1 / 29

Endoscopic and Combined Approaches

Endoscopic and Combined Approaches. Ruth E. Bristol, MD Assistant Professor of Neurosurgery. Acknowledgements. Maggie Bobrowitz, RN, MBA HH team Harold Rekate, MD Adib Abla , MD Patients and Families. Outline. How do we choose the right surgery? What does “endoscopic” mean?

ajaxe
Télécharger la présentation

Endoscopic and Combined Approaches

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Endoscopic and Combined Approaches Ruth E. Bristol, MD Assistant Professor of Neurosurgery

  2. Acknowledgements • Maggie Bobrowitz, RN, MBA • HH team • Harold Rekate, MD • AdibAbla, MD • Patients and Families

  3. Outline • How do we choose the right surgery? • What does “endoscopic” mean? • How an endoscope works • Choosing the endoscopic approach • Risks • What does “combined” mean? • Why we choose a combined approach

  4. How Do We Get There? Blow up of lesion

  5. Patient Selection • Type II, III, and IV: Endoscopic + • Type III and IV: Combined

  6. What Is An Endoscope? Working end Camera

  7. Risks of Treatment • Memory loss • Hypothalamic injury • Increased appetite • Diabetes inispidus • Other hormonal abnormalities • Vascular injuries (stroke) • Cranial nerve

  8. Case 1

  9. Endoscopic Video

  10. Post-op: Resection Cavity

  11. Endoscopy • Endoscope approaching lesion from side contralateral to attachment. • Micromanipulator on the endoscope, and stereotactic guidance frame.

  12. Terms • Contralateral • Ipsilateral

  13. Endoscopic • Pros • Comparable seizure control (49% vs 54%) • Shorter length of stays (4.1 vs 7.7 days) • Cons • Short term memory loss • Less working room (bad for large lesions) • Thalamic infarct reported (~85 % asymptomatic)

  14. Endoscopic • Background

  15. Surgery From Above • Endoscopic series • 37 patients with refractory seizures • Mean age of onset approx 10 months of age • 62 % with IQ < 70 • Always a contralateralapproach Ng, Rekate et al. Neurology 2008

  16. Open Vs. Endoscopic • Percent of disconnect/resection • Not statistically tied to seizure-free rate • 100% resection gave 100% seizure-free postop course in 8 of 12 • Compared to open approach • Endoscopic: Shorter stay: 4.5 versus 7.7 days • Comparable seizure-free rates: 49 % vs. 54 % (endo vs. TC) • Tumors smaller in endoscopic: 1.01 vs 2.43 cc (p=0.0322) • Reasons to favor open approach • Larger tumors (>1.5 cm) with bilateral attachments • Better for children younger than adolescent age

  17. Seizure Control Abla et al., AANS Philadelphia. May 3, 2010

  18. Case 2 • 7 yo female • Gelastic epilepsy • Behavioral problems (impulsivity) • Rapid progression of seizures in summer

  19. Case 2 Post op

  20. Case 3 • 20 months old • Multiple medical problems • Gelastic epilepsy

  21. Case 3 Post op

  22. Endoscopic Approach

  23. Combined Approach

  24. Combined Video

  25. Combined Approach

  26. Outcome • Seizure freedom: 29-49% • Seizure Reduction: 55-73% • In older patients, higher IQ correlated with better chance of seizure freedom • Memory loss 8% permanent • Adults had more complications than children

  27. Complications • Postoperative DI • Usually transient (< 1 week). DDAVP given in ICU • Weight gain (satiety center = VMH) • 19% • Short-term memory loss • Transient • 58 % in TC group / 14 % in endoscopic group (< 2 wks) • Permanent • ~ 8 % in both (2/26 and 3/37) Ng, Rekate et al. Epilepsia 2006

  28. BNI Treatment Paradigm Laser?

  29. Conclusions • PROPER SELECTION • No single approach is appropriate or advantageous for all patients • Decisions individualized • Surgical anatomy • Presence of acute clinical deterioration

More Related