Resection of brain lesions with a neuroendoscopic ultrasonic aspirator — a systematic literature review

Abstract

The development of minimally invasive neuroendoscopy has advanced in recent years. The introduction of the neuroendoscopic ultrasonic aspirator (NUA) increased the treatment spectrum of neuroendoscopy. This review aimed to present a systematic overview of the extent of resection, lesion characteristics, technical aspects, complications, and clinical outcomes related to using the NUA. Articles were identified by searching the PubMed/Medline, Embase, and Web of Science database through June 2022 with restriction to the last 20 years. We included case series, case reports, clinical trials, controlled clinical trials, meta-analyses, randomized controlled trials, reviews, and systematic reviews written in English. Studies reporting on endonasal approach or hematoma evacuation using the NUA were excluded. The references of the identified studies were reviewed as well. Nine full-text articles were included in the analysis, with a total of 40 patients who underwent surgery for a brain tumor using NUA. The most common underlying pathology treated by NUA was colloid cyst (17.5%), pilocytic astrocytoma (12.5%), subependymal giant cell astrocytoma (7.5%), subependymoma (7.5%), and craniopharyngioma (7.5%). Complete or near-total resection was achieved in 62.5%. The most frequently reported postoperative complication was secondary hydrocephalus (10%), meningitis/-encephalitis (7.5%), cognitive impairment (7.5%), and subdural hygroma (7.5%). In one case (2.5%), surgery-related death occurred due to a severe course of meningoencephalitis. According to the preliminary data, NUA seems to be a safe and efficient minimally invasive alternative to conventional microscopic resection of brain tumors. Further studies to investigate advantages and disadvantages of using the NUA are needed.

Predictors of hospital length of stay and long-term care facility placement in aneurysmal subarachnoid hemorrhage

“…Current evidence suggests that a rapid EVD weaning strategy can be associated with shorter LOS and lower incidence of ventriculoperitoneal shunt placement; however, there is still no consensus on how to manage EVD in aSAH patients among health care providers. 21 , 22 , 23 Although the purpose of our study was not specifically to test the association of EVD duration and outcome measures in aSAH, our data support previous studies suggesting that EVD prolongation affects LOS and therefore may contribute to worse outcome. Further prospective studies are required to address this issue further.…”

Advances in the Treatment of Pediatric Brain Tumors

“…Endoscopes can provide better visualization of the structures that could be hidden when a microscope is used [22]. Ultrasonic aspirators, including neuroendoscopic ultrasonic aspirators, have enhanced tumor debulking techniques, especially for firm lesions [23]. All these tools help achieve much safer and maximal resections.…”

Serial Diffusion Tensor Imaging and Rate of Ventricular Blood Clearance in Patients with Intraventricular Hemorrhage

“…Both rapid and gradual paradigm weaning to discontinue EVD has been used. Rapid clamping identi es patient dependency on CSF drain diversion whereas gradual weaning increases the daily ICP threshold in gradual time intervals; however, clinical evidence suggests that a mixed approach works better 32 . Another issue while managing patients with EVD is regarding the decision to administer a thrombolytic agent that facilitates CSF clearance of intraventricular blood.…”