Abstract
Background
In intraventricular surgery using a flexible endoscope, the lesion is usually aspirated via the working channel. However, the surgical view during aspiration is extremely poor because the objective lens is located adjacent to the working channel.
Method
To address this issue, we developed a novel surgical procedure using an angiographic catheter. In this procedure, the catheter is inserted into the working channel, and the lesion is aspirated through the catheter. Besides, continuous intraventricular irrigation is performed via the gap between the catheter and the working channel.
Conclusion
This procedure maintains a clear view during surgery and reduces complications.
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Data availability
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Code availability
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References
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Acknowledgements
We would like to thank Editage (www.editage.com) for English language editing.
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Authors and Affiliations
Contributions
Study conception and design: KY. Data collection: KY. Writing the article: KY. Revising the article: all authors.
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Ethical approval
The institutional ethical review board approved the off-label use of angiographic catheters in this report (protocol number 23–05). All procedures employed in the present study were performed in accordance with the ethical standards of Fujita Health University and the 1964 Helsinki Declaration and its later amendments. The patient has consented to the publication of this case report.
Consent to participate
Written informed consent was obtained from the patient for off-label use of the angiographic catheter.
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For Fig. 5, which can be used to identify individuals, consent for publication was obtained from everyone in the photograph.
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The authors declare no competing interests.
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Key points summary
1) A flexible endoscope, which is equipped with a 2.0-mm working channel, is required to perform the surgical procedure described in this paper.
2) A Y-shaped connector for endovascular surgery is connected at the outer end of the working channel.
3) An artificial CSF infusion line is connected to one end of the Y-shaped connector, and an angiographic catheter is inserted through the other end. This mechanism allows continuous intraventricular irrigation through the gap between the working channel and the catheter.
4) The catheter should be 4 Fr so that it can be inserted into the working channel without difficulty, and a catheter with a slightly curved tip, such as the Berenstein type, is recommended.
5) A semi-rigid 17.5-Fr peel-away sheath is inserted into the lateral ventricle. The insertion position depends on the location of the intraventricular lesion.
6) A flexible endoscope is inserted into the lateral ventricle to locate lesions and normal structures.
7) After manipulating the catheter together with an endoscope to bring the catheter tip into contact with the lesion, the lesion is aspirated manually. The catheter tip is carefully observed during aspiration to ensure that the normal structures are not aspirated.
8) The direction of the catheter tip can be easily changed by simply rotating the catheter without manipulating the endoscope.
9) To avoid unexpected injury to normal structures, catheter insertion should be performed when the endoscope tip is positioned within the sheath and not when the endoscope tip is near critical structures.
10) The off-label use of angiographic catheters in endoscopic procedures should be approved in advance by the institutional ethical review board. Informed consent should also be obtained after explaining to the patient that this is an off-label use.
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Yamashiro, K., Higashiguchi, S., Hayakawa, M. et al. How I do it: endoscopic evacuation of intraventricular lesions using a flexible endoscope in combination with an angiographic catheter. Acta Neurochir 166, 44 (2024). https://doi.org/10.1007/s00701-024-05948-9
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DOI: https://doi.org/10.1007/s00701-024-05948-9