Surgical outcomes of third ventriculostomy using neuronavigation-guided new modified endoscopic approach: a series of 11 patients.

Abstract

Objective: Neuroendoscopy is widely used and has become the gold standard for the most intraventricular approaches. Integration of a neuronavigation system to the neuroendoscopy system is a minimally invasive technique that brings many advantages to neurosurgeons, especially for patients with distorted anatomical landmarks. We present the surgical outcomes of 11 consecutive patients using a new, unique modified endoscopic trocar that integrates the Medtronic Stealth Station S7 Axiem shunt kit system to the Karl Storz Lotta rigid ventriculoscope system.

Material and methods: Medical records of hydrocephalus patients who underwent endoscopic third ventriculostomy surgery in our hospital during a 2-year period from 2017 to 2018 were retrospectively reviewed. All patients who underwent endoscopic third ventriculostomy using this modified technique and followed up for at least 12 months were selected as the core sample used for this study.

Results: Eleven patients were operated via this surgical approach; four patients were male and seven patients were female. Nine patients were operated to perform third ventriculostomy for obstructive hydrocephalus. One patient had a large temporal arachnoid cyst and was treated via endoscopic fenestration. One adult patient underwent endoscopic biopsy for lateral ventricular mass. The histopathological diagnosis was confirmed to be a CNS lymphoma.

Conclusion: This new modified obturator has advantages to tracker attached trocar system, such as it does not require rigid head fixation especially in babies, manipulation of the trocar is easier due to tracker's weight and shape, and less fixation difficulties of trocar. We suggest this method may be a less expensive and safe alternative to standard tracker attached systems of ventricular access.