What is Neuroendoscopy? I have been asked that question many times and many of the questioners were Doctors! So in this page I will give a brief description of Neuroendoscopy, its uses and problems.
Neuroendoscopy is a new surgical technique which utilises small thin endoscopes (aroud 5mm in diameter) to approach deep structures of the brain and perform surgical procedures there. The concept is not new, and is being used in most other parts of the body by the urologists, the gynaecologists and the general surgeons for example. However, the use of endoscopes in the brain is a relatively new concept and the speciality of s developing rapidly. The basic prerequisites of doing an endoscopic procedure anywhere in the body are as follows: firstly, there must be a preformed space into which the endoscope can be passed. Secondly, we must be able to deliver sufficient light into the cavity to visualise the structures inside. And, finally we must be able to pass instruments into that space to perform surgical procedures. Therefore, following these reqirements, the most accessible parts of the brain are the Ventricles- which are fluid filled cavities in the depth of the brain. It is now possible to perform many operations on the brain through a small hole(around 6mm diameter) in the skull and I shall describe below the conditions in which Neuroendoscopy can be used.
Hydrocephalus: Hydrocephalus means excess water in the brain. This can occur at any age and more information about is available from the link. (After reading about hydrocephalus you can come back here by pressing the Back button on your browser.) Traditionally, the treatment of hydrocephalus was to insert a shunt: which is a tube which diverts the excess water tinto the abdomen. Although, the shunt operation is simple one, but the neurosurgeons are not very happy with it because upto 20% of patients can develop complications-some of them lifethreatening. Neuroendoscopy is now being used to perform what we call a Third Ventriculostomy- in which a new passage is created within the brain itself using the endoscope and the excess water can get absorbed. It can be done through a small 6mm keyhole and does not require implantation of a foreign body. Its results are quite satisfactory and complications are few. So, in selected cases of hydrocephalus, Third ventriculostomy has become the procedure of choice. Many patients(particularly children) develop hydrocephalus after a bout of infection(like meningitis). In these cases, multiple septae form within the ventricles and shunts cannot fuction adequately. These are also ideal cases for treatment by Neuroendoscopy where these septae are divided with the help of the endoscope.
Intraventricular Tumors:These are deepseated brain tumours which arise from within or abut into the ventricular symptoms. It is now possible to take a biopsy from these tumours under vision and perform a ventriculostomy at the same time. This is usually followed by radiation therapy.
Arachnoid cysts: These are abnormal pockets of collected water outside the ventricles and can cause problems by compressing over the surrounding brain. Open surgery for these patients can be quite a major procedure sometimes, and Neuroendoscopy prvides asimple solution to these cysts simply by fenestrating them in the depth so that the extra water can be absorbed internally.
Colloid Cysts: These are rare and small cysts located in a crucial area of the ventricle whre they can block the flow of cerebrospinal fluid. Although, microsurgery for these is quite successful, endoscopic techniques have been developed to excise these cysts thru an even smaller opening.
Endoscopic Assisted Microsurgery: This is a very recent concept championed by Prof.A.Perneczky of Germany. This entails the use of an endoscope along with the familiar microscope to enable the surgeon to visualise deep seated structures very well. This opens a whole new world of possibilities and enable the surgeon to reduce the size of the craniotomy and do the surgery in a minimally invasive way.
Apart from these, many other applications of endoscopy are currently being developed and will soon be ready for use on patients.Stay tuned, I will keep updating this page with the latest developments in the field of Neuroendoscopy.