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Purely endoscopic and endoscope-assisted approaches to lesions of the third ventricle in pediatric age-a technical collection

Azab WA

Childs Nerv Syst, 2023 Dec;39(12):3371-3372.
PMID: 37328661 DOI: 10.1007/s00381-023-06030-y

BACKGROUND: One of the main difficulties in third ventricle surgery is its deep and central location within the brain, surrounded by many eloquent neurovascular structures. Such anatomical environment obviously makes it very hard to safely approach and excise lesions in there.
METHODS: The introduction of the surgical microscope into the neurosurgical field undoubtedly played an important and pivotal role in improving the surgical results and increasing the safety of operations in and around the third ventricle. Although the surgical microscope remained the gold standard of intraoperative visualization for many decades, the advent of endoscopes revolutionized surgery of the third ventricle. Neuroendoscopic procedures for lesions of the third ventricle encompass a greatly variable array of endochannel, endoscope-assisted and endoscope-controlled techniques.
CONCLUSION: In this collection on purely endoscopic and endoscope-assisted approaches to lesions of the third ventricle in pediatric age, the readership is presented with a selected group of these operations performed by experts in the field, shedding light mainly on their technical aspects and surgical pearls. The text description in each article is supplemented by a surgical video.

Matched MeSH terms: Brain/surgery
Neuronavigation with the universal probe to access intracranial targets

Waran V, Chandran H, Devaraj P, Ravindran K, Rathinam AK, Balakrishnan YK, et al.

J Neurol Surg A Cent Eur Neurosurg, 2014 Nov;75(6):422-6.
PMID: 23955263 DOI: 10.1055/s-0033-1345091

The universal probe is a tool devised to allow navigation-directed biopsies and drainage procedures to be performed in a simple manner using a single hardware and software.

Matched MeSH terms: Brain/surgery*
The utilization of cranial models created using rapid prototyping techniques in the development of models for navigation training

Waran V, Pancharatnam D, Thambinayagam HC, Raman R, Rathinam AK, Balakrishnan YK, et al.

J Neurol Surg A Cent Eur Neurosurg, 2014 Jan;75(1):12-5.
PMID: 23315670 DOI: 10.1055/s-0032-1330960

Navigation in neurosurgery has expanded rapidly; however, suitable models to train end users to use the myriad software and hardware that come with these systems are lacking. Utilizing three-dimensional (3D) industrial rapid prototyping processes, we have been able to create models using actual computed tomography (CT) data from patients with pathology and use these models to simulate a variety of commonly performed neurosurgical procedures with navigation systems.

Matched MeSH terms: Brain/surgery*
Fulltext Reduction of the dimensionality of the EEG channels during scoliosis correction surgeries using a wavelet decomposition technique

Al-Kadi MI, Reaz MB, Ali MA, Liu CY

Sensors (Basel), 2014;14(7):13046-69.
PMID: 25051031 DOI: 10.3390/s140713046

This paper presents a comparison between the electroencephalogram (EEG) channels during scoliosis correction surgeries. Surgeons use many hand tools and electronic devices that directly affect the EEG channels. These noises do not affect the EEG channels uniformly. This research provides a complete system to find the least affected channel by the noise. The presented system consists of five stages: filtering, wavelet decomposing (Level 4), processing the signal bands using four different criteria (mean, energy, entropy and standard deviation), finding the useful channel according to the criteria's value and, finally, generating a combinational signal from Channels 1 and 2. Experimentally, two channels of EEG data were recorded from six patients who underwent scoliosis correction surgeries in the Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM) (the Medical center of National University of Malaysia). The combinational signal was tested by power spectral density, cross-correlation function and wavelet coherence. The experimental results show that the system-outputted EEG signals are neatly switched without any substantial changes in the consistency of EEG components. This paper provides an efficient procedure for analyzing EEG signals in order to avoid averaging the channels that lead to redistribution of the noise on both channels, reducing the dimensionality of the EEG features and preparing the best EEG stream for the classification and monitoring stage.

Matched MeSH terms: Brain/surgery
Addition of zygomatic arch resection in decompressive craniectomy

Martin AG, Abdullah JY, Jaafar A, Ghani AR, Rajion ZA, Abdullah JM

J Clin Neurosci, 2015 Apr;22(4):735-9.
PMID: 25564264 DOI: 10.1016/j.jocn.2014.09.021

Decompressive craniectomy (DC) is a surgical option in managing uncontrolled raised intracranial pressure refractory to medical therapy. The authors evaluate the addition of zygomatic arch (ZA) resection with standard DC and analyze the resulting increase in brain volume using three-dimensional volumetric CT scans. Measurements of brain expansion dimension morphometrics from CT images were also analyzed. Eighteen patients were selected and underwent DC with ZA resection. The pre- and post-operative CT images were analyzed for volume and dimensional changes. CT images of 29 patients previously operated on at the same center were retrieved from the picture archiving and communication system (PACS) and were similarly studied. The findings obtained from the two groups were compared and analyzed. Analysis from three-dimensional CT volumetric techniques revealed an significant increase of 27.97ml (95% confidence interval [CI]: 39.98-180.36; p=0.048) when compared with standard DC. Brain expansion analysis of maximum hemicraniectomy diameter revealed a mean difference of 0.82cm (95% CI: 0.25-1.38; p=0.006). Analysis of the ratio of maximum hemicraniectomy diameter to maximum anteroposterior diameter gave a mean difference of 0.04 (95% CI: 0.05-0.07; p=0.026). The addition of ZA resection to standard DC may prove valuable in terms of absolute brain volume gain. This technique is comparable to other maneuvers used to provide maximum brain expansion in the immediate post-operative period.

Matched MeSH terms: Brain/surgery*
A new expandable cannula system for endoscopic evacuation of intraparenchymal hemorrhages

Waran V, Vairavan N, Sia SF, Abdullah B

J. Neurosurg., 2009 Dec;111(6):1127-30.
PMID: 19408977 DOI: 10.3171/2009.4.JNS081506

The authors describe a newly developed expandable cannula to enable a more efficient use of an endoscope in removing intraparenchymal spontaneous hypertensive intracerebral hematomas. The cannula is introduced like a conventional brain cannula, using neuronavigation techniques to reach the targeted hematoma accurately, and, once deployed, conventional microsurgical techniques are used under direct endoscopic visualization. This method was used in 6 patients, and, based on the results of intraoperative intracranial pressure monitoring and postoperative CT scanning, the authors were able to achieve good hematoma removal. They found that by using the expandable cannula, efficient endoscopic surgery in the brain parenchyma was possible.

Matched MeSH terms: Brain/surgery
Alpha shape theory for 3D visualization and volumetric measurement of brain tumor progression using magnetic resonance images

Hamoud Al-Tamimi MS, Sulong G, Shuaib IL

Magn Reson Imaging, 2015 Jul;33(6):787-803.
PMID: 25865822 DOI: 10.1016/j.mri.2015.03.008

Resection of brain tumors is a tricky task in surgery due to its direct influence on the patients' survival rate. Determining the tumor resection extent for its complete information via-à-vis volume and dimensions in pre- and post-operative Magnetic Resonance Images (MRI) requires accurate estimation and comparison. The active contour segmentation technique is used to segment brain tumors on pre-operative MR images using self-developed software. Tumor volume is acquired from its contours via alpha shape theory. The graphical user interface is developed for rendering, visualizing and estimating the volume of a brain tumor. Internet Brain Segmentation Repository dataset (IBSR) is employed to analyze and determine the repeatability and reproducibility of tumor volume. Accuracy of the method is validated by comparing the estimated volume using the proposed method with that of gold-standard. Segmentation by active contour technique is found to be capable of detecting the brain tumor boundaries. Furthermore, the volume description and visualization enable an interactive examination of tumor tissue and its surrounding. Admirable features of our results demonstrate that alpha shape theory in comparison to other existing standard methods is superior for precise volumetric measurement of tumor.

Matched MeSH terms: Brain/surgery
48-hour video-EEG monitoring for epilepsy presurgical evaluation is cost-effective and safe in resource-limited setting

Lim KS, Fong SL, Thuy Le MA, Ahmad Bazir S, Narayanan V, Ismail N, et al.

Epilepsy Res, 2020 05;162:106298.
PMID: 32172144 DOI: 10.1016/j.eplepsyres.2020.106298

INTRODUCTION: Video-EEG monitoring is one of the key investigations in epilepsy pre-surgical evaluation but limited by cost. This study aimed to determine the efficacy and safety of a 48-hour (3-day) video EEG monitoring, with rapid pre-monitoring antiepileptic drugs withdrawal.
MATERIAL AND METHODS: This is a retrospective study of epilepsy cases with VEM performed in University Malaya Medical Center (UMMC), Kuala Lumpur, from January 2012 till August 2016.
RESULTS: A total of 137 cases were included. The mean age was 34.5 years old (range 15-62) and 76 (55.8 %) were male. On the first 24 -h of recording (D1), 81 cases (59.1 %) had seizure occurrence, and 109 (79.6 %) by day 2 (D2). One-hundred and nine VEMs (79.6 %) were diagnostic, in guiding surgical decision or further investigations. Of these, 21 had less than 2 seizures recorded in the first 48 h but were considered as diagnostic because of concordant interictal ± ictal activities, or a diagnosis such as psychogenic non-epileptic seizure was made. Twenty-eight patients had extension of VEM for another 24-48 h, and 11 developed seizures during the extension period. Extra-temporal lobe epilepsy and seizure frequency were significant predictors for diagnostic 48 -h VEM. Three patients developed complications, including status epilepticus required anaesthetic agents (1), seizure clusters (2) with postictal psychosis or dysphasia, and all recovered subsequently.
CONCLUSIONS: 48-h video EEG monitoring is cost-effective in resource limited setting.

Matched MeSH terms: Brain/surgery*
Behavioral effects of deep brain stimulation of different areas of the Papez circuit on memory- and anxiety-related functions

Hescham S, Jahanshahi A, Meriaux C, Lim LW, Blokland A, Temel Y

Behav Brain Res, 2015 Oct 1;292:353-60.
PMID: 26119240 DOI: 10.1016/j.bbr.2015.06.032

Deep brain stimulation (DBS) has gained interest as a potential therapy for advanced treatment-resistant dementia. However, possible targets for DBS and the optimal stimulation parameters are not yet clear. Here, we compared the effects of DBS of the CA1 sub-region of the hippocampus, mammillothalamic tract, anterior thalamic nucleus, and entorhinal cortex in an experimental rat model of dementia. Rats with scopolamine-induced amnesia were assessed in the object location task with different DBS parameters. Moreover, anxiety-related side effects were evaluated in the elevated zero maze and open field. After sacrifice, we applied c-Fos immunohistochemistry to assess which memory-related regions were affected by DBS. When comparing all structures, DBS of the entorhinal cortex and CA1 sub-region was able to restore memory loss when a specific set of stimulation parameters was used. No anxiety-related side effects were found following DBS. The beneficial behavioral performance of CA1 DBS rats was accompanied with an activation of cells in the anterior cingulate gyrus. Therefore, we conclude that acute CA1 DBS restores memory loss possibly through improved attentional and cognitive processes in the limbic cortex.

Matched MeSH terms: Brain/surgery