Assuntos
Infecções por Coronavirus , Dispositivos de Proteção dos Olhos , Microcirurgia/instrumentação , Neuroendoscópios , Procedimentos Neurocirúrgicos/instrumentação , Pandemias , Pneumonia Viral , Betacoronavirus , COVID-19 , Humanos , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Equipamento de Proteção Individual , SARS-CoV-2 , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Fibrous dysplasia is a non-heritable, congenital disease involving the bones. Its diagnosis relies on image examination and pathology. Treatment is usually conservative, but in cases of cranial nerve impingement or extension to the condyles, surgery should be considered. In this paper, we describe a singular case of monostotic fibrous dysplasia of the clivus in a child. CASE REPORT: A 14-year-old boy presented with chronic headache and diplopia. A neurological examination revealed palsy of the right VIth cranial nerve. The radiological findings were consistent with fibrous dysplasia, with a hypointense and isointense clival lesion on T (1)- and T (2)-weighted images, respectively. Surgical treatment was indicated by cranial nerve impairment. An endoscopic endonasal approach with an image-guided system was used. The patient was discharged four days after surgery and his diplopia improved postoperatively. DISCUSSION: A variety of surgical approaches have been used in the treatment of midline extra-axial cranial base tumors. Fibrous dysplasia of the clivus without expansion to the condylus can be removed with a transsphenoidal endonasal endoscopic approach. Preoperative imaging reveals the individual patient's anatomy and improves the intraoperative orientation. CONCLUSION: Image-guided transsphenoidal endoscopic surgery is recommended for its safety and minimal invasiveness.
Assuntos
Fossa Craniana Posterior/cirurgia , Displasia Fibrosa Monostótica/cirurgia , Neuroendoscópios , Neuronavegação/instrumentação , Adolescente , Fossa Craniana Posterior/patologia , Diagnóstico Diferencial , Adesivo Tecidual de Fibrina/uso terapêutico , Displasia Fibrosa Monostótica/diagnóstico , Displasia Fibrosa Monostótica/patologia , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Neuronavegação/métodos , Retalhos Cirúrgicos , Tomografia Computadorizada por Raios XRESUMO
Worldwide in the last two decades, in Latin America in the last decade, and Mexico in particular cerebral endoscopy as part of the minimally invasive neurological surgery, has constituted a significant advance for the treatment of neurological diseases such as congenital or acquired hydrocephalus, Chiari malformation, neurocysticercosis, stroke, ventricular and paraventricular tumors and cysts, arachnoidal cyst and hydrocephalus secondary to shunt malfunction. The lateral ventricles, the third ventricle, the cerebral aqueduct, the fourth ventricle, and the subarachnoid basal cisterns are among the most non-accessible regions of the central nervous system. Due to light-rand fiber optic-systems in combination with the experiences of nine consecutive year's and more than 600 endoscopies, most of them flexible neuroendoscopies, we present the neuroendoscopic approach with flexible cerebral endoscope to the anatomy and its normal variants of the whole ventricle system and the subarachnoid basal cisterns including the subarachnoid space of the cervical spine. We also describe their site related structures including veins, arteries, cranial nerves, pituitary gland, choroidal plexus and their normal anatomic variants.
Assuntos
Neuroendoscopia/métodos , Ventrículos Cerebrais/anatomia & histologia , Humanos , Neuroendoscópios , Base do Crânio/anatomia & histologia , Espaço Subaracnóideo/anatomia & histologiaRESUMO
En las últimas dos décadas a nivel mundial y en la última década en Latinoamérica, especialmente en México, la endoscopia cerebral como parte de la cirugía neurológica de mínima invasión ha sido un paso de gran importancia para el tratamiento de enfermedades neurológicas T4 como hidrocefalia congénita o adquirida, malformaciones Chiari, neurocisticercosis, enfermedad vascular cerebral, tumores o quistes ventriculares y paraventriculares, quistes aracnoideos e hidrocefalias secundarias a disfunciones valvulares. Entre las regiones más inaccesibles al sistema nervioso central se encuentran los ventrículos laterales, el tercer ventrículo, el acueducto cerebral, el cuarto ventrículo y el espacio subaracnoideo de la base del cráneo. Gracias a los sistemas de fibra óptica y luz en combinación con la experiencia de nueve años consecutivos y más de 600 endoscopias realizadas, en su mayoría endoscopias cerebrales flexibles, presentarnos el abordaje por medio de neuronavegación con endoscopía cerebral flexible de la anatomía normal y sus variantes de todo el sistema ventricular y el espacio subaracnoideo de la base del cráneo, incluyendo el espacio subaracnoideo de la médula cervical. También presentamos las estructuras relacionadas a estos sitios como: venas, arterias, nervios craneales, glándula pituitaria y plexos coroideos.
Worldwide in the last two decades, in Latin America in the last decade, and Mexico in particular cerebral endoscopy as part of the minimally invasive neurological surgery, has constituted a significant advance for the treatment of neurological diseases such as congenital or acquired hydrocephalus, Chiari malformation, neurocysticercosis, stroke, ventricular and paraventricular tumors and cysts, arachnoidal cyst and hydrocephalus secondary to shunt malfunction. The lateral ventricles, the third ventricle, the cerebral aqueduct, the fourth ventricle, and the subarachnoid basal cisterns are among the most non accessible regions of the central nervous system. Due to light rand fiber optic systems in combination with the experiences of nine consecutive year's and more than 600 endoscopies, most of them flexible neuroendoscopies, we present the neuroendoscopic approach with flexible cerebral endoscope to the anatomy and its normal variants of the whole ventricle system and the subarachnoid basal cisterns including the subarachnoid space of the cervical spine. We also describe their site related structures including veins, arteries, cranial nerves, pituitary gland, choroidal plexus and their normal anatomic variants.
Assuntos
Humanos , Neuroendoscopia/métodos , Ventrículos Cerebrais/anatomia & histologia , Neuroendoscópios , Base do Crânio/anatomia & histologia , Espaço Subaracnóideo/anatomia & histologiaRESUMO
This paper reports the testing of a lightweight wearable stereoscopic display during neuroendoscopies and endoscope assisted neurosurgeries. The viewers tested were a binocular (for the surgeon) and a monocular system (for the instrumenting nurse), whose optics are specially designed for wearable, portable applications and comprise a color corrected refractive magnifying system.
Assuntos
Neuroendoscópios , Neuroendoscopia , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/métodos , Desenho de Equipamento , HumanosRESUMO
Shunt placement was the most common procedure used for ventricular dilatation, but in many neurosurgical centers it has been substituted by flexible neuroendoscope; however, none of them had solved the problem of the trapped and dilated fourth ventricle. The combination of the ventricle-peritoneal catheter placement in the center of the fourth ventricle by direct visualization with a flexible neuroendoscope using a single coronal burr-hole has solved this problem. Eleven patients with a trapped fourth ventricle, with previous third ventriculostomy and aqueductal plasty, were treated with this procedure; all patients were evaluated clinically and with computed tomography 8 to 24 months (mean, 18 months) later. Here, we describe the technical procedure.