Endoscopic neurosurgery "around the corner" with a rigid endoscope. Technical note

Area of Science:

• Neurosurgery
• Medical Devices
• Endoscopy

Background:

• Current "working around the corner" endoscopic techniques are limited to flexible endoscopes or endoscope-assisted microneurosurgery (EAM).
• These methods present challenges in maneuverability and access for complex neurosurgical procedures.

Purpose of the Study:

• To develop and evaluate novel endoscopic equipment and techniques for "working around the corner" using rigid endoscopes.
• To overcome the limitations of existing flexible and EAM approaches in neuroendoscopy.

Main Methods:

• Development of a rigid endoscope system featuring a steerable insert with a 5 French working channel for active instrument bending.
• Implementation of a specialized fixation device for precise axial rotation of the endoscope.
• Performance of endoscopic procedures (aqueductal stenting, pellucidotomy, third ventriculostomy, biopsy) in human cadavers.

Main Results:

• The developed pediatric neuroendoscope system demonstrated reliable fixation, axial rotation, and controlled instrument steering.
• Procedures like endoscopic third ventriculostomy and biopsy were successfully performed in cadavers, showcasing potential for reduced surgical trauma.
• The system allows for simultaneous endoscopic third ventriculostomy and biopsy through a single burr hole for obstructive hydrocephalus.

Conclusions:

• The novel rigid endoscopic system offers enhanced safety and reduced surgical trauma for specific neurosurgical applications.
• Limitations include anatomical constraints (foramen of Monro size, third ventricle height) and instrument bending angles (40-50 degrees).
• This technology represents a significant advancement for neuroendoscopic interventions requiring "working around the corner" capabilities.