Možnosti endoskopických technik v neurochirurgii při řešení hydrocefalu – první zkušenosti s využitím laparoskopie

Possibilities of Endoscopic Techniques in Neurosurgery in Solving Hydrocephalus – First Experience with the Use of Laparoscopy

Objective:
The communication deals with the application of endoscopic techniques in the treatment of hydrocephalus. Endoscopy can be used in intracranial introduction of catheter and in placing the distal catheter in abdominal cavity. From the abdominal cavity laparoscopy enables to remove a dislocated distal catheter or to disintegrate the adhesions or pseudocysts. The communication describes our first experience with the used of laparoscopy in surgical treatment of hydrocephalus.

Material and methods:
The group included patients, where clinical findings indicated modified anatomical conditions in abdominal cavity. The patients were purposely examined by standard imaging methods (computed tomography, magnetic resonance and sonography). The laparoscopic operations were performed in general anesthesia with the application of laparoscopic instruments of the 3–5 mm diameter (Olympus). The port for camcorder is localized under the umbilicus and the further working port is localized according to pathological-anatomical conditions under visual control. The intervention is performed by a children surgeon. In the intracranial localization (in arachnoidal cysts, septations, asymmetric chambers or narrow chamber system) a narrow neuroendoscope is introduced from a frontally localized drill hole, which enables a precise control of introduction of the proximal catheter. The intervention is performed by a neurosurgeon.

Results:
In the years 2003–2005 four patients were operated on by laparoscopy. In three cases the dislocated catheter was removed and in the fourth patient the old catheter was replaced by a new distal catheter. The interventions were made without complications and the shunts were functional.

Conclusion:
The first experience indicate that in indicated cases laparoscopy may contribute in a difficult or risky introduction of distal catheter or in solving intra-abdominal complications associated with ventriculo-peritoneal drainage.

Key words:
hydrocephalus, laparoscopy, endoscopy