Portable Neuroendoscopy: Initial Experience with a Portable, Self-Contained Endoscopy System within the Intracranial Space

Introduction: Neuroendoscopic techniques have advanced the capabilities of minimally invasive cranial and skull base neurosurgery. While widely available, workflow issues can create significant barriers to the successful use of endoscopes. Such barriers include staff unfamiliarity, camera incompatibilities, sterile processing errors, and scope-camera-video tower malfunctions. In addition, the bulk and complexity of the necessary equipment make bedside intensive care application of neuroendoscopy impractical if not impossible. Small, self-contained, portable and integrated endoscope-camera workstations now commercially exist, and hold promise for neurosurgical applications. The author presents his experience with the usage of one such system for human ventricular and subdural endoscopy.

Case Descriptions: A 45-year-old female presented with congenital hydrocephalus, and underwent insertion of a right frontal ventriculoperitoneal shunt. A commercially available 1.2-mm diameter disposable endoscope (OnPoint, Zimmer-Biomet Corporation, Jacksonville, FL) integrated with a reusable camera and image processing workstation (roughly the size of a small laptop) was used to assist in the insertion of the ventricular catheter and to inspect the intraventricular space. The image processing unit has an 8 cm × 5 cm adjustable screen combined with digital storage (both still and video capture capabilities). In a second case, the endoscope was used to break down adhesions and inspect the subdural space during evacuation of an extensive 20–mm-thick loculated subacute subdural hematoma overlying the cerebral convexity in an 84-year-old male.

Discussion: The new generation of small, self-contained endoscopes may allow expanded application of neuroendoscopy, including bedside usage. Limitations of the current systems include the lack of a working channel, and optical quality that is inferior to standard reusable glass lens systems. By refining the use cases for portable neuroendoscopy, technical issues will be more easily solved. Ultimately, such self-contained systems could be applied in bedside settings, such as intensive care units or in health-care delivery systems with limited infrastructure resources.