Primary endoscopic procedures for children with intraventricular brain tumors include endoscopic tumor biopsy and endoscopic tumor removal. The simultaneous treatment of hydrocephalus with endoscopic third ventriculostomy (ETV) or endoscopic septostomy increases the appeal of a minimally invasive endoscopic approach.
Eighty-five patients who underwent endoscopic management of an intraventricular brain tumor were identified from a prospective database. Of these patients, 26 were younger than 21 years of age at the time of diagnosis. The surgical technique, its success rate, and patient outcome were assessed. Illustrative cases are used in this study to detail the procedure of endoscopic tumor biopsy and resection. Endoscopic tumor procedures were successful in 96% of cases (23 of 24 endoscopic tumor biopsy samples and both endoscopic tumor removals). Fourteen simultaneous procedures were performed to treat hydrocephalus successfully. There was no recognized morbidity from the surgical procedures.
Endoscopic surgery in children with intraventricular brain tumors is an effective and safe method for sampling of the lesion and, in select cases, its resection. This minimally invasive technique should be considered in situations in which the patient might thereby avoid a more conventional procedure, given the high rate of success and low morbidity associated with endoscopic management.
"The burr hole was most commonly placed at some variant of Kocher's point, although slightly more lateral (5–7 cm lateral to midline) on occasion. [3, 11, 36] Several authors make note of the importance of beveling the burr hole into a conical shape to allow for a greater degree of scope manipulation and visualization during the procedure [11, 37]. In some cases, the burr hole was placed more anteriorly (e.g., 5 cm anterior to the coronal suture, n = 183 [25, 26, 30, 31, 38, 39]; or 1.5–3 cm above the orbital rim in cases where a supraorbital trajectory was used, (n = 8 [27, 40])) to allow for better visualization of more posteriorly located tumors. "
[Show abstract][Hide abstract] ABSTRACT: Introduction. Though traditional microsurgical techniques are the gold standard for intraventricular tumor resection, the morbidity and invasiveness of microsurgical approaches to the ventricular system have galvanized interest in neuroendoscopic resection. We present a systematic review of the literature to provide a better understanding of the virtues and limitations of endoscopic tumor resection. Materials and Methods. 40 articles describing 668 endoscopic tumor resections were selected from the Pubmed database and reviewed. Results. Complete or near-complete resection was achieved in 75.0% of the patients. 9.9% of resected tumors recurred during the follow-up period, and procedure-related complications occurred in 20.8% of the procedures. Tumor size ≤ 2cm (P = 0.00146), the presence of a cystic tumor component (P < 0.0001), and the use of navigation or stereotactic tools during the procedure (P = 0.0003) were each independently associated with a greater likelihood of complete or near-complete tumor resection. Additionally, the complication rate was significantly higher for noncystic masses than for cystic ones (P < 0.0001). Discussion. Neuroendoscopic outcomes for intraventricular tumor resection are significantly better when performed on small, cystic tumors and when neural navigation or stereotaxy is used. Conclusion. Neuroendoscopic resection appears to be a safe and reliable treatment option for patients with intraventricular tumors of a particular morphology.
Minimally Invasive Surgery 09/2013; 2013:898753. DOI:10.1155/2013/898753
[Show abstract][Hide abstract] ABSTRACT: Low-rank estimators for higher order statistics are considered in
this paper. The bias-variance tradeoff is analyzed for low-rank
estimators of higher order statistics using a tensor product formulation
for the moments and cumulants. In general, the low-rank estimators have
a larger bias and smaller variance than the corresponding full-rank
estimator, and the mean-squared error can be significantly smaller. This
makes the low-rank estimators extremely useful for signal processing
algorithms based on sample estimates of the higher order statistics. The
low-rank estimators also offer considerable reductions in the
computational complexity of such algorithms. The design of subspaces to
optimize the tradeoffs between bias, variance, and computation is
discussed, and a noisy input, noisy output system identification problem
is used to illustrate the results
IEEE Transactions on Signal Processing 04/1997; 45(3-45):673 - 685. DOI:10.1109/78.558484 · 2.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Endoscopic fenestration has been recognized as an accepted treatment choice for patients with symptomatic arachnoid cysts. The success of this procedure, however, is greatly influenced by individual cyst anatomy and location as well as the endoscopic technique used. This review was conducted to assess what variables influence the treatment success for different categories of arachnoid cysts.
Thirty-three consecutive patients who underwent endoscopic fenestration for treatment of an intracranial arachnoid cyst were identified from a prospective database. The surgical indications and techniques were reviewed, and surgical success rates and patient outcomes were assessed. Specific examples of each cyst category are included to illustrate the technical aspects of endoscopic cyst fenestration. Endoscopic fenestration of arachnoid cysts was successful when judged by cyst decompression, and symptom resolution was noted in 32 (97%) of 33 cases. The one patient with short-term treatment failure underwent a successful repetition of the operation. There were no surgery-related morbidities or deaths.
Arachnoid cysts are a relatively benign pathological entity that can be managed by performing endoscopically guided cyst wall fenestrations into the ventricular system or cerebrospinal fluid-containing cisterns. Proper patient selection, preoperative planning of endoscope trajectory, use of frameless navigation, and advances in endoscope lens technology and light intensity combine to make this a safe procedure with excellent outcomes.
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