Aan dit artikel is enkele uren gewerkt. Opzoeken, vertalen, plaatsen enz. Als u ons wilt ondersteunen dan kan dat via een al of niet anonieme donatie. Elk bedrag is welkom hoe klein ook. Klik hier als u ons wilt helpen kanker-actueel online te houden Wij zijn een ANBI organisatie en dus is uw donatie aftrekbaar voor de belasting.

1 augustus 2012: Bron: Neurosurg Focus. 2011 Apr;30(4):E6.

De Myriad, een neuroendoscopische apparaatje, opereert beter en preciezer bij hersentumoren - intracraniale operaties en kan ook tumorweefsel of cystes weghalen diep uit de hersenen

De NICO Myriad, een apparaatje dat o.a. gebruikt kan worden als operatie techniek bij hersentumoren, de zogeheten neuroendoscopische operatie wordt meer en meer ingezet bij hersentumoren, ook bij intracraniale operaties. De Myriad is een apparaatje kleiner dan de doorsnee van een potlood met binnenin een kleine volledig geautomatiseerde snijmachine - schaar, afzuiging, dissector, en sonde alles in een -  waarbij geen warmte of koude wordt gebruikt zoals bv. bij de nanoknife en cyberknife. De Myriad is specifiek gepatenteerd voor neurochirurgie - operaties van hersentumoren, maar ook voor oogoperaties en operaties dicht bij kwetsbare organen en plaatsen zoals bv bij halsslagaders.  De Myriad is een heel klein apparaarje met alle instrumentarium in een zodat de chirurg niet meer zelf in en uit het geopereerde gebied hoeft tijdens een operatie. Voor een operatie in de hersenen is dat een groot voordeel want elke verkeerde beweging gemaakt tijdens een zogeheten intracraniale operatie kan functieverlies betekenen voor de patiënt. 

De Myriad wordt al in meer dan 80 ziekenhuizen in de VS, Canada en Australië gebruikt. Meer dan 2.000 operaties zijn uitgevoerd op kinderen en volwassenen en een aantal klinische studies zijn gepubliceerd n.a.v. de ervaringen met het gebruik van de Myriad en het voordeel voor de patiënten. Neurochirurgen ervaren verbeterde klinische resultaten met behulp van het apparaat in bepaalde situaties en er kunnen zelfs cysten diep in de hersenen mee worden verwijderd via een zeer kleine ingreep.

 

Dit filmpje laat zien hoe de Myriad werkt. Via deze website kunt u zien hoe een jongetje van 12 jaar oud met een hersentumor geholpen werd met de Myriad. Via de website van de producent  van de Myriad kunt u wellicht informatie verkijgen of de Myriad ook al in Europa wordt gebruikt

Deze studie Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of craniopharyngiomas vergeleek verschillende operatietechnieken en onderaan artikel staat een abstract hiervan. Een andere studie Emerging technology in intracranial neuroendoscopy: application of the NICO Myriad. beschrijft de ervaringen met de Myriad. Het abstract van die studie staat ook hieronder.

Een laatste review met een vergelijking van verschillende operatietechnieken voor hersentumoren is deze: Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of craniopharyngiomas.


The endoscopic endonasal approach is a safe and effective alternative for the treatment of certain craniopharyngiomas

2012 Feb;77(2):329-41. Epub 2011 Nov 1.

Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of craniopharyngiomas.

Source

Department of Neurological Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.

Abstract

OBJECTIVE:

Craniopharyngiomas have traditionally represented a challenge for open transcranial or transsphenoidal microscopic neurosurgery because of their anatomical location and proximity to vital neurovascular structures. The extended endoscopic endonasal transsphenoidal approach has been more recently developed as a potentially surgically aggressive, yet minimal access, alternative. To gain a more comprehensive assessment of the benefits and limitations of the various approaches to resection of craniopharyngiomas, we performed a systematic review of the available published reports after endoscope-assisted endonasal approaches and compared their results with transsphenoidal purely microscope-based or transcranial microscope-based techniques.

METHODS:

We performed a MEDLINE search of the modern literature (1995-2010) to identify open and endoscopic surgical series for pediatric and adult craniopharyngiomas. Comparisons were made for patient and tumor characteristics as well as extent of resection, morbidity, and visual outcome. Statistical analyses of categorical variables were undertaken by the use of χ(2) and Fisher exact tests with post-hoc Bonferroni analysis to compare endoscopic, microsurgical transsphenoidal, and transcranial approaches.

RESULTS:

Eighty eight studies, involving 3470 patients, were included. The endoscopic cohort had a significantly greater rate of gross total resection (66.9% vs. 48.3%; P < 0.003) and improved visual outcome (56.2% vs. 33.1%; P < 0.003) compared with the open cohort. The transsphenoidal cohort had similar outcomes to the endoscopic group. The rate of cerebrospinal fluid leakage was greater in the endoscopic (18.4%) and transsphenoidal (9.0%) than in the transcranial group (2.6%; P < 0.003), but the transcranial group had a greater rate of seizure (8.5%), which did not occur in the endonasal or transsphenoidal groups (P < 0.003).

CONCLUSIONS:

The endoscopic endonasal approach is a safe and effective alternative for the treatment of certain craniopharyngiomas. Larger lesions with more lateral extension may be more suitable for an open approach, and further follow-up is needed to assess the long-term efficacy of this minimal access approach.

Copyright © 2012 Elsevier Inc. All rights reserved.

Comment in

PMID:
22501020
[PubMed - indexed for MEDLINE]

Endocrinological and ophthalmological consequences of an initial endonasal endoscopic approach for resection of craniopharyngiomas.

1Departments of Neurosurgery and 2Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania
Abbreviations used in this paper: DI = diabetes insipidus; GTR = gross-total resection; NTR = near total resection; STR = subtotal resection; VP = ventriculoperitoneal.
Address correspondence to: Peter G. Campbell, M.D., Department of Neurosurgery, 909 Walnut St, 3rd Floor, Philadelphia, Pennsylvania 19107. email: .

Abstract

Object

The expanded endoscopic approach to craniopharyngiomas has recently been described in several small case series. The authors present their experience with this technique and review the available literature.

Methods

Between September 2006 and September 2009, 14 patients underwent a purely endoscopic, endonasal approach for resection of newly diagnosed craniopharyngiomas. These procedures represent index surgeries; no patient had undergone previous tumor resection. A retrospective review of endocrinological and ophthalmological outcomes, extent of resection, and complication prevalence was completed. Additionally, a review of the English literature was performed to evaluate outcomes of similar endoscopic techniques for resection of craniopharyngiomas.

Results

Four patients (28.6%) underwent gross-total resection; near total resection or better was achieved in 9 patients (64.3%). All patients presented with some form of visual field or acuity deficit. Postoperatively, 12 patients (85.7%) experienced visual improvement, with 6 patients (42.9%) having complete visual recovery. One patient experienced worsening of her visual deficit. Visual acuity improved in 8 patients ((57.1%), while visual field defects improved in 11 (78.6%). The pituitary stalk was preserved in all cases. Eight (57.1%) of 14 patients experienced some form of anterior pituitary dysfunction postoperatively. Although 9 patients (64.3%) were documented to have either transient or permanent new diabetes insipidus immediately after surgery, at 1-month follow-up only 1 patient met clinical criteria. Five patients (35.7%) developed CSF leaks that were successfully treated by subsequent endoscopic revision. All CSF leaks occurred early in the series. Two patients (14.2%) were treated for presumed meningitis postoperatively.

Conclusions

The endoscopic endonasal approach is a minimally invasive alternative to open transcranial approaches for select craniopharyngiomas. Similar to previous transcranial series, rates of endocrinopathy and gross-total resection were dependent upon the adherence of the tumor capsule to the hypothalamus, pituitary stalk, and associated vasculature. A review of the literature suggests that the results of the current series are similar to other published series on this topic.

Cited by

  1. Juan C. Fernandez-Miranda, Paul A. Gardner, Carl H. Snyderman, Kenneth O. Devaney, Primož Strojan, Carlos Suárez, Eric M. Genden, Alessandra Rinaldo, Alfio Ferlito, David W. Eisele. (2012) Craniopharyngioma: A pathologic, clinical, and surgical review. Head & Neck 34:7, 1036-1044. Online publication date: 1-Jul-2012.
  2. Lewis Z. Leng, Vijay K. Anand, Theodore H. Schwartz. (2011) Endoscopic management of craniopharyngiomas. Operative Techniques in Otolaryngology-Head and Neck Surgery 22:3, 215-222. Online publication date: 1-Sep-2011.
  3. Lewis Z Leng, Jeffrey P Greenfield, Mark M Souweidane, Vijay K Anand, Theodore H Schwartz. (2011) Endoscopic, endonasal resection of craniopharyngiomas: analysis of outcome including extent of resection, cerebrospinal fluid leak, return to preoperative productivity, and body mass index. Neurosurgery1. Online publication date: 1-Sep-2011.
  4. Aldo C. Stamm, Eduardo Vellutini, Leonardo Balsalobre. (2011) Craniopharyngioma. Otolaryngologic Clinics of North America 44:4, 937-952. Online publication date: 1-Aug-2011.
  5. Bernd M. Hofmann, Christopher Nimsky, Rudolf Fahlbusch. (2011) Benefit of 1.5-T intraoperative MR imaging in the surgical treatment of craniopharyngiomas. Acta Neurochirurgica 153:7, 1377-1390. Online publication date: 1-Jul-2011.
  6. Songtao Qi, Yuntao Lu, Jun Pan, Xi’an Zhang, Hao Long, Jun Fan. (2011) Anatomic relations of the arachnoidea around the pituitary stalk: relevance for surgical removal of craniopharyngiomas. Acta Neurochirurgica 153:4, 785-796. Online publication date: 1-Apr-2011.
  7. James K. Liu, M.D., Lana D. Christiano, M.D., Smruti K. Patel, B.A., and Jean Anderson Eloy, M.D.. (2011) Surgical nuances for removal of retrochiasmatic craniopharyngioma via the endoscopic endonasal extended transsphenoidal transplanum transtuberculum approach. Neurosurgical FOCUS 30:4, E14. Online publication date: 1-Apr-2011. Abstract | Full Text | PDF (613 KB) 
  8. Zhiyuan Xu, Chun-Po Yen, David Schlesinger, Jason Sheehan. (2010) Outcomes of Gamma Knife surgery for craniopharyngiomas. Journal of Neuro-Oncology. Online publication date: 14-Dec-2010.
  9. Peter G. Campbell, M.D., Erin Kenning, B.S., David W. Andrews, M.D., Sanjay Yadla, M.D., Marc Rosen, M.D., and James J. Evans, M.D.. (2010) Outcomes after a purely endoscopic transsphenoidal resection of growth hormone–secreting pituitary adenomas. Neurosurgical FOCUS 29:4, E5. Online publication date: 1-Oct-2010. Abstract | Full Text | PDF (492 KB) 
  10. Edward H. Oldfield, M.D.. (2010) Editorial. Neurosurgical FOCUS 28:4, E8a. Online publication date: 1-Apr-2010. Citation | Full Text | PDF (870 KB) 

Emerging technology in intracranial neuroendoscopy: application of the NICO Myriad

2011 Apr;30(4):E6.

Emerging technology in intracranial neuroendoscopy: application of the NICO Myriad.

Source

Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.

Abstract

Improvement in fiber optics and imaging paved the way for tremendous advancements in neuroendoscopy. These advancements have led to increasingly widespread use of the endoscope in neurosurgical procedures, which in turn incited a technological revolution leading to new approaches, instruments, techniques, and a diverse armamentarium for the treatment of a variety of neurosurgical disorders. Soft-tissue removal is often a rate-limiting aspect to endoscopic procedures, especially when the soft tissue is dense or fibrous. The authors review a series of cases involving patients treated between August 2009 and October 2010 with a new device (the NICO Myriad), a non-heat-generating, oscillating, cutting, and tissue removal instrument that can be used through the working channel of the endoscope as well as in open neurosurgical procedures. They used this device in 14 purely endoscopic intracranial procedures and 1 endoscope-assisted keyhole craniotomy. They report that the device was easy to use and found that tissue resection was more efficient than with other available endoscopic instruments, especially in the resection of fibrotic tissue. There were no observed device-related complications. The authors discuss the technical aspects of using this device in endoscopic resection of pituitary tumors, craniopharyngiomas, and colloid cysts. They also demonstrate its use in hydrocephalus and intraventricular clot removal and discuss its potential use in other neurosurgical disorders.

PMID:
21456933
[PubMed - indexed for MEDLINE]

Plaats een reactie ...

Reageer op "De Myriad, een neuroendoscopische apparaatje opereert beter en preciezer bij hersentumoren en kan ook tumorweefsel weghalen diep uit de hersenen"


Gerelateerde artikelen
 

Gerelateerde artikelen

Veel maagkankerpatienten zijn >> Intra-operatieve fluorescerend >> NeuroBlate - een nieuwe vorm >> Operatieve ingreep bij hersentumoren >> Vroege operatie geeft betere >> De Myriad, een neuroendoscopische >> Wakkere operatie: zie hier >> Operatie bij hersentumoren: >> Operatie van hersentumoren: >> Operatie van hersentumoren: >>