Application of the ISG Viewing Wand for Endoscopic Procedures

Abstract

The use of intracranial endoscopy for operative procedures is increasing. Navigation within the ventricular system is straightforward, using known anatomical landmarks. Interactive image-guided surgical systems are helpful for defining the trajectory to the ventricular system and for performing endoscopy within cystic cavities where there are no landmarks for orientation. We have used the Viewing Wand system, a passive mechanical arm, with rigid endoscopes for the following applications: (1) defining the trajectory to the frontal horn for endoscopic III ventriculocisternostomy, colloid cyst removal, arachnoid cyst fenestration, or external ventricular drain placement (n = 5); (2) defining the trajectory to the ventricle from the occipital region for ventriculoperitoneal or cyst-peritoneal shunts (n = 4); (3) defining the trajectory to the frontal horn for shunt placement in cases of benign intracranial hypertension (n = 3); (4) fenestration of multiloculated parenchymal cysts occurring post brachytherapy (n = 3); and (5) placement of an Ommaya reservoir into a parenchymal cyst (n = 1). The system requires the use of rigid lens or fiberoptic endoscopes, custom measuring probes, and adapters to connect different endoscopes to the Viewing Wand. The operating room setup, probe adapters for rigid endoscopes with the Viewing Wand, and a single surgeon experience are presented.