of 100 cases. The overall success rate was 76%. Patients with benign space-occupying lesions and nontumorous aqueductal stenosis had the highest success rates, which were 95 and 83%, respectively. Complications were arterial bleeding in one case, venous bleeding in three cases, intracerebral bleeding in one case, and infection in one case. There were no permanent morbidities or mortalities. CONCLUSION: ETV is most effective in treating uncomplicated occlusive hydrocephalus caused by aqueductal stenosis and space-occupying lesions. ETV is still effective in two-thirds of the patients with previous infections or intraventricular bleeding. Patients who have previously undergone shunting and who have occlusive hydrocephalus should undergo ETV at the time of shunt failure, with immediate ligation or removal of the shunt device. In selected cases of distorted anatomy or impaired visual conditions, stereotactic guidance is helpful.
Asunto(s)
Endoscopía , Hidrocefalia/cirugía , Ventriculostomía , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
To evaluate the usefulness of transendoscopic sonography, we have studied the use of a new sonographic probe of 6 F diameter in 11 fresh specimens. We achieved a precise imaging of well known anatomic structures and, moreover, obtained an additional dimension in endoscopy, since the sonographic probe adds a transverse scan to the endoscopic view, like a mini-CT at the tip of the probe. In this way, we also examined the guiding characteristics of this imaging technique, both in real time and on-line. Our results promise further interesting aspects of this technique in minimally invasive neurosurgery and suggest that further development and clinical experience seem to be justified.
Asunto(s)
Cadáver , Ventrículos Cerebrales/diagnóstico por imagen , Endoscopía/métodos , Neurocirugia/instrumentación , Ultrasonografía Intervencional/instrumentación , Ventriculografía Cerebral , Terminales de Computador , Ecoencefalografía/instrumentación , Ecoencefalografía/métodos , Humanos , Periodo Intraoperatorio/instrumentación , Periodo Intraoperatorio/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Neurocirugia/métodos , Tomografía Computarizada por Rayos X , Ultrasonografía Intervencional/métodosRESUMEN
To evaluate the usefulness of transendoscopic sonography we studied two new sono probes 6 F in diameter in 17 fresh specimens. We saw precise imaging of well-known anatomical structures and also gained an additional dimension in endoscopy, as the sono adds to the endo-view a transverse scan like a mini-CT at the tip of the probe. We also experienced the navigation characteristic of this imaging technique, both in real time and on line. Some 3-D reconstructions of the ventricular system were examined. The equipment has been used in clinical practice and must now be adapted for neurosurgery.
Asunto(s)
Ecoencefalografía/métodos , Endosonografía/métodos , Adulto , Encéfalo/diagnóstico por imagen , Encéfalo/cirugía , Preescolar , Ecoencefalografía/instrumentación , Endosonografía/instrumentación , Humanos , Procesamiento de Imagen Asistido por Computador , Tomografía Computarizada por Rayos XRESUMEN
The endoscopic view offers a new anatomical dimension to the neurosurgeon. The fact makes it basically necessary to study the topographic anatomy under endoscopic conditions. In this paper attention was drawn to the ventricles because they are the most common region of clinical application. In 25 specimens neuroendoscopic explorations of the ventricles have been done. The dissections have been carried out through one- and two burr hole approaches (two working endoscopes at the same time). The instrumentation includes rigid 4 mm and 6 mm endoscopes. The procedures have been documented by continuous video recording and parallel photography.