|
INTRACRANIAL ENDOSCOPIC NEUROSURGERY
MARK M. SOUWEIDANE, M.D.
New York-Presbyterian Hospital Minimal Access Surgery Center
Endoscopic Neurosurgery
Endoscopic neurosurgery has greatly simplified the management
of many intracranial ailments in adults and children. Similar
in concept to other endoscopic surgery, intracranial neuroendoscopy
reduces the surgical morbidity, shortens the hospital stay,
and minimizes the cosmetic concerns associated with many major
neurosurgical conditions. In general, neuroendoscopy does
not require large incisions on the scalp, removal of skull
flaps, or extensive dissection through brain tissue. The introduction
of the endoscope for neurosurgical use is the result of advanced
technological breakthroughs in optical and illuminating systems.
Intracranial endoscopic procedures are currently being performed
for a number of disorders.
Brain tumors
Brain tumors situated in the intraventricular compartment
are amenable to an endoscopic biopsy or resection. Endoscopic
biopsy for intraventricular brain tumors avoids many of the
inherent risks associated with conventional surgical approaches.
Because these tumors are typically situated deep within the
brain, the ability to approach these tumors with a minimally
invasive technique offers a very significant advantage to
the patient. A subset of intraventricular brain tumors, the
colloid cyst of the third ventricle, has long been recognized
to be associated with significant morbidity following attempted
removal with a conventional craniotomy. The complete removal
of these tumors through the endoscope is proven for both long
term management and reduced surgical risk.
Hydrocephalus
The mainstay of treatment for patients with hydrocephalus
has been the insertion of a permanent shunting device for
over 40 years. While very effective in successfully treating
the problems associated with hydrocephalus, shunts have a
significant rate of failure. These failures are associated
with significant risk and result in repeated surgery and many
hospital admissions. In certain cases of hydrocephalus, shunts
can now be avoided through the use of endoscopic third ventriculostomy.
This endoscopic technique creates a small 3-5 millimeter fenestration
in the floor of the third ventricle under direct vision. The
obvious advantage of endoscopic third ventriculostomy is that
the patient has no implanted hardware and thus avoids all
the inherent complications associated with shunts.
Intracranial Cysts
The treatment of intracranial cysts has relied upon inserting
a permanent draining device such as a shunt or performing
an extensive surgical procedure to fenestrate the membrane
of the cyst. Cyst fenestration is typically favored due to
the high success rate of this procedure. However, shunt placement
is appealing due to the simplicity of the operation. With
the advent of endoscopic cyst fenestration, an equally high
rate of success can now be accomplished without the risks
associated with a formal craniotomy. Endoscopic cyst fenestration
takes a fraction of the time with a greatly reduced hospital
stay.
|
