|Practical aspects in neuroendoscopic techniques and complication avoidance: A systematic review.|
|Yad Ram Yadav1, Jitin Bajaj1, Vijay Parihar1, Shailendra Ratre1, Anurag Pateriya1|
|1NSCB Medical College Jabalpur MP India, Neurosurgery, Jabalpur,
Although endoscopic techniques have many advantages including improved visualizations and magnification., these are also associated with limitations. Objective of this study is to discuss practical aspects that can reduce complications after endoscopic procedures, and their management. Review is based on personal experience of more than 2000 neuroendoscopic procedures performed by the senior author. Topic search was made on PubMed using Neuroendoscopy, complications and neuroendoscopy, complication avoidance and neuroendoscopy, endoscopic neurosurgery, and minimally invasive neurosurgery. Relevant articles were selected after analyzing abstracts and or topics. Endoscopic procedures are also associated with limitations such as obstruction in instruments manipulation, steep learning curve, blind area, difficulty in visualization, disorientation, loss of stereoscopic image and others. Neuroendoscopy is distinct from micro‐surgery and the surgeon has to learn endoscopic skill in addition to microsurgical techniques. Difficulties in controlling bleeding, working in limited area, higher complication rate during initial learning curve and longer operative time are some of limitations. Attending live workshops, practice on models, and hands on cadaveric workshops can reduce learning curve. Proper case selection, multidisciplinary team approach, watching operative video, visiting other departments, observing skillful endoscopic surgeon, Lab training, and simulators can improve results and shorten learning curve. Limitations of this review is that the search is limited to English literature and personal experience of a single surgeon which may have some bias. Conclusion: Although neuroendoscopy techniques are associated with improved results in some indications, it has many limitations. Neuroendoscopic skills need to be learnt to improve results.
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