gms | German Medical Science

Objective: To describe the experience with a multipurpose ventriculoscopic system.

Method: An endoscopic system has been designed which includes 2 working ventriculoscopes with 6.1 and 3.6 mm diameter and 2 endoscopic sheaths with 6.8 and 4.1 mm outer diameter respectively, and a corresponding trocar. The working length is 14 cm. Each scope contains a rod lens, light fibers, a main working channel (2.9 mm and 1.6 mm), and side channels. Additionally, 3 diagnostic scopes (0°, 30°, and 45°) for inspection and various instruments are available.

Results: To date, 138 procedures including 68 ETV, 22 septostomies, 14 tumor biopsies, 8 aqueductal stentings, 6 ventriculocystostomies, 4 tumor resections, 4 colloid cyst extirpations, 4 aqueductoplasties, 4 cystocisternostomies, 2 foraminoplasties, and 2 ventriculocystocisternostomies have been performed. The age of the patients ranged from 2 days to 81 years. All procedures were successfully completed. No procedure had to be abandoned because of technical problems. However, in three patients, the diameter of the foramen of Monro was too small to allow insertion of the larger scope into the third ventricle. There was no mortality and no permanent morbidity. Transient complications included 3 meningitis, 2 CSF fistula, 1 intraventricular hemorrhage, and 1 salt wasting syndrome after ETV in a 1.5-year-old girl (5 % transient morbidity).

Conclusions: The Lotta ventriculoscopic system is a multipurpose neuroendoscopic system with which all endoscopic intraventricular procedures can be performed in all age groups. The smaller scope is preferentially used for ETV, septostomies, and tumor biopsies. The larger scope is designed for tumor resections, colloid cyst removal, fenestration of arachnoid cysts, and stenting procedures. Because of its diameter, the smaller scope is usually used in premature and mature newborns.