World Neurosurg
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Idiopathic aqueductal stenosis is a cause of noncommunicating hydrocephalus, which actual treatment with endoscopic third ventriculostomy (ETV) could assess without any interference with the etiology. The results of ETV in this indication therefore could be interpreted as the result of the surgical procedure alone, without any additional factors related to the etiology of the cerebrospinal fluid pathway obstruction, such as hemorrhage, infection, brain malformations, or brain tumors or cysts. ⋯ Several issues, such as the cause of failures in well-selected patients, long-term outcome in infants treated with ETV, effects of persistent ventriculomegaly on neuropsychological developmental, remain unanswered. Larger and more detailed studies are needed.
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The treatment of choice for several types of obstructive hydrocephalus is endoscopic third ventriculostomy (ETV). However, in certain cases ETV is not clearly superior to shunt placement, and a question of choice arises. Apart from the possibility of success in each case, knowledge of complication rates is of major importance as well. ⋯ The complication rate of ETV is low, and rarely is a reason for choosing shunt placement instead. However, as a method it requires considerable experience, and several studies report a relation of experience not only with success rates but also with complication avoidance.
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Review Case Reports
Endoneurosurgical resection of intraventricular and intraparenchymal lesions using the port technique.
Deep-seated intraventricular and intraparenchymal lesions have traditionally been resected via transcortical routes, often requiring the use of retractors to maintain the corridor created to reach the lesion and proceed with a bimanual microsurgical resection. A transparent cylindrical conduit (port) has been developed to resect deep-seated lesions using the endoscope or, more recently, Video Telescopic Operating Microscopy (VTOM) for visualization. We describe the surgical technique of the port technique and discuss the evolution of the concept of intraaxial brain surgery performed through a conduit. ⋯ The port technique is an option for resection of intraventricular and intraparenchymal lesions. Additional studies are required to assess its impact on adjacent cerebral tissue morphology, blood flow, and metabolism. Quality-of-life assessments are also needed. High-definition fiber tracking, new visualization techniques (VTOM), and new instrumentation will add to the progress of endoscopic port surgery. We have already seen a significant evolution of the technology even since the preparation of this article.
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To describe the neuroendoscopic technique to deal with intraventricular tumors. ⋯ Intraventricular tumors and related CSF pathway obstructions can be safely and effectively treated with endoscopic techniques. Small tumors may be totally removed via a ventriculoscope.
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Case Reports Historical Article
Sellar door: Harvey Cushing's entry into the pituitary gland, the unabridged Johns Hopkins experience 1896-1912.
To review the original surgical records from the Johns Hopkins Hospital, and analyze the records of patients Cushing treated for pituitary disorders from 1896 to 1912. ⋯ This review highlights Cushing's accomplishments in the surgical treatment of suspected pituitary pathology during his early career as a young attending at Johns Hopkins Hospital. It reveals new information about patients whom Cushing did not include in his publications detailing his surgical experience at the Johns Hopkins Hospital.