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DOI: 10.4103/ajns.AJNS_367_19
A review of common endoscopic intracranial approaches
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With the evolution of surgical techniques, endoscopy has emerged as a suitable alternative to many instances of more invasive methods. In this review article, we aim to discuss the endoscopic advancements, procedural details, indications, and outcomes of the most commonly practiced neuroendoscopic procedures. We have also summarized the uses, techniques, and challenges of neuroendoscopy in select neurosurgical pathologies.
Financial support and sponsorship
Nil.
Publication History
Received: 18 December 2019
Accepted: 04 May 2020
Article published online:
16 August 2022
© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Abd-El-Barr MM, Cohen AR. The origin and evolution of neuroendoscopy. Childs Nerv Syst 2013;29:727-37.
- 2 Esposito F, Cappabianca P. Neuroendoscopy: General aspects and principles. World Neurosurg 2013;79 2 Suppl:S14.e17-9.
- 3 Hsu W, Li KW, Bookland M, Jallo GI. Keyhole to the brain: Walter Dandy and neuroendoscopy. J Neurosurg Pediatr 2009;3:439-42.
- 4 Beems T, Grotenhuis JA. Long-term complications and definition of failure of neuroendoscopic procedures. Childs Nerv Syst 2004;20:868-77.
- 5 Demerdash A, Rocque BG, Johnston J, Rozzelle CJ, Yalcin B, Oskouian R, et al. Endoscopic third ventriculostomy: A historical review. Br J Neurosurg 2017;31:28-32.
- 6 Oertel J, Vulcu S, Eickele L, Wagner W, Cinalli G, Rediker J. Long-term follow-up of repeat endoscopic third ventriculostomy in obstructive hydrocephalus. World Neurosurg 2017;99:556-65.
- 7 Yadav YR, Parihar V, Pande S, Namdev H, Agarwal M. Endoscopic third ventriculostomy. J Neurosci Rural Pract 2012;3:163-73.
- 8 Shim KW, Park EK, Kim DS, Choi JU. Neuroendoscopy: Current and future perspectives. J Korean Neurosurg Soc 2017;60:322-6.
- 9 Morgenstern PF, Osbun N, Schwartz TH, Greenfield JP, Tsiouris AJ, Souweidane MM. Pineal region tumors: An optimal approach for simultaneous endoscopic third ventriculostomy and biopsy. Neurosurg Focus 2011;30:E3.
- 10 Kobayashi N, Ogiwara H. Endoscopic third ventriculostomy for hydrocephalus in brainstem glioma: A case series. Childs Nerv Syst 2016;32:1251-5.
- 11 Fallah A, Wang AC, Weil AG, Ibrahim GM, Mansouri A, Bhatia S. Predictors of outcome following cerebral aqueductoplasty: An individual participant data meta-analysis. Neurosurgery 2015;78:285-96.
- 12 Madsen PJ, Mallela AN, Hudgins ED, Storm PB, Heuer GG, Stein SC. The effect and evolution of patient selection on outcomes in endoscopic third ventriculostomy for hydrocephalus: A large-scale review of the literature. J Neurol Sci 2018;385:185-91.
- 13 Greenfield JP, Hoffman C, Kuo E, Christos PJ, Souweidane MM. Intraoperative assessment of endoscopic third ventriculostomy success. J Neurosurg Pediatr 2008;2:298-303.
- 14 Isaacs AM, Bezchlibnyk YB, Yong H, Koshy D, Urbaneja G, Hader WJ, et al. Endoscopic third ventriculostomy for treatment of adult hydrocephalus: Long-term follow-up of 163 patients. Neurosurg Focus 2016;41:E3.
- 15 Foroughi M, Wong A, Steinbok P, Singhal A, Sargent MA, Cochrane DD. Third ventricular shape: A predictor of endoscopic third ventriculostomy success in pediatric patients. J Neurosurg Pediatr 2011;7:389-96.
- 16 Borcek AO, Ucar M, Karaaslan B. Simplest radiological measurement related to clinical success in endoscopic third ventriculostomy. Clin Neurol Neurosurg 2017;152:16-22.
- 17 Azab WA, Mijalcic RM, Abdelnabi EA, Khan TA, Mohammad MH, Shaat MS. Infundibular recess angle reduction after endoscopic third ventriculostomy: Does it reflect clinical success? World Neurosurg 2015;84:549-54.
- 18 Kulkarni AV, Riva-Cambrin J, Browd SR. Use of the ETV Success Score to explain the variation in reported endoscopic third ventriculostomy success rates among published case series of childhood hydrocephalus. J Neurosurg Pediatr 2011;7:143-6.
- 19 Kulkarni AV, Drake JM, Mallucci CL, Sgouros S, Roth J, Constantini S; Canadian Pediatric Neurosurgery Study G. Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus. J Pediatr 2009;155:254-9.e251.
- 20 Warf BC. Hydrocephalus in Uganda: The predominance of infectious origin and primary management with endoscopic third ventriculostomy. J Neurosurg 2005;102 1 Suppl:1-15.
- 21 Warf BC. Comparison of endoscopic third ventriculostomy alone and combined with choroid plexus cauterization in infants younger than 1 year of age: A prospective study in 550 African children. J Neurosurg 2005;103 6 Suppl:475-81.
- 22 Kulkarni AV, Riva-Cambrin J, Browd SR, Drake JM, Holubkov R, Kestle JR, et al. Endoscopic third ventriculostomy and choroid plexus cauterization in infants with hydrocephalus: A retrospective Hydrocephalus Clinical Research Network study. J Neurosurg Pediatr 2014;14:224-9.
- 23 Wang S, Stone S, Weil AG, Fallah A, Warf BC, Ragheb J, et al. Comparative effectiveness of flexible versus rigid neuroendoscopy for endoscopic third ventriculostomy and choroid plexus cauterization: A propensity score-matched cohort and survival analysis. J Neurosurg Pediatr 2017;19:585-91.
- 24 Fallah A, Weil AG, Juraschka K, Ibrahim GM, Wang AC, Crevier L, et al. The importance of extent of choroid plexus cauterization in addition to endoscopic third ventriculostomy for infantile hydrocephalus: A retrospective North American observational study using propensity score-adjusted analysis. J Neurosurg Pediatr 2017;20:503-10.
- 25 Riva-Cambrin J, Kestle JR, Rozzelle CJ, Naftel RP, Alvey JS, Reeder RW, et al. Predictors of success for combined endoscopic third ventriculostomy and choroid plexus cauterization in a North American setting: A Hydrocephalus Clinical Research Network study. J Neurosurg Pediatr 2019;24:1-11.
- 26 Dewan MC, Lim J, Morgan CD, Gannon SR, Shannon CN, Wellons JC 3rd, et al. Endoscopic third ventriculostomy with choroid plexus cauterization outcome: Distinguishing success from failure. J Neurosurg Pediatr 2016;25:655-62.
- 27 Liu JK, Das K, Weiss MH, Laws ER Jr., Couldwell WT. The history and evolution of transsphenoidal surgery. J Neurosurg 2001;95:1083-96.
- 28 Yang I, Wang MB, Bergsneider M. Making the transition from microsurgery to endoscopic trans-sphenoidal pituitary neurosurgery. Neurosurg Clin N Am 2010;21:643-51, vi.
- 29 Solari D, Villa A, De Angelis M, Esposito F, Cavallo LM, Cappabianca P. Anatomy and surgery of the endoscopic endonasal approach to the skull base. Transl Med UniSa 2012;2:36-46.
- 30 Gaillard S. The transition from microscopic to endoscopic transsphenoidal surgery in high-caseload neurosurgical centers: The experience of Foch Hospital. World Neurosurg 2014;82 6 Suppl:S116-20.
- 31 Juraschka K, Khan OH, Godoy BL, Monsalves E, Kilian A, Krischek B, et al. Endoscopic endonasal transsphenoidal approach to large and giant pituitary adenomas: Institutional experience and predictors of extent of resection. J Neurosurg 2014;121:75-83.
- 32 Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: The rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus 2005;19:E3.
- 33 Prosser J, Vender J, Alleyne C, Solares C. Expanded Endoscopic endonasal approaches to skull base meningiomas. J Neurol Surg Part B Skull Base 2012;73:147-56.
- 34 de Lara D, Ditzel Filho LF, Prevedello DM, Carrau RL, Kasemsiri P, Otto BA, et al. Endonasal endoscopic approaches to the paramedian skull base. World Neurosurg 2014;82 6 Suppl:S121-9.
- 35 Jho HD, Ha HG. Endoscopic endonasal skull base surgery: Part 1--The midline anterior fossa skull base. Minim Invasive Neurosurg 2004;47:1-8.
- 36 Oyama K, Tahara S, Hirohata T, Ishii Y, Prevedello DM, Carrau RL, et al. Surgical anatomy for the endoscopic endonasal approach to the ventrolateral skull base. Neurol Med Chir (Tokyo) 2017;57:534-41.
- 37 Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: The rostrocaudal axis. Part II. Posterior clinoids to the foramen magnum. Neurosurg Focus 2005;19:E4.
- 38 Fomichev D, Kalinin P, Kutin M, Sharipov O. Extended transsphenoidal endoscopic endonasal surgery of suprasellar craniopharyngiomas. World Neurosurg 2016;94:181-7.
- 39 Mascarenhas L, Moshel YA, Bayad F, Szentirmai O, Salek AA, Leng LZ, et al. The transplanum transtuberculum approaches for suprasellar and sellar-suprasellar lesions: Avoidance of cerebrospinal fluid leak and lessons learned. World Neurosurg 2014;82:186-95.
- 40 Abbassy M, Woodard TD, Sindwani R, Recinos PF. An overview of anterior skull base meningiomas and the endoscopic endonasal approach. Otolaryngol Clin North Am 2016;49:141-52.
- 41 Wardas P, Tymowski M, Piotrowska-Seweryn A, Markowski J, Ładziński P. Hadad-Bassagasteguy flap in skull base reconstruction – Current reconstructive techniques and evaluation of criteria used for qualification for harvesting the flap. Wideochir Inne Tech Maloinwazyjne 2019;14:340-7.
- 42 Amin BK, Daniel MP, Ricardo LC, Carl HS, Ajith T, Paul G, et al. Endoscopic endonasal skull base surgery: Analysis of complications in the authors' initial 800 patients. J Neurosurg 2011;114:1544-68.
- 43 Wang WH, Hung YC, Hsu SP, Lin CF, Chen HH, Shih YH, et al. Endoscopic hematoma evacuation in patients with spontaneous supratentorial intracerebral hemorrhage. J Chin Med Assoc 2015;78:101-7.
- 44 Li Y, Yang R, Li Z, Yang Y, Tian B, Zhang X, et al. Surgical evacuation of spontaneous supratentorial lobar intracerebral hemorrhage: Comparison of safety and efficacy of stereotactic aspiration, endoscopic surgery, and craniotomy. World Neurosurg 2017;105:332-40.
- 45 Ye Z, Ai X, Hu X, Fang F, You C. Comparison of neuroendoscopic surgery and craniotomy for supratentorial hypertensive intracerebral hemorrhage: A meta-analysis. Medicine 2017;96:e7876.
- 46 Yao Z, Hu X, You C, He M. Effect and feasibility of endoscopic surgery in spontaneous intracerebral hemorrhage: A systematic review and meta-analysis. World Neurosurg 2018;113:348-56.e342.
- 47 Wang C, Liu C, Xiong Y, Han G, Yang H, Yin H, et al. Surgical treatment of intracranial arachnoid cyst in adult patients. Neurol India 2013;61:60-4.
- 48 Hayes MJ, TerMaath SC, Crook TR, Killeffer JA. A review on the effectiveness of surgical intervention for symptomatic intracranial arachnoid cysts in adults. World Neurosurg 2019;123:e259-72.
- 49 Galassi E, Tognetti F, Gaist G, Fagioli L, Frank F, Frank G. CT scan and metrizamide CT cisternography in arachnoid cysts of the middle cranial fossa: Classification and pathophysiological aspects. Surg Neurol 1982;17:363-9.
- 50 Azab WA, Almanabri M, Yosef W. Endoscopic treatment of middle fossa arachnoid cysts. Acta Neurochirurgica 2017;159:2313-7.
- 51 Elhammady MS, Bhatia S, Ragheb J. Endoscopic Fenestration of middle fossa arachnoid cysts: A technical description and case series. Pediatr Neurosurg 2007;43:209-15.
- 52 Kirollos RW, Javadpour M, May P, Mallucci C. Endoscopic treatment of suprasellar and third ventricle-related arachnoid cysts. Childs Nerv Syst 2001;17:713-8.
- 53 Gui SB, Wang XS, Zong XY, Zhang YZ, Li CZ. Suprasellar cysts: Clinical presentation, surgical indications, and optimal surgical treatment. BMC Neurol 2011;11:52.
- 54 Gangemi M, Colella G, Magro F, Maiuri F. Suprasellar arachnoid cysts: Endoscopy versus microsurgical cyst excision and shunting. Br J Neurosurg 2007;21:276-80.
- 55 Crimmins DW, Pierre-Kahn A, Sainte-Rose C, Zerah M. Treatment of suprasellar cysts and patient outcome. J Neurosurg 2006;105 2 Suppl:107-14.
- 56 Gangemi M, Seneca V, Colella G, Cioffi V, Imperato A, Maiuri F. Endoscopy versus microsurgical cyst excision and shunting for treating intracranial arachnoid cysts. J Neurosurg Pediatr 2011;8:158-64.
- 57 Sengul G, Tuzun Y, Cakir M, Duman S, Colak A, Kadioglu HH, et al. Neuroendoscopic approach to quadrigeminal cistern arachnoid cysts. Eurasian J Med 2012;44:18-21.
- 58 Cinalli G, Spennato P, Columbano L, Ruggiero C, Aliberti F, Trischitta V, et al. Neuroendoscopic treatment of arachnoid cysts of the quadrigeminal cistern: A series of 14 cases. J Neurosurg Pediatr 2010;6:489-97.
- 59 El-Ghandour NM. Endoscopic treatment of quadrigeminal arachnoid cysts in children. J Neurosurg Pediatr 2013;12:521-8.
- 60 Choi JU, Kim DS, Huh R. Endoscopic approach to arachnoid cyst. Childs Nerv Syst 1999;15:285-91.
- 61 van Beijnum J, Hanlo PW, Fischer K, Majidpour MM, Kortekaas MF, Verdaasdonk RM, et al. Laser-assisted endoscopic third ventriculostomy: Long-term results in a series of 202 patients. Neurosurgery 2008;62:437-44.
- 62 Kunwar S. Endoscopic adjuncts to intraventricular surgery. Neurosurg Clin N Am 2003;14:547-57.
- 63 Lee MH, Kim HR, Seol HJ, Shin HJ. Neuroendoscopic biopsy of pediatric brain tumors with small ventricle. Childs Nerv Syst 2014;30:1055-60.
- 64 Giannetti AV, Alvarenga AY, de Lima TO, Pedrosa HA, Souweidane MM. Neuroendoscopic biopsy of brain lesions: Accuracy and complications. J Neurosurg 2015;122:34-9.
- 65 Depreitere B, Dasi N, Rutka J, Dirks P, Drake J. Endoscopic biopsy for intraventricular tumors in children. J Neurosurg 2007;106 5 Suppl:340-6.
- 66 Samadian M, Maloumeh EN, Shiravand S, Ebrahimzadeh K, Sharifi G, Mousavinejad A, et al. Pineal region tumors: Long-term results of endoscopic third ventriculostomy and concurrent tumor biopsy with a single entry approach in a series of 64 cases. Clin Neurol Neurosurg 2019;184:105418.
- 67 Knaus H, Matthias S, Koch A, Thomale UW. Single burr hole endoscopic biopsy with third ventriculostomy–measurements and computer-assisted planning. Childs Nerv Syst 2011;27:1233-41.
- 68 Veto F, Horváth Z, Dóczi T. Biportal endoscopic management of third ventricle tumors in patients with occlusive hydrocephalus: Technical note. Neurosurgery 1997;40:871-7.
- 69 Oppido PA, Fiorindi A, Benvenuti L, Cattani F, Cipri S, Gangemi M, et al. Neuroendoscopic biopsy of ventricular tumors: A multicentric experience. Neurosurg Focus 2011;30:E2.
- 70 Roth J, Constantini S. Combined rigid and flexible endoscopy for tumors in the posterior third ventricle. J Neurosurg 2015;122:1341-6.
- 71 Stachura K, Grzywna E. Neuronavigation-guided endoscopy for intraventricular tumors in adult patients without hydrocephalus. Wideochir Inne Tech Maloinwazyjne 2016;11:200-7.
- 72 Schroeder HW, Wagner W, Tschiltschke W, Gaab MR. Frameless neuronavigation in intracranial endoscopic neurosurgery. J Neurosurg 2001;94:72-9.
- 73 Decq P, Le Guerinel C, Brugieres P, Djindjian M, Silva D, Keravel Y, et al. Endoscopic management of colloid cysts. Neurosurgery 1998;42:1288-94.
- 74 Ibáñez-Botella G, Segura M, De Miguel L, Ros B, Arráez MÁ. Purely neuroendoscopic resection of intraventricular tumors with an endoscopic ultrasonic aspirator. Neurosurg Rev 2019;42:973-82.
- 75 Boogaarts HD, Decq P, Grotenhuis JA, Le Guerinel C, Nseir R, Jarraya B, et al. Long-term results of the neuroendoscopic management of colloid cysts of the third ventricle: A series of 90 cases. Neurosurgery 2011;68:179-87.
- 76 Selvanathan SK, Kumar R, Goodden J, Tyagi A, Chumas P. Evolving instrumentation for endoscopic tumour removal of CNS tumours. Acta Neurochirurgica 2013;155:135-8.
- 77 Cinalli G, Imperato A, Mirone G, Di Martino G, Nicosia G, Ruggiero C, et al. Initial experience with endoscopic ultrasonic aspirator in purely neuroendoscopic removal of intraventricular tumors. J Neurosurg Pediatr 2017;19:325-32.
- 78 Baldo S, Magrini S, Tacconi L. Purely endoscopic resection of cavernoma of the septum pellucidum. Surg J (New York, NY) 2019;5:e42-5.
- 79 Oertel JM, Schroeder HW, Gaab MR. Endoscopic stomy of the septum pellucidum: Indications, technique, and results. Neurosurgery 2009;64:482-91.
- 80 Aldana PR, Kestle JR, Brockmeyer DL, Walker ML. Results of endoscopic septal fenestration in the treatment of isolated ventricular hydrocephalus. Pediatr Neurosurg 2003;38:286-94.
- 81 Gangemi M, Maiuri F, Cappabianca P, Alafaci C, de Divitiis O, Tomasello F, et al. Endoscopic fenestration of symptomatic septum pellucidum cysts: Three case reports with discussion on the approaches and technique. Minim Invasive Neurosurg 2002;45:105-8.
- 82 Harter DH, Omeis I, Forman S, Braun A. Endoscopic resection of an intraventricular dysembryoplastic neuroepithelial tumor of the septum pellucidum. Pediatr Neurosurg 2006;42:105-7.
- 83 Udayakumaran S, Onyia CU, Cherkil S. An analysis of outcome of endoscopic fenestration of cavum septum pellucidum cyst – More grey than black and white? Pediatr Neurosurg 2017;52:225-33.
- 84 Hamada H, Hayashi N, Kurimoto M, Umemura K, Hirashima Y, Endo S. Neuroendoscopic septostomy for isolated lateral ventricle. Neurol Med Chir (Tokyo) 2003;43:582-7.
- 85 Roth J, Olasunkanmi A, Rubinson K, Wisoff J. Septal vein symmetry: Implications for endoscopic septum pellucidotomy. Neurosurgery 2010;67:395-401.