Endoscope in cranial neurosurgery Dr. Jean-Yves Fournier Department of Neurosurgery Cantonal Hospital St Gall, Switzerland 1 Endoscope in cranial neurosurgery 1. Introduction .............................................................................................................. 4 2. History of neuroendoscopy and training simulation in neurosurgery .......................... 5 First endoscopes in the history of medicine .......................................................................................................... 5 Transsphenoidal endoscopic surgery ....................................................................................................................... 6 1 From Sir Victor Horsley to Norman Dott. ............................................................................................................... 6 2 Reintroduction of the transsphenoidal approach initiated by Gérard Guiot ......................................... 7 3 Refinement of the method .............................................................................................................................................. 8 Cerebral endoscopy.......................................................................................................................................................... 9 History of training simulation in neurosurgery and its place today .......................................................... 12 Physical simulators .............................................................................................................................................................15 Virtual reality simulators .................................................................................................................................................17 Neurosurgical training simulation in 2017 .............................................................................................................19 3. Transsphenoidal surgery .......................................................................................... 21 Pituitary surgery ............................................................................................................................................................. 21 Introduction ...........................................................................................................................................................................21 Surgical approach to pituitary adenomas ...............................................................................................................22 Advantages and limitations of the endoscopic technique .................................................................................23 Introduction of the endoscopic technique ................................................................................................................25 Surgical techniques .............................................................................................................................................................25 Own experience .....................................................................................................................................................................34 Other “non-pituitary” lesions of the anterior skull base ................................................................................. 40 Introduction ...........................................................................................................................................................................40 Meningiomas of the anterior skull base ....................................................................................................................41 Own experience .....................................................................................................................................................................44 Repair of CSF leak and anterior skull base reconstruction............................................................................ 54 Confirmation and localization of the CSF leak .......................................................................................................54 Grafting materials ...............................................................................................................................................................55 Endoscopic reconstruction techniques ......................................................................................................................60 Other complications ....................................................................................................................................................... 64 Extracranial or otorhinolaryngological complications .....................................................................................64 Intracranial or neurosurgical complications .........................................................................................................64 Conclusions and observations regarding training issues ............................................................................... 67 4. Cerebral endoscopy ................................................................................................. 69 Obstructive hydrocephalus and endoscopic third ventriculostomy.......................................................... 69 Neuroendoscopes and instruments .............................................................................................................................69 Own experience .....................................................................................................................................................................79 Other indications associated with hydrocephalus or cystic formations .................................................. 86 Complex hydrocephalus ....................................................................................................................................................86 Endoscopic shunt placement ..........................................................................................................................................87 Arachnoid cysts .....................................................................................................................................................................88 Intraventricular tumors ............................................................................................................................................... 88 Colloid cysts ............................................................................................................................................................................92 Own experience .....................................................................................................................................................................95 Para- and intraventricular tumors, intraventricular cysts ........................................................................... 100 Training issues .............................................................................................................................................................. 108 2 5. Difficulties in the introduction of spinal endoscopy as a solitary starter without backup .......................................................................................................................... 110 Own experience: Evaluation of the absence of a backup on the learning curve for fully endoscopic interlaminar discectomy ................................................................................................................... 111 Materials and Methods ................................................................................................................................................... 111 Results .................................................................................................................................................................................... 113 Discussion ............................................................................................................................................................................. 117 Conclusion ............................................................................................................................................................................ 118 6. Teaching / Trainings problems ............................................................................... 119 Changes in surgical training concepts ................................................................................................................. 119 Training transsphenoidal endoscopy .................................................................................................................. 120 Own experience: development of a training model for transsphenoidal endoscopy ...................... 122 Future developments and diffusion of the model .......................................................................................... 131 Conclusions ..................................................................................................................................................................... 134 7. Future technical developments, perspectives ........................................................ 134 Endoscope improvements ........................................................................................................................................ 135 Repair material