The combined use of image-guided frameless stereotaxy and neuroendoscopy for the surgical management of occlusive hydrocephalus and intracranial cysts

The objective of the study was to report the initial experiences with the c ombined use of an infrared-based frameless stereotactic navigation device a nd neuroendoscopy. Ten hydrocephalic patients underwent endoscopic third ve ntriculostomy and two patients with intracranial cysts underwent cystoventr iculostomy. The trajectory of the rigid endoscope and target point were pla nned by frameless stereotaxy. An articulated arm served to maintain the pre determined trajectory during the surgery and to guide the endoscope. Endosc opic surgery was successfully performed in 11 of the 12 patients. In one pa tient with a small third ventricle the ventriculostomy had to be abandoned. We observed no surgical morbidity. In none of the cases was it necessary t o correct the predetermined trajectory of the endoscope to reach the planne d target area. The planning of the trajectory and the target area, as well as the maintenance of the trajectory during endoscopy reduce the risk of in advertent damage to vital structures. The combined use of frameless stereot axy and neuroendoscopy might contribute to a decrease of procedure-related morbidity.