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Endoscopic third ventriculostomy and biopsy of a tectal lesion using flexible neuroendoscopy and urological cup forceps: illustrative case

Meredith Yang, Daniel Wolfson, Melissa A. LoPresti, Emma Poland, Sandi Lam, and Michael DeCuypere

influence decision making. Thus, treatment goals for symptomatic tumors are twofold: CSF diversion and tissue diagnosis. Methods of sampling pineal region tumors include open biopsy or, more recently, endoscopic biopsy. 2 First described in 1997 while using a flexible neuroendoscope, 3 simultaneous endoscopic third ventriculostomy (ETV) and biopsy through a single burr hole has been demonstrated to be safe and diagnostically efficacious, allowing surgeons to procure tissue and treat hydrocephalus in one procedure. Herein, we describe our experience with single burr

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Symptomatic obstructive hydrocephalus caused by choroid plexus hyperplasia in a pediatric patient: illustrative case

Ana Sofia Alvarez, John P McGinnis, Rajan Patel, and Howard L Weiner

choroid plexus hyperplasia. The radiologist was concerned about a possible tumor. MRI of the spine did not show any significant findings. FIG. 1 Preoperative postcontrast sagittal T1-weighted MRI showing obstruction of the aqueduct of Sylvius by the choroid plexus. FIG. 2 Preoperative postcontrast axial T1-weighted MRI showing supratentorial hydrocephalus. Given the clinical and radiological findings, endoscopic third ventriculostomy (ETV) was indicated. The surgery was performed through a standard right frontal burr hole, and intraoperative ultrasound

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Stereotactic surgery for neurocysticercosis of the 4th ventricle: illustrative cases

Luis J. Saavedra, Carlos M. Vásquez, Hector H. García, Luis A. Antonio, Yelimer Caucha, Jesús Félix, Jorge E. Medina, and William W. Lines

-dating in diagnosis and treatment. Article in Spanish . Neurologia . 2005 ; 20 ( 8 ): 412 – 418 . 29465742 9 Sandoval-Balanzario MA , Rincón-Navarro RA , Granados-López R , Santos-Franco JA . Endoscopic third ventriculostomy for chronic communicating hydrocephalus in adults. Article in Spanish . Rev Med Inst Mex Seguro Soc . 2015 ; 53 ( 3 ): 280 – 285 . 10 Campbell BR , Reynoso D , White AC . Intraventricular neurocysticercosis and Bruns’ syndrome: a review . J Rare Dis Res Treat . 2017 ; 2 ( 2 ): 1 – 5 . 10

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Use of the 3D exoscope for the supracerebellar infratentorial approach in the concorde position: an effective and ergonomic alternative. Illustrative cases

Jorge A. Roa, Alexander J. Schupper, Kurt Yaeger, and Constantinos G. Hadjipanayis

compression ( Fig. 2A and B ). An MRI of the brain confirmed presence of a contrast-enhancing mixed cystic and solid pineal region mass, 2.3 × 1.1 × 1.7 cm with a 1.1 × 1.0 × 1.4 cm anterior cystic component compressing the cerebral aqueduct ( Fig. 2C and D ). The patient and his family were counseled on the need for surgery and treatment of his obstructive hydrocephalus. An endoscopic third ventriculostomy in combination with a diagnostic biopsy of the mass was performed. Pathological results confirmed the diagnosis of an anaplastic ependymoma. One month later, the patient

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Removal of a flanged ventricular catheter: illustrative case

M. Benjamin Larkin, Tyler T. Lazaro, Howard L. Weiner, and William E. Whitehead

completing the antibiotic schedule, the patient went to the operating room for another attempt at removing the retained flanged catheter under endoscopic visualization followed by endoscopic third ventriculostomy (ETV). The flanged catheter was visualized in the body of the right lateral ventricle with minimal scarring. The right occipital incision was opened, and the distal end of the proximal flanged catheter was exposed. The catheter was slowly removed from the tethered portion of the choroid plexus using flexible wire monopolar electrocautery, gentle rotation, and

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Transventricular endoscopic approach to the anterior interhemispheric fissure for neurocysticercosis: illustrative cases

Mao Vásquez, Luis J. Saavedra, Hector H. García, Alejandro Apaza, Yelimer Caucha, Jorge E. Medina, Dennis Heredia, Fernando Romero, and William W. Lines-Aguilar

. Surgery We used a Storz device for ventricular endoscopy, approaching through the right Kocher’s point with a trephine, in the same projection as for an endoscopic third ventriculostomy (ETV) once in the right lateral ventricle the thalamus-striate vein, choroid plexus, and the protrusion at the floor of the lateral ventricle produced by the NCC cysts in the AIF ( Fig. 2 ), which was fenestrated with bipolar coagulation up to the AIF ( Fig. 2 ). From here, some cysts began to appear and were removed with a Nelaton #8 probe, which allowed us to extract a greater volume

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Endoscopic resection of a giant colloid cyst in the velum interpositum: illustrative case

Mahdi Arjipour, Mohammad Gharib, and Mohamadmehdi Eftekharian

into consideration. Operation The patient underwent surgery through an endoscopic approach to the lesion. After entering the ventricular space from the right side, the lesion was observed. At first, a cerebrospinal fluid sample was taken and an endoscopic third ventriculostomy was undertaken for hydrocephalus treatment. Then, after the mass wall opening at the superior part, there was a firm nonsuctionable solid gray-yellow material inside the lesion, which was not typical for a colloid cyst. Thus, the solid lesion content was resected in a piecemeal manner

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Immunocompetent isolated cerebral mucormycosis presenting with obstructive hydrocephalus: illustrative case

Khoa N Nguyen, Lindsey M Freeman, Timothy H Ung, Steven Ojemann, and Fabio Grassia

to red blood cells (2,000) on cell count. The differential resulted in 8% neutrophils, 65% lymphocytes, and 27% monocytes. Cultures were negative. Four days later, the patient underwent planned endoscopic third ventriculostomy (ETV). An intraoperative decision was made to also complete an endoscopic biopsy. Induction of general anesthesia, endotracheal intubation, and patient head fixation in a neutral 30° elevated position were completed in typical fashion. After the usual surgical preparation, a right frontal burr hole was made at Kocher’s point, and the dura

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Management of failed Chiari decompression and intrasyringeal hemorrhage in Noonan syndrome: illustrative cases

Cody J. Falls, Paul S. Page, Garret P. Greeneway, Daniel K. Resnick, and James A. Stadler III

family, an endoscopic third ventriculostomy was performed. Prior to that occurrence there had been no clinical concern for elevated intracranial pressure or need for CSF diversion. One month postoperatively, the patient has complete resolution of his neck pain and headaches and continues to demonstrate no other neurological symptoms. Case 2 A 16-year-old girl with a known history of NS, tethered cord, scoliosis, CM-I, and holocord syringomyelia presented with rapid progression of her scoliosis. She had a history of a tethered cord release 7 years earlier. Lack

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Severe hyperglycorrhachia and status epilepticus after endoscopic aqueductoplasty: illustrative case

Anand A. Dharia, Ahmad Masri, Jay F. Rilinger, and Christian B. Kaufman

circumference, but his neurological exam was otherwise benign. Surgical options, which included endoscopic third ventriculostomy (ETV), ventriculoperitoneal shunt placement, and endoscopic fenestration with aqueductoplasty, were offered nonurgently when the patient reached 3 months of age. Considering the potential for future revisions with shunting and the 50% predicted failure rate calculated by the ETV success score, the family elected to proceed with endoscopic aqueductoplasty. At the time of surgery, intraventricular access was obtained via a right frontal approach using