VENTRICULOSCOPY
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It is an examination of a ventricle of the brain by means of an endoscope. The endoscope is a tiny telescopic camera that is inserted into the ventricle through a small incision in the scalp and a small hole in the skull. It is a minimally invasive procedure. It can be used to treat hydrocephalus (where the surgeon then creates a hole in the membrane at the bottom of the ventricle avoiding the necessity of a shunt) or to remove tumours situated in the ventricles as shown below.
A) Endoscopic 3rd ventriculostomy (ETV)
Endoscopic 3rd ventriculostomy for congenital hydrocephalus due to aqueduct stenosis.
This 10 year old boy presented with persistent headaches. MRI brain showed large ventricles due to aqueduct stenosis. 3rd ventriculostomy was performed by endoscope. The boy did well postoperatively.
B) Third Ventricular Colloid CYST Excision
Colloid cysts are benign unilocular cysts of neuroepithelial origin, consistently located in the anterior third ventricle. They represent 0.2 to 2.0% of all intracranial tumours. They can be removed micro surgically or endoscopically.
Colloid cysts are benign growths that are usually located either in the third ventricle or at or near the foramen of Monroe which is found at the anterior aspect of the third ventricle of the brain. The cysts are comprised of epithelial lining filled with gelatinous material that commonly contains mucin, old blood, cholesterol, and ions. Colloid cysts can cause a variety of symptoms including headaches, diplopia, memory problems, and vertigo. They most common symptoms are headaches, nausea, and vomiting secondary to obstructive hydrocephalus. The obstructive hydrocephalus is precipitated by blocking the egress of cerebrospinal fluid (CSF) from the lateral ventricles at the foramen of Monroe, which connects the lateral and third ventricles
A colloid cyst can be removed with a craniotomy or endoscopically. A third option to treat a colloid cyst is a stereotactic aspiration. Aspiration of a colloid cyst may not be achievable if the contents of the colloid cyst are particularly thick or if there is no safe corridor to the colloid cyst. Stereotactic aspiration of a colloid cyst has less relative surgical risk than an endoscopic or open resection of the colloid cyst but has the highest reoperation rate compared to the other two treatment modalities.
A colloid cyst can be removed with a craniotomy or endoscopically. A third option to treat a colloid cyst is a stereotactic aspiration. Aspiration of a colloid cyst may not be achievable if the contents of the colloid cyst are particularly thick or if there is no safe corridor to the colloid cyst. Stereotactic aspiration of a colloid cyst has less relative surgical risk than an endoscopic or open resection of the colloid cyst but has the highest reoperation rate compared to the other two treatment modalities.
Endoscopic excision is a safe and effective, minimally invasive method for colloid cyst removal.
This 30-year-old gentleman had headaches and vomiting. The MRI brain showed a large colloid cyst blocking the foramen of Monroe causing hydrocephalus. The colloid cyst was punctured and then excised completely by endoscopy. The patient had an uneventful recovery.
MICROSCOPIC SURGERY
C) Endoscopic Temporal Horn Fenestration
This patient had a fall from 20 feet tall chemical tank 10 years ago and had sustained subdural hematoma, which was operated. He was asymptomatic for almost 9 years, when he started complaining constant dull headache at the site of surgery. MRI brain revealed entrapped temporal horn of the lateral ventricle. The CSF pressure of the temporal horn was high. The medial wall of the temporal horn was fenestrated by endoscope, thereby communication it with the basal cisterns. He was relived of the headache completely.