Ultrasonic aspiration in neuroendoscopy: first results with a new tool

Oertel, Joachim; Krauss, Joachim K.; Gaab, M. R.

doi:10.3171/jns/2008/109/11/0908

Cited by 51 publications

(49 citation statements)

References 17 publications

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“…Indeed, the main technique of endoscopic tumor resection in the early years was the use of angled scissors and cutting instruments, whereas technologically advanced instrumentation like the side-cutting aspiration device or ultrasonic surgical aspirators have only been very recently introduced in EES, and they may need further improvement for adequate results. 3,30,33 The absence of cortical cuff as a factor in reduced GTR rates in EES actually reflects the absence of clear arachnoid plane between the tumor and the brain parenchyma/neurovascular structures, which represents a challenge regardless of the surgical approach. Although advanced age was not a limitation for GTR with EES (Table 5), advanced age and coexisting comorbidities were the main indicators that changed the goal of surgery toward less aggressive resections.…”

Section: Surgical Outcomementioning

confidence: 99%

Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients

Koutourousiou

Fernández-Miranda

Wang

et al. 2014

FOC

107

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Object Recently, endoscopic endonasal surgery (EES) has been introduced in the management of skull base tumors, with constantly improving outcomes and increasing indications. The authors retrospectively reviewed the effectiveness of EES in the management of olfactory groove meningiomas. Methods Between February 2003 and December 2012, 50 patients (64% female) with olfactory groove meningiomas underwent EES at the University of Pittsburgh Medical Center. The authors present the results of EES and analyze the resection rates, clinical outcome, complications, and limitations of this approach. Results Forty-four patients presented with primary tumors, whereas six were previously treated elsewhere. The patients’ mean age was 57.1 years (range 27–88 years). Clinical presentation included altered mental status (36%), visual loss (30%), headache (24%), and seizures (20%). The mean maximum tumor diameter was 41.6 mm (range 18–80 mm). All patients underwent EES, which was performed in stages in 18 giant tumors. Complete tumor resection (Simpson Grade I) was achieved in 66.7% of the 45 patients in whom it was the goal, and 13 (28.9%) had near-total resection (> 95% of the tumor). Tumor size, calcification, and absence of cortical cuff from vasculature were significant factors that influenced the degree of resection (p = 0.002, p = 0.024, and p = 0.028, respectively). Tumor residual was usually at the most lateral and anterior tumor margins. Following EES, mental status was improved or normalized in 77.8% of the cases, vision was improved or restored in 86.7 %, and headaches resolved in 83.3 %. There was no postoperative deterioration of presenting symptoms. Complications were increased in tumors > 40 mm and included CSF leakage (30%), which was significantly associated with lobular tumor configuration (p = 0.048); pulmonary embolism/deep vein thrombosis, more commonly in elderly patients (20%); sinus infections (10%); and delayed abscess months or years after EES (6%). One patient had an intraoperative vascular injury resulting in transient hemiparesis (2%). There were no perioperative deaths. During a mean follow-up period of 32 months (median 22 months, range 1–115 months), 1 patient underwent repeat EES for tumor regrowth. Conclusions Endoscopic endonasal surgery has shown good clinical outcomes regardless of patient age, previous treatment, or tumor characteristics. Tumor size > 40 mm, calcification, and absence of cortical vascular cuff limit GTR with EES; in addition, large tumors are associated with increased postoperative complications. Significant lateral and anterior dural involvement may represent indications for using traditional craniotomies for the management of these tumors. Postoperative CSF leakage remains a problem that necessitates innovations in EES reconstruction techniques.

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Section: Surgical Outcomementioning

confidence: 99%

Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients

Koutourousiou

Fernández-Miranda

Wang

et al. 2014

FOC

107

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“…Oertel et al 38 used this device in 2 patients with pituitary adenomas, 2 patients with obstructive hydrocephalus from intraventricular clot blocking the aqueduct, and 1 patient with obstructive hydrocephalus caused by blocking of the aqueduct by a cystic craniopharyngioma. It was effective in all patients without complications.…”

Section: Discussionmentioning

confidence: 99%

“…Although the Myriad is the first mechanical device invented for use through the working channel, other instruments have been designed for tissue removal through the working channel, including an ultrasonic aspirator, 38 developed and designed specifically for the universal GAAB neuroendoscopic system (Karl Storz GmbH & Co.). Oertel et al 38 used this device in 2 patients with pituitary adenomas, 2 patients with obstructive hydrocephalus from intraventricular clot blocking the aqueduct, and 1 patient with obstructive hydrocephalus caused by blocking of the aqueduct by a cystic craniopharyngioma.…”

Section: Discussionmentioning

confidence: 99%

Emerging technology in intracranial neuroendoscopy: application of the NICO Myriad

Dlouhy¹,

Dahdaleh²,

Greenlee³

2011

FOC

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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.

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“…10,12,15 The first experience with ultrasonic aspiration in neuroendoscopy was reported by Oertel et al in 2008. 13 The accuracy and reliability of tissue aspiration, issues with visibility, and the application of suction were tested in cadaveric porcine brains. The authors achieved reliable, accurate, and effective aspiration of the paraventricular brain parenchyma under water at the wall of the lateral ventricle.…”

Section: Discussionmentioning

confidence: 99%

“…The technical features of the endoscopic ultrasonic aspirator are fully described elswhere. 13 The basic hardware and setup are shown in Fig. 1.…”

Section: Methodsmentioning

confidence: 99%

Initial experience with endoscopic ultrasonic aspirator in purely neuroendoscopic removal of intraventricular tumors

Cinalli¹,

Imperato²,

Mirone³

et al. 2017

PED

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OBJECTIVE Neuroendoscopic removal of intraventricular tumors is difficult and time consuming because of the lack of an effective decompression system that can be used through the working channel of the endoscope. The authors report on the utilization of an endoscopic ultrasonic aspirator in the resection of intraventricular tumors. METHODS Twelve pediatric patients (10 male, 2 female), ages 1–15 years old, underwent surgery via a purely endoscopic approach using a Gaab rigid endoscope and endoscopic ultrasonic aspirator. Two patients presented with intraventricular metastases from high-grade tumors (medulloblastoma, atypical teratoid rhabdoid tumor), 2 with subependymal giant cell astrocytomas (associated with tuberous sclerosis), 2 with low-grade intraparaventricular tumors, 4 with suprasellar tumors (2 craniopharyngiomas and 2 optic pathway gliomas), and 2 with pineal tumors (1 immature teratoma, 1 pineal anlage tumor). Hydrocephalus was present in 5 cases. In all patients, the endoscopic trajectory and ventricular access were guided by electromagnetic neuronavigation. Nine patients underwent surgery via a precoronal bur hole while supine. In 2 cases, surgery was performed through a frontal bur hole at the level of the hairline. One patient underwent surgery via a posterior parietal approach to the trigone while in a lateral position. The endoscopic technique consisted of visualization of the tumor, ventricular washing to dilate the ventricles and to control bleeding, obtaining a tumor specimen with biopsy forceps, and ultrasonic aspiration of the tumor. Bleeding was controlled with irrigation, monopolar coagulation, and a thulium laser. RESULTS In 7 cases, the resection was total or near total (more than 90% of lesion removed). In 5 cases, the resection was partial. Histological evaluation of the collected material (withdrawn using biopsy forceps and aspirated with an ultrasonic aspirator) was diagnostic in all cases. The duration of surgery ranged from 30 to 120 minutes. One case was complicated by subdural hygroma requiring a subduro-peritoneal shunt implant. CONCLUSIONS In this preliminary series, endoscopic ultrasonic aspiration proved to be a safe and reliable method for achieving extensive decompression or complete removal in the management of intra- and/or paraventricular lesions in pediatric patients.

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Ultrasonic aspiration in neuroendoscopy: first results with a new tool

Cited by 51 publications

References 17 publications

Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients

Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients

Emerging technology in intracranial neuroendoscopy: application of the NICO Myriad

Initial experience with endoscopic ultrasonic aspirator in purely neuroendoscopic removal of intraventricular tumors

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