COMPUTER-ASSISTED ENDOSCOPY FOR NEUROSURGICAL PROCEDURES - TECHNICAL NOTE

OBJECTIVE: As neuroendoscopy technology evolves, the ventriculoscope i s playing a greater role in the diagnosis and treatment of disorders a ffecting the ventricular system. However, even with direct visualizati on, correctly orienting and safely navigating an endoscope may be diff icult with abnormal anatomy, in small ventricles, or when searching fo r small periventricular lesions identified on neuroimaging studies. Th e ability to define the location of the endoscope during such procedur es enhances its effectiveness and safety. INSTRUMENTATION: We report t he successful adaptation of an image-guided stereotactic wand to a rig id neuroendoscope. With computer-assisted neuroendoscopy (CANE), the t ip position and orientation of a rigid ventriculoscope were visualized in real-time on neuroimaging studies that were obtained before surger y. Because computer guidance may also be used with the neuroendoscope obturator during ventricular access, uncertainty in accessing small ve ntricles is minimized. RESULTS: Eleven patients were operated on at Th e Cleveland Clinic Foundation using the CANE system. All patients exce pt one were improved after surgery. Early experience suggests that CAN E is useful for certain endoscopic procedures by aiding in trajectory planning, ventricular navigation, and localizing certain pathological conditions. CONCLUSION: Even with direct visualization, ventriculoscop y in abnormal anatomy may be difficult. Although the CANE system may n ot always be necessary in neuroendoscopy, correlation of the endoscope tip location, with an intraoperative magnetic resonance image via con tinuous computer updates, may enhance the safety, as well as the effic iency, of neuroendoscopy in the future.