World Neurosurg
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Endoscopic third ventriculostomy (ETV) is the treatment of choice for noncommunicating hydrocephalus. In the last decade, its routine use also has taken place in patients who have previously undergone shunt placement (secondary ETV). ⋯ Shunt infection should not be considered a contraindication to ETV, even if the success rate may be lower. Considering the higher complication rate and higher risk of intraoperative failure, secondary ETV should be performed by expert neuroendoscopists.
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Massive intracerebral and intraventricular hemorrhages require aggressive and rapid management to decrease intracranial hypertension. The amount of intraventricular blood is a strong prognostic predictor, and its fast removal is a priority. Neuroendoscopy may offer some advantages over more traditional surgical approaches. ⋯ Early neuroendoscopic surgery is a feasible approach, allowing, in most instances, rapid clinical and radiological improvement.
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In the modern era, neuroendoscopy has had an increasingly prominent role in neurosurgery. As attention has focused the development of minimally invasive surgical methods, neuroendoscopy has advanced both as an independent treatment modality for various neurologic disorders and as an adjunct to microneurosurgery. ⋯ In addition to its advantages, neuroendoscopy is associated with unique obstacles that must be anticipated, appreciated, and accounted for to prevent complications. This article outlines techniques to reduce and manage complications during more common intraventricular neuroendoscopic procedures including endoscopic third ventriculostomy (ETV), colloid cyst resection, tumor biopsy and resection, and treatment of loculated hydrocephalus.
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To term and describe neuroendoscopic techniques. ⋯ Endoscopic techniques are a valuable addition to the neurosurgeon's armamentarium. Endoscopes are especially beneficial in deep and narrow surgical approaches and when "looking around a corner" is required.
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Endoscopy for hydrocephalus caused by infectious diseases presents clear challenges to the surgeon. Hydrocephalus caused by tuberculous meningitis is a good model to explore many of the issues that should be considered in the management of these patients. Tuberculous hydrocephalus may be communicating or noncommunicating management options include medical treatment (for communicating hydrocephalus), ventriculoperitoneal shunting, and endoscopic third ventriculostomy. ⋯ However, this also must be weighed against the surgical and long-term complications associated with the procedures used. There are specific endoscopic challenges that occur as the result of abnormal anatomy and the fact that hydrocephalus presents during the acute phase of the disease, rather than being postinfectious. In this article we examine the arguments for various therapeutic approaches and discuss the gathering experience in the literature about endoscopy in tuberculous meningitis in the context of overall management options.