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Toshiki Endo, Toshiyuki Takahashi, Hidefumi Jokura, and Teiji Tominaga

use endoscopic techniques in spinal surgery in 2000. Since then, we have treated 6 cases of spinal arachnoid cysts by surgically exposing up to 3 vertebral levels followed by endoscopic fenestration and partial cyst wall removal through the operative window. Here, we report the results of long-term follow-up of spinal intradural arachnoid cysts treated at our institute using minimal surgical exposure combined with partial cystectomy and endoscopic fenestration. We compared these findings with those obtained from the 5 cases treated without endoscopy between 1997 and

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Amit Parmar, Kristian Aquilina, and Michael R. Carter

examination. 11 The opening was situated in the weakest part of the floor of the third ventricle; it was 3 mm in diameter and was patent into the subarachnoid space. This is similar to the endoscopic description in our patient and appears identical to surgical endoscopic third ventriculostomy. Endoscopy has only been reported in one other case of ventriculostomy where hydrocephalus secondary to aqueduct stenosis was associated with a cystic lesion in the supracerebellar region. 13 A flexible endoscope was advanced from the right lateral ventricle through an ostium in its

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Mahmoud Messerer, Juan Carlos De battista, Gérald Raverot, Sebouh Kassis, Julie Dubourg, Veronique Lapras, Jacqueline Trouillas, Gilles Perrin, and Emmanuel Jouanneau

improvement, especially with regards to the lateral and upper fields of vision. Introduced in the 1990s, 21 endoscopy marked an important milestone for pituitary or skull base surgery and was widely promoted in particular by Cappabianca et al. 2 and Jho and Carrau. 7 , 25–27 While the endoscopic endonasal approach is becoming the technique of choice for pituitary surgery, 4 , 8 , 10 improvements with regard to surgical outcome remain undetermined. Immunonegative, gonadotropic, and silent adenomas are grouped under the name of NFPA since they have no specific clinical

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Pankaj A. Gore, Peter Nakaji, Vivek Deshmukh, and Harold L. Rekate

C omplex ventricular lesions include those that involve multiple ventricles and/or cisterns, those with a nonlinear axis, and those that adhere to critical anatomical or neurovascular structures. These lesions can be challenging to resect both endoscopically and microsurgically. The synchronous use of microsurgery and endoscopy via two different trajectories can allow these complex ventricular lesions to be resected safely and effectively while the effectiveness of each modality is maximized. We present three cases in which this new method was used; good

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David F. Jimenez, Michael J. McGinity, and Constance M. Barone

invasive corrections have been associated with a decrease in the cost of performing these operations. 20 A criticism of suturectomy has been a lack of hypoteloric correction. However, endoscopic suturectomy has been demonstrated to be equivalent to open repairs in correcting hypotelorism. 31 Endoscopy-assisted strip craniectomy of the metopic suture was first performed by the authors in 1998, and they have been performing the procedure for the past 19 years with excellent results. Methods The authors have collected a detailed, prospective pre-, intra-, and

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Michael L. J. Apuzzo, Milton D. Heifetz, Martin H. Weiss, and Theodore Kurze

absorption through a traditional small telescope is very high, and this light loss limits the efficiency of most endoscopy units; however, the Hopkins unit has a higher percentage of light transmission resulting in a much brighter image. A significant step forward in obtaining improved illumination was provided by Lamm 4 with the development of small flexible fiberglass threads for the transmission of light. Because of the small diameter of the Hopkins lens system, it is possible to place a thin layer of lighttransmitting optical fiber bundles around the rod lenses to

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Marc R. Mayberg, Eric LaPresto, and Edwin J. Cunningham


Neuroendoscopic approaches to lesions of the central nervous system and spine are limited by the loss of stereoscopic vision and high-fidelity image quality inherent in the operating microscope. Image-guided endoscopy (IGE) and image-guided surgery (IGS) have the potential to overcome these limitations. The goal of this study was to evaluate IGE for its potential applications in neurosurgery.


To determine the feasibility of IGE, a rigid endoscope was tracked using an IGS system that provided navigational data for the endoscope tip and trajectory as well as a computer-generated, three-dimensional, virtual representation of the image provided by the endoscope.

The IGE procedure was successfully completed in 14 patients (nine with pituitary adenomas, one with a temporal cavernous malformation, and four with unruptured aneurysms). No complications could be attributed to the procedure. Compared with direct microscopy performed using anatomical landmarks, registration of the endoscope, and virtual image were highly accurate.


This procedure offers many potential advantages for central nervous system and spinal endoscopy. Advances in IGE may enable its application to regions outside the central nervous system as well.

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Joshua J. Chern, Amber S. Gordon, Robert P. Naftel, R. Shane Tubbs, W. Jerry Oakes, and John C. Wellons III

T he use of endoscopy in the diagnosis and treatment of various spinal disorders has steadily increased in the past 2 decades. While the term “spinal endoscopy” is most commonly used, the utility of endoscopy differs, depending on whether the targeted pathological entity is osseous, epidural, or intradural in location. In the osseous spine, endoscopic procedures have been reported for lumbar/thoracic discectomy, laminectomy, and foraminotomy. Endoscopy has also been used as a surgical adjunct in anterior and posterior lumbar and thoracic fusion procedures

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David F. Jimenez and Constance M. Barone

such as vertical dystopia, craniofacial scoliosis, and nasal deviation are not adequately treated with these extensive techniques. The simple removal and repositioning of the supraorbital rim does nothing to correct the medial, inferior, and lateral walls of the dystopic orbit. In an effort to better address these deformational changes we have introduced the concept of minimally invasive, endoscopy-assisted suture osteotomies in young infants, followed by cranial molding using cranial orthoses. Although we have previously published on this subject 1 , 10–16 , 30 in

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David F. Jimenez, Constance M. Barone, Maria E. McGee, Cathy C. Cartwright, and C. Lynette Baker

patients with sagittal suture synostosis in whom endoscopy-assisted wide-vertex craniectomies were performed with bitemporal and biparietal barrel stave osteotomies. Postoperatively custom-made cranial molding helmets were placed to achieve and maintain normocephaly. The results of using endoscopic techniques in the management of sagittal synostosis are presented. We present follow-up data after the original introduction of the technique several years ago. 20 Clinical Material and Methods Patient Population One hundred thirty-nine consecutive children in whom