Endoscopic Navigation of the Fourth Ventricle
Endoscopic Navigation of the Fourth Ventricle
Transaqueductal navigation of the fourth ventricle has long been considered dangerous and of no clinical relevance. After the refinement of the endoscopic technique and supported by the extensive experience gained at the authors' institution since 1994, endoscopic exploration of the fourth ventricle has been performed by the same surgeon in 54 patients. In all cases reviewed, endoscopic navigation of the fourth ventricle was successfully performed with no related neurological deficit. This preliminary experience shows the feasibility of transaqueductal navigation of the fourth ventricle, which is made possible by the use of small, flexible endoscopes in expert hands.
The transaqueductal pathway to the fourth ventricle should not be considered analogous to the Pillars of Hercules, beyond which one dares not navigate. On reviewing the historical experience, we noted that the very few pioneers of endoscopic approaches to the aqueductal region by a frontal route preferred rigid instruments, and that the extraordinary versatility of flexible scopes has not been fully exploited to achieve complete control of the ventricular cavities.
In this study we summarize our findings in a series of 54 patients presenting with different pathological conditions in which transaqueductal navigation has been successfully performed using flexible endoscopes. This instrument has allowed us to apply this approach, not as a challenge to the status quo, but as a surprisingly similar method to those commonly used in the more usual neuroendoscopic procedures.
Transaqueductal navigation of the fourth ventricle has long been considered dangerous and of no clinical relevance. After the refinement of the endoscopic technique and supported by the extensive experience gained at the authors' institution since 1994, endoscopic exploration of the fourth ventricle has been performed by the same surgeon in 54 patients. In all cases reviewed, endoscopic navigation of the fourth ventricle was successfully performed with no related neurological deficit. This preliminary experience shows the feasibility of transaqueductal navigation of the fourth ventricle, which is made possible by the use of small, flexible endoscopes in expert hands.
The transaqueductal pathway to the fourth ventricle should not be considered analogous to the Pillars of Hercules, beyond which one dares not navigate. On reviewing the historical experience, we noted that the very few pioneers of endoscopic approaches to the aqueductal region by a frontal route preferred rigid instruments, and that the extraordinary versatility of flexible scopes has not been fully exploited to achieve complete control of the ventricular cavities.
In this study we summarize our findings in a series of 54 patients presenting with different pathological conditions in which transaqueductal navigation has been successfully performed using flexible endoscopes. This instrument has allowed us to apply this approach, not as a challenge to the status quo, but as a surprisingly similar method to those commonly used in the more usual neuroendoscopic procedures.
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