Endoscopic Neurological Surgery David F Jimenez
Page numbers followed by f refer to figure.
Abscesses 78
Absorbable galeal suture 44
Adson's forceps 141, 143
Alkaline phosphatase 60
general 54, 73, 81
principles of 26
local 140
regional 140
Anesthetic induction 142
Anesthetic management 140
Antebrachial fascia 143, 144f
Arachnoid cyst 34, 60, 67, 69f, 70f, 153
enlarging midline 110f
surgical procedure 62
treatment options 62
wall 68f, 70f
Arachnoid cystic contents, analysis of 153
Arachnoid knife 135f
Arachnoid membrane 135f
after fenestration of 66f
medial 65f
Arachnoid villi 34
Arachnoidal trabeculations 44f
Arrhythmia 164
Arterial vessel loop 136f, 137f
Arteries 128
Articulated nonpneumatic holders, rigid 20
Autonomic dysfunctions 53
catheters 24, 25f
rhizotomy 129
Basal veins 68f
Basilar artery 45f
tip 32f
top of 11f
tortuosity 125
Bier block 140
Bimanual microdissection, performing 6
forceps 21, 56f, 119f
types of 22f
intraventricular 88
tumors 115
lesion 119f
less bloody 120f
Bipolar diathermy 115
Bipolar electrode 23f
Bleeding, intraoperative 125
Blood vessels 123f
Blunt probe 43f
of caudate 10f
of frontal horns 9f
of lateral ventricle 12
Bozzini's invention 2
Brain 100f, 104f
cavities 3
lab system 100f, 105
lab's instrument calibration matrix 108f
retractor, small 136f
ribbon 70f
retractor 70f
ventricular system 8
Brainstem 67f, 135
evoked response 138
tumor of 34
Brittle ligaments 146f
Bulging lamina terminalis 120f
Burr hole 76f, 83f, 84f, 134f
anterior 87f
appropriate 124
lateral 32f
single 133f
distal end of 145f
edges of 146f
Cannulate frontal horn 54
Carpal tunnel 143f, 144f
complete release of 147f
decompressions 6
release 141f
syndrome 140
Catheters, types of 19f
Caudate nucleus
head on
left side 10f
right side 10f
injure head of 81f
Cauterized shrunken capsule 87f
Cavum septum pellucidum 49, 51f, 58f
asymptomatic 50f
cysts, symptomatic midline 49
Cavum vergae
decompression of 58f
enlarged 58f
Cerebellar access 32
Cerebellar artery
posterior inferior 15f
superior 45f
Cerebellar infarct 34
Cerebellopontine angle 129
Cerebellum 67f, 68f
compression of 68f
Cerebral artery
anterior 11f
middle 65f, 66f, 70f
posterior 45f
Cerebrospinal fluid 3, 27, 34, 51, 60, 80, 90, 113, 149
abnormal 92f
normal 92f
conduits 67
drainage 97
fistula 166
leakage 164
liquorrhea 166
over drainage 90
Charged-coupling devices 6
Choreoathetosis 152
Choroid plexectomies 4
Choroid plexus 10f12f, 15f, 34, 79, 81, 84f86f, 91, 118f, 150, 151
bilateral 40
cauterization 38, 39
cysts 149151, 151f, 159f
epithelium 150
Cochleovestibular nerve compression syndrome 167
Collapsed balloon 44f
Colloid cyst 28, 34, 79, 79f, 80, 80f, 81f, 84f, 87f, 88, 149
at foramen of Monro 84f
column of right fornix 85f
endoscopic management of 87
large 79
resection of 85f
Communicating artery, anterior 11f
Communicating hydrocephalus 35, 96f
Communication system 103
Consciousness, loss of 53
Convexity arachnoid cysts 66
Cook's monopolar electrode 22
Coronal brain section 50f
Coronal magnetic resonance imaging 55f
Corpus callosum 8, 10f, 13
rostrum of 10f
Cranial access 73
Cranial computed tomography 50
Cranial nerve
fifth 136f
IX, lower 136f
Cranial pressure, increased 164
Cranial stabilization 133f
Craniosynostosis 6
Craniotomy 151
Cyst 30, 70f, 123f, 166
after full fulguration of 159f
collapsed walls of 101f
complete resection of 87f
complex intraventricular 105f
contents, after removal of 123f
decompression of 101f, 157f
deep midline 110f, 111f
edges of 158f
fenestration of 100f, 155f
fluid 62
green liquid material inside 123f
interior 161f
intraventricular 149, 154f
laser fenestration of 157f
large 100f
location 60
membranes 150
multiple 111f
recurrence 152
removal 124f
resection, complete 86f
types of 149
Cyst wall 60, 84f, 84f, 123f, 155f, 156f, 160f
fenestration of deep 111f
intervening 111f
laser coagulation of 111f
thick 110f
vessels 160f
Cystic cavity 151
Cytokeratins 149
Dandy years 4
Dandy-Walker malformation 34
Deflated balloon 156f
Degenerative spine disease 6
Deliver gold laser energy 25f
Delivering coagulating energy 120f
Desormeaux 2
device 2
endoscope, operation of 3f
Diabetes insipidus 164
Disposable hook
blade 146f
knife 141
Dissect basal arachnoid membrane 65f
Drowsiness 165
Ear 104f
Ectatic vertebral artery 132f, 136f
Electrodes 22
Encephalocele 34
elements 80
origin 149
Endoscope 4, 16
channel of 156f
disposable 18
first 2
holders 20
types of 20
retractor, simpler 28f
smaller 18
trajectory of 31f, 117f
Endoscope-controlled microsurgery 6
Endoscopic approaches 130
Endoscopic carpal tunnel release 140
Endoscopic colloid cyst resection 28f, 83f
Endoscopic cyst fenestration 94, 101f
Endoscopic cystoventriculostomy 62
Endoscopic fenestration 52, 63f, 66f
first 95
Endoscopic instruments 21
Endoscopic investigation 7
Endoscopic management, complications for 125
Endoscopic microvascular decompression 128
clinical presentation 131
patient positioning 132
surgical procedure 132
Endoscopic neuronavigation 103
Endoscopic neurosurgery, complications with 164
Endoscopic prehistory 1
Endoscopic resection of colloid cysts 79
Endoscopic systems 16
large array of 17
Endoscopic techniques 78, 96, 125
Endoscopic technology 5
contemporary 7
Endoscopic third ventriculostomy 6, 34, 37, 38, 165
complications 45
efficacy 36
history of 35
success score 46
Endoscopic tools 166
first 2f
Endoscopic treatment 49, 88
Endoscopic tumor biopsy 116
and resection 113
Endoscopic vascular decompression 129
Endoscopic ventricular
anatomy 8
surgery 15
Endoscopy, image-guided 111f
Endotrac endoscopic instruments 141f
Endotracheal intubation 73
Enterobacter cloaca 98
Ependymal arachnoid cysts 90
Ependymal cyst 149, 152
abscess 76f
frontal lesion, right 78f
hematoma 166
lesions 73
Epilepsy 92, 167
focal 150
Epithelial debris 149
Epithelial membrane antigen 149
Excise brain tumors 24
Fenestrated arachnoid cyst 71f
Fenestrated wall 156f
Fenestration 70f
into occipital horn 157f
primary 156f
Fevers 97f
fascial 143
multiple light 18
optical 19f
optics 5
Fibroglial septa, formation of 93
Fibrous cyst wall 160f
Flexible endoscope 18, 21f, 74f
Floor of fourth ventricle 15f
Fluid attenuation inversion recovery 79f, 80f
Fogarty catheter 66, 156f, 160f, 166
Foramen of magendie, fastigium to 14
Foramen of Monro 8, 10f, 118f
demonstrates, level of 79f
located near 151f
Forcep's cups 21
Forehead incision, superb healing of 119f
Fornices 11f
Fornix 10f, 118f
column of 84f, 86f, 159f
cysts, middle 62
middle 67
Fourth ventricle 14
Frame-based stereotactic systems 103
Frazier suction tube 84f
Frazier type suction 83
Frontal arachnoid cyst, large 66f
Frontal epidural lesions, endoscopic management of 73
Frontal horn 8, 29f, 143f
access 27, 28f
demonstrates, right 119f
enlargement of 57f
right 10f, 84f
tip of 118f
Frontal hypointense lesion, right 75f
Frontal lobe syndrome 66f
Fulgirized debris, remove 56f
GAAB system 28f
Gadolinium, intravenous injection of 117f
Gait disturbance 150
Gastroenterologists 18
Gastrointestinal tract 3
Gently holds cerebellar hemisphere 136f
Genu of corpus callosum 10f, 41f, 58f, 119f
anterior to 66f
Germ cell tumors 114
Germinoma, biopsy of 120f
Glial cell tumors 114
Glial tumors 114
Gliotic neuropil 152
Glycerol injections 129
Gold laser 24
delivery system 24f
microfiber 70f
Gram-negative organisms 97f
Grasping forceps 22, 123f, 156f
types of 22f
Guyon's canal 142, 143
Hamartomas 30
Hand and forearm 143f
enlargement 150
injury 90
of caudate 10f, 41f
in frontal horn 10f
Headache 91, 100, 150
chronic 86
Hearing loss 137
Hematoma 78, 164
intraventricular 34
risk of postoperative 147f
Hemianopia 164
Hemiballismus 152
Hemifacial spasm 167
Hemiparesis 164
intraoperative 164
intraventricular 90, 167
severity of 91
Hemostasis, achieving 6
Hopkins’ endoscopes 16
Hopkins’ fiberscope 5
Human central system, unique nature of 16
Hydranencephalic hydrocephalus 40
Hydrocephalic symptoms 150
Hydrocephalus 10f, 28f
acute 53
chronic 35
classification of 34
multiloculated 92f
uniloculated 91, 92f
etiologies of 36
indicative of 121f
loculated 90
longstanding 42f
pathology of 34
treatment of 34
type of 90
Hygroma 164
Hyperdense lesion 121f
Hyperkalemia 165
Hyperphagia 165
Hypertension 164
Hypoglossal trigone 15f
Hyponatremia 165
Hypothalamic autonomic system 49
Hypothalamic walls 32f
medial 42f
Hypothalamus 165
medial 11f
wall of 120f
Idiopathic carpal tunnel syndrome
signs of 140
symptoms of 140
Incision 73, 82
small 143f
Inexperienced endoscopist 30
Inflammatory processes 90
Inflated balloon, fully 156f
Infratentorial arachnoid cysts 67
Infundibular recess 41f43f
Intracerebral hemorrhage 167
cysts 6
pressure 27, 41, 62
surgery 90
Intraventricular arachnoid cysts 153
classification 153
Intraventricular cyst
decompression of 156f
large 154f
midline 159f
Intraventricular tumors 6, 113
Ipsilateral frontal horn 64f
Ipsilateral temporal lobe 69f
Jannetta's proposal, artistic representation of 128f
Jannetta's surgical procedure 128f
Juxtraventricular region 152
Kaplan's cardinal line 142, 142f, 143
Kerrison rongeur 74f
Kocher's point 30, 81
of entrance 54
Lamina terminalis 11f, 32f
Laser 23
Left fornix, column of 87f
frontal location of 74f
type of 150
LOTTA endoscope 18f
Magnetic resonance ventriculography 93
Mammillary body 8, 11f, 32f, 41f, 42f
right 12f
Mayfield clamp 107f
Mayfield cranial fixation clamp 105f
Mayfield head
clamp 133f
holder 41, 105
Meckel's cave 129
Medtronic stealthstation systems 105
Medulla 136f
Mesencephalon 11, 12f
Metastatic germinoma 119f
Microvascular decompression 128, 129, 134, 138, 166
complications 137
Midbrain 11
Middle fossa arachnoid cyst, large right 64f
Minimally invasive neurosurgery 1
Mitaka pneumatic endoscope arm 27f
Monopolar electrodes, types of 23f
Mucicarmine 149
Multiloculated hydrocephalus 90, 91, 93, 94
etiology for 90
physiologically complex 91
simple 91, 92f
Musculature weakness, thenar 140
Nausea 100, 150
Needle biopsies 167
Neodymium-doped yttrium-aluminum-garnet 23
laser 23, 24
Neonatal bacterial meningitis 90
Neonatal meningitis 90
compression, median 140
palsy 164
transient oculomotor 166
transient trochlear 166
Neural injury 55f
Neural ventricular structures 155f
Neuralgia, relief of 128f
Neuroendoscopic biopsy, intraventricular 113
Neuroendoscopic instruments 113
Neuroendoscopic procedures 35, 109
Neuroendoscopic techniques 96, 161
Neuroendoscopic tools 165
Neuroendoscopy 1, 6, 7, 109111, 115, 125
emerges 3
history of 1
intraoperative image-guided navigation in 103
rebirth of 5
Neuroepithelial cyst 149, 153
complications 165
deficit 152
examination 100
Neurological deficit, permanent 167
Neuromas 140
Neuronavigation 104f
monitor, snapshot of 117f
Neuropen neuroendoscope 19f
Neuropsychiatric disorders 53
Neurosurgical brain tissue procedures 24
Nitze and modern endoscope 3
Nitze's concept 3
Nitze's design 5
Nitze's endoscope 5
Nitze's telescoping design 5
Nitze-Leiter cystoscope, prototype of 3f
Nonabsorbable dermal suture 44
Non-neoplastic masses 114
Nose 104f
Numerous pinocytotic vesicles 153
Obstructive hydrocephalus 115
Occipital horn 11f
access 31
and trigone 13
right 14f
Oculomotor nerve, left 42f
OI handypro endoscope 17f
OI system 27f
Ophthalmic ointment, lubricating 73
Optic chiasm 11f, 32f, 41f
posterior aspect of 10f
Optimized visualization, maintaining 6
complete delineation of 56f
of septal leaflet 56f
Pacchionian granulations 34
Pain, characterization of 131
Palmaris longus, tendon of 142, 142f
Papilledema 85, 156
Parinaud syndrome 164
Pediatric populations 62
Peel-away cannula 86f
Periodic acid-Schiff stains 149
Petrous bones 135f
canals, enter 135f
Petrus pyramid 134f
Phalen's sign, positive 140
Pineal gland 12f
Pineal parenchymal tumors 114
Pineal recess 12f
Pineal region tumor 114
type of 114
Pineal tumor 34
Pineoblastoma 118
Pituitary adenoma 104
Pneumatic holder 20
Pneumocephalus 125
Pneumoventricolography technique 4
Pons 11f
Poor appetite 100
Populations, adult 62
Posthemorrhagic hydrocephalus 91
Postmeningitic cases 91
Postmeningitic hydrocephalus 40
crystal 23
laser 23
Povidone-iodine scrub 141
Pseudoaneurysm formation 147
manifestations 152
problems 53
symptoms 79, 152
Puncturing cyst 161
Radiosurgery 129
Registered endoscope 108f
Resect colloid cysts 80f
Residual tumor apoplexy, postoperative 125
Respiratory dysfunction 164
Retractable monopolar system 22
Reveals cysts 151
Right ventricular system, communication of 99f
Rigid endoscope 16, 27f
GAAB system 17f
Rigid rod-lens system 7
Rod-lens system 5, 16
Scalp incision 26
Schizophrenia 152
Scissors 22
types of 23f
Seizure 53, 166
disorder, chronic 167
Self-focusing optical lens 5
Selfoc lens 5
technology 6
Semirigid holders 20
branches, superficial 143
rhizotomy, partial 129
Septal vein 83, 86f, 118f, 159f
Septated hydrocephalus 91
Septum pellucidotomies 28
Septum pellucidum 10f, 49, 86f, 87f
absence of 11f
cyst of 50, 53
leaflets of 49f
implantation 37
infection 90
treatment 37
Shunt-related infection 93
Silica glass 18
Skin incision 73
Skull base endoscopy 6
Spine 104f
Spongioblastic cells, differentiation of 152
Stereotaxy 103
Striae terminalis 15f
Stryker's mask 108f
Stryker's system 108f
Subcortical nuclei 93
Subdural hematoma 166
Subdural hygroma 166
Subtemporal transtentorial route 128
Sulcus, median 15f
Suprasellar arachnoid cysts 28
Supratentorial cerebral parenchyma 152
Surgical procedure 40
burr hole and dural opening 41
patient positioning 41
preoperative preparation 40
ventricular access 41
Surgically complex multiloculated hydrocephalus 91
Sylvius, aqueduct of 12f, 123f
Symptomatic arachnoid cysts, treatment of 67
Syndrome of inappropriate antidiuretic hormone secretion 164
Synovial elevator 141, 144f
Tamponade bleeding 25f
Tectal tumor 34
Teflon pledget 136f
Tela choroidea, superior layer of 11
Temporal arachnoid cyst 65f
Temporal branches, primary 70f
Temporal fossa, middle 70f
Temporal gyrus, middle 33, 33f
Temporal horn 13, 15f
access 33
Temporal lobe 70f
adjacent 60
inferior 69f
Temporal ventricular horns 121f
Tenotomy scissors 141
pair of 144f
Thalamic tubercle, anterior 10f, 41f, 42f
Thalamostriate vein 41f, 42f, 118f
on right side 11f
Thalamus 10f, 11f
left 12f
Thicker inner wall, remove 123f
Third ventricle 12f, 123f
anterior 8, 10f, 30f, 41f, 161f
floor of anterior 11f
posterior 10, 11f, 123f
wall of 12f
structures, posterior 31f
Third ventricular access
anterior 30
posterior 29
Third ventricular cyst 123f
Third ventricular floor 43f
Third ventriculostomy 30f, 34, 118f
complications 45
Throat 104f
Tinel's sign, positive 140
Transverse carpal ligament 140, 143f, 145f147f
cutting 146f
Trigeminal cranial nerve 136f
Trigeminal nerve 135f, 136, 136f, 137f
decompressing 128f
left 133f
Trigeminal neuralgia 128, 128f, 131, 167
left-sided 136f
Trochlear nerve palsy 137
Tuber cinereum 11f, 41f
Tumor 30, 128
biopsy 21, 166
dissemination 125
highly vascularized 115
larger 115
medial wall of 120f
originating 114
posterior 125
recurrence, evidence of 85
Ulnar nerve decompressions 7
Under focal pressure 57f
Uniloculated hydrocephalus, simple 91, 91f
Vagal trigone 15f
Vein 128
of Galen 68f
hemorrhage 166
structure 135f
Venous/arterial hemorrhage 164
Ventricular anatomy, anatomy of 14
Ventricular catheter 160f
tip of 19f
Ventricular collapse 125
Ventricular compartmentalization 91
Ventricular dilation, acute 154f
Ventricular neuroendoscopy 113
Ventricular septations 91
Ventricular system 8, 161f
approaches to 26
left 80f
posterior lateral 11f
right 95f
tumor of 113
Ventriculofibroscope 6
Ventriculogram, intraoperative 95f
Ventriculoscopy 113
location of 43f
patent third 45f
technique 42
Vertebral artery 136f
Vessel loop 137f
Viscous center 79
Vomiting 100, 150
Washboard 143, 146
Wireless soft-touch pointer for registration 105f
Wound infection 164
Yttrium aluminum garnet laser 159f, 160f
fiber 119f, 120f, 123f, 159f
Zygomatic arch 62
Chapter Notes

Save Clear

fm1Endoscopic Neurological Surgery
fm2fm3Endoscopic Neurological Surgery
Editor David F Jimenez MD FACS Professor Department of Neurosurgery University of Texas Health Science Center San Antonio, Texas, USA
Jaypee Brothers Medical Publishers (P) Ltd
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Overseas Offices
J.P. Medical Ltd
83 Victoria Street, London
Phone: +44-2031708910
Fax: +02-03-0086180
Jaypee Brothers Medical Publishers Inc
City of Knowledge, Bld. 235, 2nd Floor, Clayton
Panama City, Panama
Phone: +1 507-301-0496
Fax: +1 507-301-0499
Jaypee Brothers Medical Publishers (P) Ltd
17/1-B Babar Road, Block-B, Shaymali
Mohammadpur, Dhaka-1207
Mobile: +08801912003485
Jaypee Brothers Medical Publishers (P) Ltd
Bhotahity, Kathmandu, Nepal
Phone +977-9741283608
© 2019, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. The CD/DVD-ROM (if any) provided in the sealed envelope with this book is complimentary and free of cost. Not meant of sale.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
Endoscopic Neurological Surgery
First Edition: 2019
Printed at
This book is dedicated to all the patients whom I treated with endoscopic neurosurgical techniques and contributed to the expanding volume of knowledge of this surgical disciplinefm6
fm7Contributors fm9Preface
I became very interested and fascinated by the concept of minimally invasive brain surgery during my pediatric neurosurgery fellowship. Very little had been written on the subject, so I approached several of the world leaders in the area and sought their opinions and advice. As my academic career matured over the last quarter of a century, my experience and confidence grew, thereby allowing me to care for many patients and many different clinical conditions. With experience came knowledge and facility of execution. Many “surgical pearls” were learned, developed and adapted over the years. The impetus for writing this book came from the desire to share many of these “pearls” with those interested in the field and who are beginning to embark in its execution. Additionally, it has also been written for those in the medical profession who may be interested in the subject. These include residents, medical students, physician assistants, and nurses. The chapters cover a wide spectrum of clinical problems that are amenable to endoscopic treatment. A review of the literature presents the reader with an overview in each chapter. The actual surgical technique is then described in a concise, simple but yet detailed fashion. I find that carefully executed endoscopic neurosurgical techniques provide the patients with significantly less trauma, morbidity and complications. It is my hope that these techniques are taken up by many more developing surgeons and that many more patients are helped in the process.
David F Jimenezfm10
I especially appreciate the constant support and encouragement of Shri Jitendar P Vij (Group Chairman) and Mr Ankit Vij (Group President) of Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India in helping to publish this textbook and also their associates particularly Ms Chetna Malhotra Vohra (Associate Director—Content Strategy) and Ms Nikita Chauhan (Development Editor) who have been prompt, efficient and most helpful.fm12