Ebook: Neuroendoscopic Surgery

The grow ing body of knowledge and the fast
pace of innovation in neuroendoscopic surgery
com bine to create a thirst for practical inform ation
am ong both new and experienced neurosurgeons.
Neuroendoscopic Surgery will do m uch to slake that
thirst. In this book, highly experienced contributors
from around the world cover the num erous clinical
indications and procedures for treating patients using
neuroendoscopic surgical techniques.
Who better to pull together such a stellar collection
of w ritings on the state of the art than a triad of
neurosurgeons representative of the span of the
prototypical neurosurgeon’s career? They include
my esteem ed contem porary, the renow ned senior
neurosurgeon Jaim e Torres-Corzo of Mexico, w ho is
know n for his work on neurocysticercosis, flexible
neuroendoscopy, and m inim ally invasive surgery. Dr.
Torres-Corzo stands at the apex of his career at the
Autonom ous University of San Luis Potosi Medical
School and as president of the Mexican Society of
Neurological Surgeons. His coeditors include Dr.
Torres-Corzo’s form er student, Dr. Leonardo RangelCastilla, w ho is at the beginning of his career,
follow ing a neurosurgery endovascular fellowship at
the University at Buffalo in New York. His grow ing
clinical training, and already extensive scholarly
output, portend a productive academ ic career. Dr.
Rangel-Castilla com pleted a cerebrovascular and skull
base neurosurgery fellowship w ith us here at Barrow
Neurological Institute (BNI) in Phoenix. While w ith
us, he also studied w ith my BNI colleague and the
third editor of this book, Dr. Peter Nakaji, and indeed,
it is from this association that the inspiration for this
book arose. Dr. Nakaji bridges these two extrem es
of experience of his coauthors, being between them
in seniority, but having already m ade significant
contributions to m inim ally invasive neurosurgery
and neuroendoscopy. These fields have always been
a special interest for him beyond the edges of our
shared field of cerebrovascular surgery and neurooncology. A dedicated educator, Dr. Nakaji serves
as the director of our BNI neurosurgery residency
program , is involved in num erous research studies,
and has a passion for sharing learning that you w ill
find in these pages. These three neurosurgeons
have not only recruited an experienced cadre of
international colleagues to share their expertise on
the topics covered in this collective work but have
also contributed substantively to the text them selves.
Neuroendoscopic Surgery begins w ith a discussion
of the history of this highly skilled surgical art. In
Section I, authors reveal the dram a behind the hitor-m iss attem pts to develop the first endoscopes,
from their hum ble beginnings in the 1850s, to the
increasingly complex neuroendoscopes that enhance
the m inim ally invasive surgical techniques used
today. The w ide-ranging technology now w ithin
arm ’s reach is covered, along w ith a description of the
developm ent of the first flexible neuroendoscope, a
tool that has becom e integral to our work.
Subsequent sections of the text describe the relevant
anatomy, clinical indications, neuroendoscopic and
m icroneurosurgical procedures, and special topics,
such as com plications. The greatest weight is given
to indications and procedures, and readers w ill find
that the num erous chapters on these areas offer
m uch guidance for better m atching patients to the
appropriate procedure.
Section II on intraventricular and basal cistern
anatomy includes chapters that present in great detail
the lateral and third ventricles, the cerebral aqueduct
and fourth ventricle, and the basal cisterns. These
neuroanatom ists bring to bear their considerable
m icroneuroanatomy skills on the explication of
regions of the brain. Their illustrations, cadaver
studies, specim en slices, and intraoperative clinical
im ages, as well as their detailed explanations of them ,
are an excellent review before a surgical procedure.
Of the fourteen chapters in Section III on indications,
six are on hydrocephalus alone and serve as a
comprehensive overview of its variants. The extent of
this coverage emphasizes the importance of this topic.
Other topics in this section include tum ors, colloid
cysts, hypothalam ic ham artom as, pineal region
tum ors, intraventricular hem orrhage, arachnoid cysts,
and ventriculoperitoneal shunt m alfunction.
Section IV on neuroendoscopic procedures, and
Section V on m icroneurosurgical procedures encompass
nine and seven chapters, respectively. The chapters on
neuroendoscopic procedures give in-depth overviews
of procedures for dealing w ith hydrocephalus, such as
the endoscopic third ventriculostomy, or for facilitating
hydrocephalus treatm ent, such as aqueductoplasty,
fenestration, and foram inoplasty.
Perhaps m ost exciting from the standpoint of the
recent technological advances of the past two decades
and as a precursor to future advancem ents is the
discussion of endoscope-assisted m icroneurosurgery
in the exploration and biopsy of the basal cisterns, in
m icrovascular decom pression, intra- and extra-axial
brain tum ors and aneurysm s, and the shift toward
the use of fluorescence for better visualization.
The final section of the book, Section VI, deals
w ith special topics from com plications to anesthesia,
neuroendoscopy in developing countries, and the
future of neuroendoscopy. The last chapter offers a
glim pse of the future yet to com e as it exam ines recent
and im m inent changes in the neurosurgeon’s toolkit,
such as three-dim ensional endoscopy, hyperspectral
im aging, confocal endom icroscopy, and exoscopes.
Accom panying the chapters throughout the book
are num erous intraoperative videos that showcase
the anatomy and the neuroendoscopic approaches
for various surgical procedures. Each chapter also
concludes w ith a sum m ation of key points in the
form of pearls that give a quick review of the m aterial
covered.
From its earliest beginnings w ith endoscopy m ore
than a hundred and fift y years ago, neuroendoscopic
surgery has becom e not only increasingly com plex
but also increasingly m inim alistic. As I and other
neurosurgeons began to realize that reducing
surgical traum a and tissue m anipulation during
procedures conveyed a better prognosis for our
patients, we explored less invasive ways of accessing
the target areas of the brain requiring treatm ent.
Neuroendoscopic surgery now provides an excellent
way to access critical regions of the brain w ith the
least traum a possible. It stands at the vanguard of
treatm ent for brain lesions, and the physicians w ho
practice it are aided by an increasingly sophisticated
arm am entarium that includes rigid-lens endoscopes;
flexible fiberscopes; three-dim ensional, highdefinition endoscopes; and videoendoscopes.
Doubtless, newer innovations, greater technological
breakthroughs, and m ore beneficial clinical outcom es
w ill com e to light even as Neuroendoscopic Surgery
rolls off the press. Such is the very nature of our
work as neurosurgeons—we constantly question the
status quo, seek newer and better ways of perform ing
procedures, and strive through continual learning to
always deliver to our patients the best possible care
for the m ost optim al outcom e