Navegando por Palavras-chave "neuroendoscopy"

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    Endoscopic third ventriculostomy is a safe and effectiveprocedure for the treatment of Blake's pouch cyst
    (Academia Brasileira de Neurologia - ABNEURO, 2013-08-01) Brusius, Carlos Vicente [UNIFESP]; Cavalheiro, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital da Crianca Santo Antonio Santa Casa de Misericordia de Porto Alegre; Hospital Moinhos de Vento
    OBJECTIVE: Blake's pouch cyst (BPC) is a midline cystic malformation of the posterior fossa, within Dandy-Walker's complex (DWC), often associated with hydrocephalus. Endoscopic third ventriculostomy (ETV) has been an alternative to conventional methods for BPC treatment. This study aimed at reporting our experience with ETV in a series of patients with BPC. METHODS: Of 33 patients diagnosed with midline posterior fossa cyst, 26 met the protocol criteria for DWC, and eight subjects with BPC were selected (aged one month to two years old). All cases were treated with ETV. RESULTS: Five patients were male; and three were prenatally diagnosed. They had hydrocephalus and motor deficiencies. Motor assessment at a five-year follow-up yielded normal findings. All patients improved, and only one had residual cognitive dysfunction, despite overall neurological improvement. There were no complications. CONCLUSIONS: ETV was a safe and effective procedure, reducing risks and morbidity associated with open surgery and shunt-related problems.
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    Frameless Image-Guided Neuroendoscopy Training in Real Simulators
    (Georg Thieme Verlag Kg, 2011-06-01) Coelho, G. [UNIFESP]; Kondageski, C.; Vaz-Guimaraes Filho, F. [UNIFESP]; Ramina, R.; Hunhevicz, S. C.; Daga, F.; Lyra, M. R.; Cavalheiro, S. [UNIFESP]; Zymberg, S. T. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Neurologia Inst Curitiba; Universidade Federal de Pernambuco (UFPE)
    Background: Over the last decade, neuroendoscopy has re-emerged as an interesting option in the management of intraventricular lesions in both children and adults. Nonetheless, as it has become more difficult to use cadaveric specimens in training, the development of alternative methods was vital. the aim of this study was to analyze the performance of a real simulator, in association with image-guided navigation, as a teaching tool for the training of intraventricular endoscopic procedures.Methods: 3 real simulators were built using a special type of resin. 1 was designed to represent the abnormally enlarged ventricles, making it possible for a third ventriculostomy to be performed. the remaining 2 were designed to simulate a person's skull and brain bearing intraventricular lesions, which were placed as follows: in the foramen of Monro region, in the frontal and occipital horns of the lateral ventricles and within the third ventricle. in all models, MRI images were obtained for navigation guidance. Within the ventricles, the relevant anatomic structures and the lesions were identified through the endoscope and compared with the position given by the navigation device. the next step consisted of manipulating the lesions, using standard endoscopic techniques.Results: We observed that the models were MRI compatible, easy and safe to handle. They nicely reproduced the intraventricular anatomy and brain consistence, as well as simulated intraventricular lesions. the image-based navigation was efficient in guiding the surgeon through the endoscopic procedure, allowing the selection of the best approach as well as defining the relevant surgical landmarks for each ventricular compartment. Nonetheless, as expected, navigation inaccuracies occurred. After the training sessions the surgeons felt they had gained valued experience by dealing with intraventricular lesions employing endoscopic techniques.Conclusion: the use of real simulators in association with image-guided navigation proved to be an effective tool in training for neuroendoscopy.
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    Neuroendoscopic surgery for unilateral hydrocephalus due to inflammatory obstruction of the Monro foramen
    (Academia Brasileira de Neurologia - ABNEURO, 2011-04-01) Vaz-guimarães Filho, Francisco A. [UNIFESP]; Ramalho, Clauder O. [UNIFESP]; Suriano, Ítalo C. [UNIFESP]; Zymberg, Samuel Tau [UNIFESP]; Cavalheiro, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: Unilateral hydrocephalus (UH) is characterized by enlargement of just one lateral ventricle. In this paper, the authors will demonstrate their experiences in the neuroendoscopic management of this uncommon type of hydrocephalus. METHOD: The authors retrospectively reviewed a serie of almost 800 neuroendoscopic procedures performed from September 1995 to July 2010 and selected seven adult patients with UH. Clinical and radiological charts were reviewed and analyzed. RESULTS: Six patients had intraventricular neurocysticercosis and one patient had congenital stenosis of the foramen of Monro. Headaches were the most common symptom. A septostomy restored cerebrospinal fluid circulation. During follow-up period (65.5 months, range 3-109) no patient has presented clinical recurrence as well as no severe complications have been observed. CONCLUSION: UH is a rare condition. A successful treatment can be accomplished through a neuroendoscopic approach avoiding the use of ventricular shunts.
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    Neuroendoscopic Training: Presentation of a New Real Simulator
    (Georg Thieme Verlag Kg, 2010-02-01) Zymberg, Samuel Tau [UNIFESP]; Vaz-Guimaraes Filho, F.; Lyra, M.; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Pernambuco (UFPE)
    Introduction: There are several models in use in surgical training such as cadaveric, synthetic and animal models as well as virtual reality simulators. Despite having different models for training, unfortunately, financial, technical and operational obstacles more often limit their application in developing countries. the authors have worked out a new synthetic model that could provide a reliable neuroendoscopic training method. the main goal of this study is to introduce the model and discuss relevant data regarding its use.Description of the model: the model is made from a synthetic thermo-retractile and thermo-sensible rubber called Neoderma (R). It can be used for neuroendoscopic, rhinological and endonasal skull base surgical training. Recorded videos showed a great similarity between the model and the human brain. Thirty-seven neurosurgeons were presented to the model. All of them considered it extremely useful. This model does not need any special techniques for maintenance or conservation. After training, it can be easily cleaned and stored. Furthermore, it is atoxic and easy to use.Discussion: A well-designed and realistic training model can help neurosurgeons to improve gradually their skills with no risks. Use of all instruments is strongly recommended. They also hope that, in the future, the model will become a standard simulator able to assist in the training of neurosurgeons.
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    Quality assessment of a new surgical simulator for neuroendoscopic training
    (Amer Assoc Neurological Surgeons, 2011-04-01) Guimaraes Filho, Francisco Vaz [UNIFESP]; Coelho, Giselle; Cavalheiro, Sergio [UNIFESP]; Lyra, Marcos; Zymberg, Samuel Tau [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Curitiba Neurol Inst; Universidade Federal de Pernambuco (UFPE)
    Object. Ideal surgical training models should be entirely reliable, atoxic, easy to handle, and, if possible, low cost. All available models have their advantages and disadvantages. the choice of one or another will depend on the type of surgery to be performed. the authors created an anatomical model called the S.I.M.O.N.T. (Sinus Model Oto-Rhino Neuro Trainer) Neurosurgical Endotrainer, which can provide reliable neuroendoscopic training. the aim in the present study was to assess both the quality of the model and the development of surgical skills by trainees.Methods. the S.I.M.O.N.T. is built of a synthetic thermoretractable, thermosensible rubber called Neoderma, which, combined with different polymers, produces more than 30 different formulas. Quality assessment of the model was based on qualitative and quantitative data obtained from training sessions with 9 experienced and 13 inexperienced neurosurgeons. the techniques used for evaluation were face validation, retest and interrater reliability, and construct validation.Results. the experts considered the S.I.M.O.N.T. capable of reproducing surgical situations as if they were real and presenting great similarity with the human brain. Surgical results of serial training showed that the model could be considered precise. Finally, development and improvement in surgical skills by the trainees were observed and considered relevant to further training. It was also observed that the probability of any single error was dramatically decreased after each training session, with a mean reduction of 41.65% (range 38.7%-45.6%).Conclusions. Neuroendoscopic training has some specific requirements. A unique set of instruments is required, as is a model that can resemble real-life situations. the S.I.M.O.N.T. is a new alternative model specially designed for this purpose. Validation techniques followed by precision assessments attested to the model's feasibility. (DOI: 10.3171/2011.2.FOCUS10321)