Emerging technology in intracranial neuroendoscopy: application of the NICO Myriad

Abstract

<jats:p>Improvement in fiber optics and imaging paved the way for tremendous advancements in neuroendoscopy. These advancements have led to increasingly widespread use of the endoscope in neurosurgical procedures, which in turn incited a technological revolution leading to new approaches, instruments, techniques, and a diverse armamentarium for the treatment of a variety of neurosurgical disorders. Soft-tissue removal is often a rate-limiting aspect to endoscopic procedures, especially when the soft tissue is dense or fibrous. The authors review a series of cases involving patients treated between August 2009 and October 2010 with a new device (the NICO Myriad), a non–heat-generating, oscillating, cutting, and tissue removal instrument that can be used through the working channel of the endoscope as well as in open neurosurgical procedures. They used this device in 14 purely endoscopic intracranial procedures and 1 endoscope-assisted keyhole craniotomy. They report that the device was easy to use and found that tissue resection was more efficient than with other available endoscopic instruments, especially in the resection of fibrotic tissue. There were no observed device-related complications. The authors discuss the technical aspects of using this device in endoscopic resection of pituitary tumors, craniopharyngiomas, and colloid cysts. They also demonstrate its use in hydrocephalus and intraventricular clot removal and discuss its potential use in other neurosurgical disorders.</jats:p>

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

“…With angled endoscopes, an angled line of sight can be achieved that brings into view previously hidden regions and areas typically blocked by the standard microscope. 18,19 …”

“…19 In 2005, Kassam et al published the first report of an EEA being used to perform an odontoidectomy. 47 More recently, others have demonstrated the effectiveness of the EEA for the resection of ventral CVJ pathology in case reports and small case series.…”

Use of the NICO Myriad device for tumor and cyst removals in a developing country

“…But the Myriad's optimal usefulness is in minimally invasive approaches and endoscopic tumor removals. Dlouhy et al [1] have reported the utility of the Myriad in the endoscopic removal of brain tumors, primarily pituitary adenomas, colloid cysts and craniopharyngiomas, in 14 adult patients. Garcia-Navarro et al [2] used the Myriad in the endoscopic, endonasal, resections of 13 skull base tumors, primarily macroadenomas.…”

Side-Cutting Aspiration Device for Endoscopic and Microscopic Tumor Removal

“…To date, only one case report and two smaller series describe its use, mostly in the context of endonasal endoscopic surgery. 24,25,26 Our experience with the Myriad NICO has shown it to be a versatile and multifunctional instrument. This instrument was easily maneuvered in conventional skull base approaches (Illustrative case 1) as well as in the keyhole approaches (supraorbital and retrosigmoid), the endonasal endoscopic procedures (Illustrative case 2) and the brain port surgeries (Illustrative case 3).…”