Clinical trial NCT04569201: Endoscopic and Endoscopic-Assisted Microsurgery of Intraventricular Lesions
Official title: Endoscopic and Endoscopic-Assisted Microsurgery of Intraventricular Lesions: Efficacy of Technique and Outcome Assessment
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Endoscopy in Intraventricular Lesions
Lead sponsor: Assiut University
Sponsor class: OTHER
First posted: 2020-09-29
Enrollment: 20
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: PAtients with intraventricular lesions, presented to The Neurosurgery Department, At Assiut University Hospital in Assiut, Egypt

Brief summary: * Assess the efficacy of the endoscope as a single tool or as an adjuvant tool to the microscope in intraventricular procedures.
* Evaluate the limitations of the endoscope in these procedures.
* Review the outcome of endoscopic and/or endoscopic assisted microsurgical intraventricular procedures.
* Achieve a verdict in the long-standing controversy about the most effective, least invasive, and optimal way to resect intraventricular lesions, can the endoscope rival the surgical microscope?

Detailed description: Lesions within the ventricular system present a challenge to neurosurgeons (1). Their deep location and proximity to eloquent neurovascular anatomy complicate surgical approach and resection (2). Microsurgery remains the gold standard for the treatment of intraventricular tumors, but microsurgical approaches are not without limitations (3). With the use of the operative microscope, most lesions of the lateral and third ventricles are accessed by a craniotomy and either a transcortical or interhemispheric transcallosal approach. These approaches are associated with brain retraction that can result in seizures, focal neurologic deficits, and cognitive impairment (1). Also with standard microsurgical techniques, complete resection is sometimes not achieved either because of nonvisualization of hidden parts of the tumor or requirement of significant retraction of the neurovascular structures which is potentially hazardous (4). The addition of the endoscope for resection of intraventricular lesions has been described and represents a minimally invasive approach that limits brain retraction and provides direct lesion visualization (1,5,6). The recent development of endoscopic instrumentation has greatly enhanced microsurgical access to the ventricular system and would allow enhanced microsurgical access, minimize the size of the transcortical corridor, and reduce brain retraction during removal of challenging intraventricular lesions performed with the surgical microscope (7). The application of the endoscope can be used in the treatment of intraventricular lesions as arachnoid cyst with intraventricular extensions, colloid cysts, biopsies and intraventricular brain tumor removal (8). Reestablishment of CSF communication pathways is also possible endoscopically when patients develop obstructive hydrocephalus due to their intraventricular pathology (1). The biggest issues when it comes to a pure endoscopic approach concern the size and extent of the lesion, possibility of complete cure or at least long-term control of the disease, and the presence of remnants that were not completely excised (8) , However, The desire for a less invasive technique and an effective surgical approach to intraventricular pathology has directed the attention of many in the neurosurgical community towards the introduction of the endoscope as an adjuvant to or even a replacement for the microscope in intraventricular surgery (5) and consequently, neuroendoscopy has grown rapidly in the last 25 years as a therapeutic modality in the treatment of intraventricular pathologies (9,10).

Eligibility criteria: Inclusion Criteria:

* Intraventricular arachnoid cysts
* Intraventricular colloid cysts
* Intraventricular tumors.

Exclusion Criteria:

* Intraventricular lesions extending outside the ventricle (exception to arachnoid cysts)
* Patients who are unfit for any neurosurgical interventions.

Primary outcomes:
measure: Early Clinical outcome using Glasgow Outcome Scale
timeFrame: Early outcome: 24 hours post-operatively.
measure: Early Clinical outcome using Modified Rankin Scale
timeFrame: Within 6 weeks after surgery.
measure: Late outcome assessment
timeFrame: within 6 months after surgery
Secondary outcomes:
Other outcomes:
Locations:
Study officials:
References:
citation: Nduom EK, Sribnick EA, Ormond DR, Hadjipanayis CG. Neuroendoscopic Resection of Intraventricular Tumors and Cysts through a Working Channel with a Variable Aspiration Tissue Resector: A Feasibility and Safety Study. Minim Invasive Surg. 2013;2013:471805. doi: 10.1155/2013/471805. Epub 2013 Jun 13.
citation: Yasargil MG, Abdulrauf SI. Surgery of intraventricular tumors. Neurosurgery. 2008 Jun;62(6 Suppl 3):1029-40; discussion 1040-1. doi: 10.1227/01.neu.0000333768.12951.9a.
citation: Barber SM, Rangel-Castilla L, Baskin D. Neuroendoscopic resection of intraventricular tumors: a systematic outcomes analysis. Minim Invasive Surg. 2013;2013:898753. doi: 10.1155/2013/898753. Epub 2013 Sep 26.
citation: Singh I, Rohilla S, Kumar P, Krishana G. Combined microsurgical and endoscopic technique for removal of extensive intracranial epidermoids. Surg Neurol Int. 2018 Feb 14;9:36. doi: 10.4103/sni.sni_392_17. eCollection 2018.
citation: Cappabianca P, Cinalli G, Gangemi M, Brunori A, Cavallo LM, de Divitiis E, Decq P, Delitala A, Di Rocco F, Frazee J, Godano U, Grotenhuis A, Longatti P, Mascari C, Nishihara T, Oi S, Rekate H, Schroeder HW, Souweidane MM, Spennato P, Tamburrini G, Teo C, Warf B, Zymberg ST. Application of neuroendoscopy to intraventricular lesions. Neurosurgery. 2008 Feb;62 Suppl 2:575-97; discussion 597-8. doi: 10.1227/01.neu.0000316262.74843.dd.
citation: Souweidane MM, Luther N. Endoscopic resection of solid intraventricular brain tumors. J Neurosurg. 2006 Aug;105(2):271-8. doi: 10.3171/jns.2006.105.2.271.
citation: Harris AE, Hadjipanayis CG, Lunsford LD, Lunsford AK, Kassam AB. Microsurgical removal of intraventricular lesions using endoscopic visualization and stereotactic guidance. Neurosurgery. 2005 Jan;56(1 Suppl):125-32; discussion 125-32. doi: 10.1227/01.neu.0000146227.75138.08.
citation: Brunori A, de Falco R, Delitala A, Schaller K, Schonauer C. Tailoring Endoscopic Approach to Colloid Cysts of the Third Ventricle: A Multicenter Experience. World Neurosurg. 2018 Sep;117:e457-e464. doi: 10.1016/j.wneu.2018.06.051. Epub 2018 Jun 26.
citation: Yadav YR, Parihar V, Sinha M, Jain N. Endoscopic treatment of the suprasellar arachnoid cyst. Neurol India. 2010 Mar-Apr;58(2):280-3. doi: 10.4103/0028-3886.63772.
citation: Romano A, Chibbaro S, Marsella M, Oretti G, Spiriev T, Iaccarino C, Servadei F. Combined endoscopic transsphenoidal-transventricular approach for resection of a giant pituitary macroadenoma. World Neurosurg. 2010 Jul;74(1):161-4. doi: 10.1016/j.wneu.2010.02.024.