Preliminary Experience with a New Multidirectional Videoendoscope for Neuroendoscopic Surgical Procedures

Abstract

Purpose: We assessed the applicability of a new multidirectional videoendoscope (digiCAMeleon, Karl Storz GmbH, Tuttlingen, Germany) in various neuroendoscopic procedures.

Methods: A 4-mm-diameter rigid videoendoscope (digiCAMeleon, Karl Storz GmbH, Tuttlingen, Germany) with 1 sensor and an internal LED light source was tested. The device offers a resolution of 1920 x 1080 pixels and weighs ≈ 215 g. The prototype was tested on three cadaveric heads using three different approaches: a) endoscopic endonasal transsphenoidal; b) frontal transcortical intraventricular; c) supraorbital.

Results: We identified several major benefits of the integrated system as applied to endoscopic endonasal, transcortical intraventricular, and endoscopic supraorbital keyhole approaches. These included improved maneuverability of the scope on account of reduced bulk and integration of the camera and fiberoptic light components, a variable angle of view from 0-70 degrees, and a novel feature that can be activated to maintain orientation of the surgical horizon. Our preliminary report highlights the potential for handling the videoendoscope in one hand, as one would a microsurgical instrument. The videoendoscope harbors all its electronic and lighting data into a unique and thin cable, thus resembling a modern "all-in-one" computer technology. Because of its reduced weight and ergonomic shape, controlling its movements is very easy and comfortable, even in the microsurgical environment. Furthermore, the videoendoscope offers the unique feature of orienting the horizon of vision, thanks to the possibility of offering angled views while working; this helps the surgeons to stay oriented with direct visualization and improved control of the instruments over a specific area of interest.

Conclusions: The videoendoscope prototype represents an HD-image quality versatile tool in a neurosurgical environment, thanks to its reduced weight and dimensions; in these preliminary simulations, we have identified optimized visibility and maneuverability as major benefits of this novel surgical adjunct.

Fig 1. Image of the digiCAMeleon.

Fig 2. Comparative images of the endoscopic endonasal approach obtained with the HD-camera (a) and the videoendoscope (b).

Exposure of the pituitary gland enclosed between the internal carotid arteries. The videoendoscope grants proper illumination in each part of field, in both high and low light (shadow) areas. PS: planum sphenoidale; sis: superior intercavernous sinus; ICA: internal carotid artery; Pg: pituitary gland; C: clivus.

Fig 3. Endoscopic endonasal extended approach to the clivus; comparative images obtained with HD-camera (a) and the videoendoscope (b).

BA: basilar artery; sca: superior cerebellar artery; III: oculomotor nerve; VA: vertebral artery; VI: abducent nerve.

Fig 4. Frontal transcortical approach to the lateral and third ventricle.

Picture obtained with the aid of the HD-camera (a, c) and the videoendoscope (b, d). FM: foramen of Monro; CP: choroid plexus; SV: septal vein; TSV: thalamo-striate vein; MB: mammilary body; TC: tuber cinereum; *: chiasmatic recess; **: infundibulum.

Fig 5. Supraorbital approach to the opto-chiasmatic region.

HD-camera (a) and videoendoscopic views (b). ON: optic nerve; Ch: chiasm; PS: planum sphenoidale; Lt: lamina terminalis; ICA: internal carotid artery.”