The development of a new, ultra-fine, and flexible neuroendoscope for intracranial observation

Abstract

Background: A neuroendoscope is a technical advance that allows surgeons to visualize certain regions of the brain that was previously inaccessible through the use of a surgical microscope. Several neuroendoscope designs have been implemented by other neurosurgeons over the past 5 years. The advantage of a neuroendoscope is the addition of a flexible and narrow tip that allows for safe entry into intracranial structures for clinical observation. However, there are some limitations to this approach. Here, we report the use of a modified angioscope as a newly developed neuroendoscope to be employed in observing intracranial structures.

Methods: We report the use of an angioscope that is 1.8 mm in diameter and has both a thin and flexible tip. In this study, the angioscope was inserted into the lumen of an aspirator tube, and the tip of the device was placed at the intracranial area of intended observation area. Image findings were evaluated using an established in vivo goat brain model.

Results: The angioscope was light in weight and maneuverable and could be reached and observed in the blind spot using a surgical microscope. From the cerebellopontine angle, the lower cranial nerves and trigeminal nerve could be observed, and from the cisterna magna, the floor of the fourth ventricle and the aqueduct could be seen.

Conclusion: The angioscope is a useful instrument to observe intracranial locations safely and effectively even within a limited surgical field. Further modifications will be required to use the angioscope in various craniotomy procedures.

Keywords: Angioscope; Intracranial; Neuroendoscope; Neurosurgery.

Figure 1:

Observations of the angioscope. Panel a depicts an angioscope that has a thin and flexible tip. Panel b depicts the use of the angioscope into the lumen of the aspirator tube allowing for safe observation of the intracranial cavity. The scale bar is 2 mm.

Figure 2:

Observations of an angioscope inserted into the cerebellopontine angle Panel (a) depicts the use of the angioscope to observe the glossopharyngeal (arrow head) and vagus nerves (double arrow heads) in the cerebellopontine angle. Panel (b) indicates the use of the angioscope to observe the trigeminal nerve (arrow) and Meckel’s cavity (double arrows).

Figure 3:

Observations of an angioscope inserted into the cisterna magna Panel (a) depicts the use of the angioscope to observe the floor of the fourth ventricle of the central sulcus (arrow), as well as the cerebral aqueduct (arrow head). Panel (b) indicates the use of the angioscope inserted through the foramen magnum to observe the anterior surface of the spinal cord (double arrow), which could be evaluated up to the C3 vertebrae.