Short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive int-racerebral hemorrhage

BACKGROUND Hypertensive intracerebral hemorrhage is a common critical disease of the nervous system,comprising one fifth of all acute cerebrovascular diseases and has a high disability and mortality rate.It severely affects the patients’quality of life.AIM To analyze the short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive intracerebral hemorrhage.METHODS From March 2018 to May 2020,118 patients with hypertensive intracerebral hemorrhage were enrolled in our study and divided into a control group and observation group according to the surgical plan.The control group used a hard-channel minimally invasive puncture and drainage procedure.The observation group underwent minimally invasive neuroendoscopic surgery.The changes in the levels of serum P substances(SP),inflammatory factors[tumor necrosis factor-α,interleukin-6(IL-6),IL-10],and the National Hospital Stroke Scale(NIHSS)and Barthel index scores were recorded.Surgery related indicators and prognosis were compared between the two groups.RESULTS The operation time(105.26±28.35)of the observation group was min longer than that of the control group,and the volume of intraoperative bleeding was 45.36±10.17 mL more than that of the control group.The hematoma clearance rates were 88.58%±4.69%and 94.47%±4.02%higher than those of the control group at 48 h and 72 h,respectively.Good prognosis rate(86.44%)was higher in the observation group than in the control group,and complication rate(5.08%)was not significantly different from that of the control group(P>0.05).The SP level and Barthel index score of the two groups increased(P<0.05)and the inflam-matory factors and NIHSS score decreased(P<0.05).The cytokine levels,NIHSS score,and Barthel index score were better in the observation group than in the control group(P<0.05).CONCLUSION Neuroendoscopic minimally invasive surgery is more complicated than hard channel minimally invasive puncture drainage in the treatment of hypertensive intracerebral hemorrhage;however,hematoma clearance is more thorough,and the short-term effect and long-term prognosis are better than hard channel minimally invasive puncture drainage.

Research progress of localization technique assisted neuroendoscopy for cerebral hemorrhage

Neurosurgeons who perform intracere-bral hemorrhage(ICH)evacuation procedures have lim-ited options for monitoring hematoma evacuation and intraoperatively assessing residual-hematoma burden.In recent years,neuroendoscope-assisted,minimally inva-sive surgery for spontaneous ICH is simple and effective and becoming increasingly common.Many methods are applied in neuronavigation-assisted surgery for ICH evac-uation,such as neuroendoscopy,three-dimensional(3D)reconstruction,intraoperative ultrasound,and stereotac-tic craniotomy.Compared with a traditional craniotomy operation,hematoma removal(using methods of accurate localization)can reduce iatrogenic damage,protect white matter,and shorten patients’recovery time.This paper mainly outlines the treatment of basal ganglia-cerebral hemorrhage with neuroendoscopy assistance using local-ization techniques.

Individualized Sellar Floor Reconstruction Method and Nursing Strategy for the Intraoperative Cerebrospinal Fluid Leakage Caused by Neuroendoscopic Transsphenoidal Pituitary Adenoma Resection

Objective: To explore the clinical effect of and the method and nursing strategy for sellar reconstruction for intraoperative cerebrospinal fluid (CSF) leakage in pituitary adenoma resection under neuroendoscopy. Methods: The data from 20 cases of intraoperative CSF leak caused by transsphenoidal pituitary adenoma resection were retrospectively analyzed. Six patients were treated with mucosal flap and artificial dural reconstruction of sellar (simple sellar floor reconstruction). In 45 patients, autologous fat, fascia lata, and artificial dura were used to repair and reconstruct the sellar floor (multilayer sellar floor reconstruction). After the operation, all patients underwent follow-up for 6 - 24 months. Results: Fifty patients were followed up without CSF leakage. One patient was cured after leakage of CSF through the lumbar cistern 1 month after discharge. Conclusion: For patients with CSF leakage during neuroendoscopic transsphenoidal pituitary adenoma resection, individualized sellar floor reconstruction should be adopted according to the degree of CSF leakage and the size of the sellar floor defect. Strict nursing measures can effectively prevent CSF leakage and reduce postoperative complications.

Application of robotic-assisted endoscopic third ventriculostomy

Objective:This case series study explored the application of ROSA(robot of stereotactic assistant)robotic-assisted endoscopic third ventriculostomy(ETV)in the treatment of hydrocephalus.Methods:Three patients(January2016-October2017)diagnosed with hydrocephalus based on preoperative computed tomograph(CT)and magnetic resonance imaging(MRI)scans were recruited.Navigation planning scan was performed before operation.ROSA robot localization program was used to simulate and analyze the path planning of hydrocephalus ETV and store it in the system.All the three patients underwent robotic-assisted ETV.The patients'clinical symptoms,imaging manifestations and related complications were evaluated,and a3-month follow-up survey was conducted.Prognostic factors were also analyzed.Results:ETV under the guidance of ROSA robot was successfully performed on the three patients.CT,MRI and cerebrospinal fluid(CSF)cine showed that the ventricles were narrowed,that the velocity and flow of the stoma were normal,and that the CSF flow was smooth.After discharge,the symptoms of hydrocephalus were significantly improved.Localization of the robot and design of the surgical path were key to success of the operation.Conclusions:ROSA robotic-assisted ETV is a feasible procedure.The patients recovered well,and the symptoms relieved.More efforts are needed to optimize artificial intelligence and the application of precision treatment in the nervous system.

Effect of Single Nostril Transsphenoidal Resection of Pituitary Adenoma under Neuroendoscope on Hospitalization Time and Bleeding Volume in Patients with Pituitary Adenoma

Objective:This study mainly discusses the clinical effect of treating pituitary adenoma by using single nostril transsphenoidal resection of pituitary adenoma under neuro-endoscope,and analyzes the influence on hospitalization time and bleeding volume.Methods:A total of 335 patients with pituitary adenoma treated in our hospital from January 2017 to January 2019 were randomly selected for study.The patients were divided into two groups by number table method.167 patients in the reference group underwent single nostril transsphenoidal resection of pituitary adenoma under microscope.Also,168 patients in the study group underwent single nostril transsphenoidal resection of pituitary adenoma under neuroendoscope.The hospitalization time and bleeding volume and other surgical treatment effects were observed and compared.Results:There was no significant difference in the levels of prolactin(PRL),adrenocorticotropic hormone(ACTH)and thyroid stimulating hormone(TSH)between the two groups before operation(P>0.05);After surgical treatment,the levels of PRL,ACTH and TSH in the study group were lower than those in the control group(P<0.05);In terms of surgical indexes,the operation time and hospital stay in the study group were shorter than those in the reference group,and the amount of surgical bleeding was less than that in the reference group(P<0.05);The total tumor resection rate in the study group was higher than that in the reference group,and the incidence of complications such as nasal septal defect,cerebrospinal fluid leakage and diabetes insipidus in the study group was lower than that in the reference group(P<0.05).Conclusion:For pituitary adenoma diseases,using single nostril transsphenoidal resection of pituitary adenoma under neuroendoscope can improve the tumor resection rate,reduce the bleeding volume and shorten postoperative hospitalization time.

Complications's prophylaxis in neuroendoscopic endonasal transsphenoidal surgery for pituitary adenomas

Objective To discuss the complicatiaons’s prophylaxis of removing pituitary adenomas by neuroendoscopy in tranasphenoidal surgery. Methods Clinical data of 253 cases treated by endoscopic endanasal transsphenoidal surgery were analysed. Results The total tumor removal was done in 216 (85.38%) cases,subtotal in

Hypertensive intracranial hematomas: endoscopic-assisted keyhole evacuation and application of patent viewing dissector

To study the effect of endoscopic assisted keyhole operation (EAKO) on treating hypertensive intracranial hematomas and the value of our patent dissector appli ed during the operation Methods A total of 25 patients with hypertensive intracranial hematomas underwent endos copic assisted keyhole evacuation, during which, the viewing dissector, which h ad recently achieved national patent, was connected to the tip of endoscope and used to help dissect hematomas The outcome of this procedure were compared wit h those of 22 comparable cases undergone conventional surgical treatment (large or smaller craniotomy) The items for comparison included the volum e of remaining hematoma, the duration of operation, postsurgical Glasgow Coma Sc ale (GCS) and Glasgow Outcome Scale (GOS) Results Remaining hematoma was ascertained 48 h after operation with the use of comp uterized tomography (CT) scans In the case of EAKO, nearly complete evacuation (>84%) was achieved in 21 cases; GCS was evaluated at 7 d postsurgery result ing in GCS >12 in 9 patients, GCS 9-12 in 12 patients and GCS <9 in 4 patients The follow up period ranged from 6 to 21 mon GOS was estimated at half a year and good recovery rate as defined by GOS was assigned to 76% of the EAKO pa tients There are significant differences in the volumes of remaining hematomas and the duration of operation between the EAKO and craniotomy group ( P <0 0 5) In addition, better clinical outcomes were obtained in EAKO Conclusion EAKO has the advantage of being minimally invasive, improving surgical results a nd the prognosis of hypertensive intracranial hematoma patients We conclude th at keyhole operation is a safe, effective alternative for removal of hypertensiv e intracranial hematoma, particularly during acute stages

Anatomical study of endoscope-assisted far lateral keyhole approach to the ventral craniocervical region with neuronavigational guidance

Background Image-guided neurosurgery, endoscopic-assisted neurosurgery and the keyhole approach are three important parts of minimally invasive neurosurgery and have played a significant role in treating skull base lesions. This study aimed to investigate the potential usefulness of coupling of the endoscope with the far lateral keyhole approach and image guidance at the ventral craniocervical junction in a cadaver model. Methods We simulated far lateral keyhole approach bilaterally in five cadaveric head specimens （10 cranial hemispheres）. Computed tomography-based image guidance was used for intraoperative navigation and for quantitative measurements. Skull base structures were observed using both an operating microscope and a rigid endoscope. The jugular tubercle and one-third of the occipital condyle were then drilled, and all specimens were observed under the microscope again. We measured and compared the exposure of the petroclivus area provided by the endoscope and by the operating microscope. Statistical analysis was performed by analysis of variance followed by the Student-Newman-Keuls test. Results With endoscope assistance and image guidance, it was possible to observe the deep ventral craniocervical junction structures through three nerve gaps （among facial-acoustical nerves and the lower cranial nerves） and structures normally obstructed by the jugular tubercle and occipital condyle in the far lateral keyhole approach. The surgical area exposed in the petroclival region was significantly improved using the 0° endoscope （1147.80 mm2） compared with the operating microscope （（756.28±50.73） mm2）. The far lateral retrocondylar keyhole approach, using both 0° and 30° endoscopes, provided an exposure area （（1147.80±159.57） mm2 and （1409.94±155.18） mm2, respectively） greater than that of the far lateral transcondylar transtubercular keyhole approach （（1066.26±165.06） mm2） （P 〈0.05）. Conclusions With the aid of the endoscope and image guidance, it is possible to approach the ventral craniocervical junction with the far lateral keyhole approach. The use of an angled-lens endoscope can significantly improve the exposure of the petroclival region without drilling the jugular tubercle and occipital condyle.

Clinical characteristics and surgical treatment of patients with giant intracranial aneurysms

Background Compared with smaller aneurysms, giant intracranial aneurysms （GICAs） have a poorer prognosis and require more meticulous surgical planning and techniques to exclude them from the circulation. GICAs continue to challenge the limits of neurosurgical techniques. A series of 170 patients with GICAs were reviewed for understanding the clinical characteristics, surgical treatment and outcomes of patients with GICAs.Methods Collected data of 170 consecutive patients with GICAs from January 1995 to July 2007 were analyzed. The clinical characteristics in this study included age, sex, intracranial aneurysms size, the first presentations, locations and Hunt ＆ Hess grade. Surgical methods included direct clipping of the aneurysm neck, parent artery reconstruction, proximal artery ligation, trapping and wrapping. Surgical results were evaluated postoperatively by the Glasgow Outcome Scale （GOS）.Results GICAs were more commonly diagnosed at age 30 to 50 years with a mean age of 39.3 years and without obvious gender preponderance in our study （88 male and 82 female patients）. The size of the GICAs ranged from 2.5 cm to 8.0 cm （mean, 2.9 cm）. Hemorrhage （41%）, mass effect （34%） and headache （12%） were the first 3 most common presentations. Regarding the Hunt ＆ Hess classification, at admission there were 100 cases in grade 0. 24 in grade 1,21 in grade 2, 16 in grade 3, 8 in grade 4 and 1 in grade 5. There were 84 cases of GICAs treated by direct neck-clipping, 47 by parent artery reconstruction, 19 by proximal artery occlusion （with 4 combined with revascularization）, 18 by trapping and 2 by wrapping. The follow-up study （ranging from 6 to 115 months, mean 32 months） showed good results in 108 cases, moderate disability in 26 and severe disability in 15 accordina to GOS. Six cases died. Conclusions Surgical treatment is an effective treatment for GICAs. Surgical strategies should be made carefully and individually. Doppler ultrasonography, neuroendoscope and intraoperative angiography are useful to perfect surgical results.

A case report on subarachnoid and intraventricular neurocysticercosis

Neurocysticercosis is the most common central nervous system helminthic infection in humans.We hereby present a case combining two rare manifestations of neurocysticercosis:the subarachnoid and intraventricular forms.The patient presented with hydrocephalus and neurologic deficits and although endoscopic removal of the cysts and two cycles of postoperative cysticidal drugs resulted in resolution of symptoms,they later recurred.Ventriculoperitoneal shunt placement and a further cycle of albendazole plus dexamethasone led to substantial clinical improvement.Extraparenchymal neurocysticercosis may be challenging to diagnose and treat and is usually associated with a poorer prognosis.Clinicians should be aware of this condition.