Endoscopic and Endoscopic-Assisted Microsurgery of Intraventricular Lesions

NCT ID: NCT04569201

Last Updated: 2020-09-29

Basic Information

• Recruitment Status: UNKNOWN
• Total Enrollment: 20 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2020-11-01
• Study Completion Date: 2022-12-01

Brief Summary

• Assess the efficacy of the endoscope as a single tool or as an adjuvant tool to the microscope in intraventricular procedures.
• Evaluate the limitations of the endoscope in these procedures.
• Review the outcome of endoscopic and/or endoscopic assisted microsurgical intraventricular procedures.
• Achieve a verdict in the long-standing controversy about the most effective, least invasive, and optimal way to resect intraventricular lesions, can the endoscope rival the surgical microscope?

Detailed Description

Lesions within the ventricular system present a challenge to neurosurgeons (1). Their deep location and proximity to eloquent neurovascular anatomy complicate surgical approach and resection (2). Microsurgery remains the gold standard for the treatment of intraventricular tumors, but microsurgical approaches are not without limitations (3). With the use of the operative microscope, most lesions of the lateral and third ventricles are accessed by a craniotomy and either a transcortical or interhemispheric transcallosal approach. These approaches are associated with brain retraction that can result in seizures, focal neurologic deficits, and cognitive impairment (1). Also with standard microsurgical techniques, complete resection is sometimes not achieved either because of nonvisualization of hidden parts of the tumor or requirement of significant retraction of the neurovascular structures which is potentially hazardous (4). The addition of the endoscope for resection of intraventricular lesions has been described and represents a minimally invasive approach that limits brain retraction and provides direct lesion visualization (1,5,6). The recent development of endoscopic instrumentation has greatly enhanced microsurgical access to the ventricular system and would allow enhanced microsurgical access, minimize the size of the transcortical corridor, and reduce brain retraction during removal of challenging intraventricular lesions performed with the surgical microscope (7). The application of the endoscope can be used in the treatment of intraventricular lesions as arachnoid cyst with intraventricular extensions, colloid cysts, biopsies and intraventricular brain tumor removal (8). Reestablishment of CSF communication pathways is also possible endoscopically when patients develop obstructive hydrocephalus due to their intraventricular pathology (1). The biggest issues when it comes to a pure endoscopic approach concern the size and extent of the lesion, possibility of complete cure or at least long-term control of the disease, and the presence of remnants that were not completely excised (8) , However, The desire for a less invasive technique and an effective surgical approach to intraventricular pathology has directed the attention of many in the neurosurgical community towards the introduction of the endoscope as an adjuvant to or even a replacement for the microscope in intraventricular surgery (5) and consequently, neuroendoscopy has grown rapidly in the last 25 years as a therapeutic modality in the treatment of intraventricular pathologies (9,10).

Conditions

Endoscopy in Intraventricular Lesions

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Interventions

Endoscope

The use of the neuro endoscope in excision of intraventricular lesions either alone or in assistance of the surgical microscope

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• Intraventricular arachnoid cysts
• Intraventricular colloid cysts
• Intraventricular tumors.

Exclusion Criteria

• Intraventricular lesions extending outside the ventricle (exception to arachnoid cysts)
• Patients who are unfit for any neurosurgical interventions.

• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Assiut University

OTHER

Sponsor Role: lead

Responsible Party

Nour Imam

Assistant Lecturer (Principal Investigator)

Responsibility Role: PRINCIPAL_INVESTIGATOR

Central Contacts

Nour Eldin H. M. K. Imam, Masters Degree in Neurosurgery

Role: CONTACT

nourimam@outlook.com

+201099855603

References

Nduom EK, Sribnick EA, Ormond DR, Hadjipanayis CG. Neuroendoscopic Resection of Intraventricular Tumors and Cysts through a Working Channel with a Variable Aspiration Tissue Resector: A Feasibility and Safety Study. Minim Invasive Surg. 2013;2013:471805. doi: 10.1155/2013/471805. Epub 2013 Jun 13.

Reference Type: BACKGROUND

PMID: 23844287 (View on PubMed)

Yasargil MG, Abdulrauf SI. Surgery of intraventricular tumors. Neurosurgery. 2008 Jun;62(6 Suppl 3):1029-40; discussion 1040-1. doi: 10.1227/01.neu.0000333768.12951.9a.

Reference Type: BACKGROUND

PMID: 18695523 (View on PubMed)

Barber SM, Rangel-Castilla L, Baskin D. Neuroendoscopic resection of intraventricular tumors: a systematic outcomes analysis. Minim Invasive Surg. 2013;2013:898753. doi: 10.1155/2013/898753. Epub 2013 Sep 26.

Reference Type: BACKGROUND

PMID: 24191196 (View on PubMed)

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Reference Type: BACKGROUND

PMID: 29527394 (View on PubMed)

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Reference Type: BACKGROUND

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Reference Type: BACKGROUND

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Harris AE, Hadjipanayis CG, Lunsford LD, Lunsford AK, Kassam AB. Microsurgical removal of intraventricular lesions using endoscopic visualization and stereotactic guidance. Neurosurgery. 2005 Jan;56(1 Suppl):125-32; discussion 125-32. doi: 10.1227/01.neu.0000146227.75138.08.

Reference Type: BACKGROUND

PMID: 15799800 (View on PubMed)

Brunori A, de Falco R, Delitala A, Schaller K, Schonauer C. Tailoring Endoscopic Approach to Colloid Cysts of the Third Ventricle: A Multicenter Experience. World Neurosurg. 2018 Sep;117:e457-e464. doi: 10.1016/j.wneu.2018.06.051. Epub 2018 Jun 26.

Reference Type: BACKGROUND

PMID: 29959067 (View on PubMed)

Yadav YR, Parihar V, Sinha M, Jain N. Endoscopic treatment of the suprasellar arachnoid cyst. Neurol India. 2010 Mar-Apr;58(2):280-3. doi: 10.4103/0028-3886.63772.

Reference Type: BACKGROUND

PMID: 20508350 (View on PubMed)

Romano A, Chibbaro S, Marsella M, Oretti G, Spiriev T, Iaccarino C, Servadei F. Combined endoscopic transsphenoidal-transventricular approach for resection of a giant pituitary macroadenoma. World Neurosurg. 2010 Jul;74(1):161-4. doi: 10.1016/j.wneu.2010.02.024.

Reference Type: BACKGROUND

PMID: 21300008 (View on PubMed)

Other Identifiers

Intraventricular Endoscopy

Identifier Type: -

Identifier Source: org_study_id