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Background The unilateral biportal endoscopic (UBE) technique is a minimally invasive procedure for spinal surgery, while open microscopic discectomy is the most common surgical treatment for ruptured or herniated discs of the lumbar spine. A new endoscopic technique that uses a UBE approach has been applied to conventional arthroscopic systems for the treatment of spinal disease. In this study, we aimed to compare and evaluate the perioperative parameters and clinical outcomes, including recovery from surgery, pain and life quality modification, patient’s satisfaction, and complications, between UBE and open lumbar microdiscectomy (OLM) for single-level discectomy procedures. Methods This study included 141 patients with degenerative disc disease requiring discectomy at a single level from L2–L3 to L5–S1. A total of 60 and 81 patients underwent UBE and OLM, respectively. Analysis was based on comparison of perioperative metrics, operation time (OT); estimated blood loss (EBL); length of hospital stay (HS); clinical outcomes, including assessment using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI); patient satisfaction (the MacNab score); and the incidence of reoperation and complications. Results The study cohort was 56.7% women, and the mean patient age was 50.98 ± 18.23 years. The mean VAS (the back and leg), MacNab score, and ODI improved significantly from the preoperative period to the last follow-up (12.92 ± 3.92) in both groups ( p  < 0.001). One week after operation, the back VAS score in the UBE group showed significantly more improvement than that in the OLM group. However, the 1-week, 3-month, and 12-month VAS (the back and leg), ODI improvement, modified MacNab score, and OT were not significantly different between the two groups. In the UBE group, EBL (34.67 ± 16.92) was smaller and HS (2.77 ± 1.2) was shorter than that of the OLM group (140.05 ± 57.8, 6.37 ± 1.39). However, OT (70.15 ± 22.0) was longer in the UBE group than in the OLM group (60.38 ± 15.5), and the difference was statistically significant. Meanwhile, the differences in the rate of surgical conversion and complications between the two groups were not statistically significant. Conclusions The UBE for single-level discectomy yielded similar clinical outcomes to OLM, including pain control, functional disability, and patient satisfaction, but incurred minimal EBL, HS, and postoperative back pain. Trial registration Not applicable.

Purpose This study evaluated the effect of preoperative carbohydrate fluid intake on gastric volume (GV), blood glucose (BG), reflux aspiration, and postoperative nausea and vomiting (PONV) in patients with sellar tumors undergoing neuroendoscopic transnasal–sphenoidal sinus resection (NTSR). Methods Fifty-eight patients scheduled for elective NTSR were randomly assigned to Group A ( n  = 29), who received 400 mL of 10% glucose solution orally 2 h before anesthesia, or Group B ( n  = 29), who fasted for at least 8 h. Gastric ultrasound was used to measure antral diameters before induction and after surgery, from which GV was estimated. BG levels were recorded at fasting (T1), before induction (T2), and after surgery (T3). The incidence of PONV within 24 h, reflux aspiration, and hospital stay duration were also assessed. Results In Group A, the mean GV decreased significantly from 47.81 ± 2.45 mL before induction to 45.71 ± 2.08 mL after surgery ( p  < 0.05), while no significant change was observed in Group B. Before induction, GV was higher in Group A than in Group B ( p  < 0.05). No patients experienced reflux aspiration in either group. The incidence of PONV was significantly lower in Group A (23.1%, 6/26) than in Group B (65.4%, 17/26; p  < 0.05). BG levels at all time points showed no significant intergroup differences. Conclusions Carbohydrate fluids taken 2 h before anesthesia do not increase GV or aspiration risk but reduce PONV in NTSR patients without affecting BG levels.

Background Spontaneous supratentorial intracerebral hemorrhage is the deadliest form of stroke with mortality rates over 50%. Currently, no sufficiently effective treatment to improve both mortality and functional outcome rates exists. However, it seems that minimally invasive surgery, especially endoscopic surgery, might be beneficial in improving survival and functional outcome rates, yet large confirmatory studies thereof are lacking. The aim of this trial is to compare whether early minimally invasive endoscopic surgery leads to improved functional outcome rates compared to the best medical treatment. Methods This is a prospective, parallel-arm, outcome assessor blinded multicenter trial across Switzerland. Endoscopic surgery will be compared to the best medical treatment in a 1:1 randomization over a total time of 12 months. The primary outcome is defined as improved functional outcome (mRS < 3) after 6 months; secondary outcomes include mortality and morbidity rates as well as patient reported outcomes and the temporal evolution of serum biomarkers for brain damage. Discussion Currently, large, randomized trials assessing the role and potential effect of early endoscopic surgery in intracerebral hemorrhage are lacking. Potential practical and methodological issues faced in this trial are patient enrollment, adherence to the hematoma evacuation technique used, potential patient cross-over, and the adaptive Bayesian statistical design. Nonetheless, this trial would be among the first to research the effects of early minimally invasive endoscopic surgery for SSICH and can provide class I evidence for future treatment options in intracerebral hemorrhage. Trial registration ClinicalTrials.gov NCT05681988. Registered on January 3, 2023.

Background Intraventricular haemorrhage (IVH) is a common and severe complication of preterm birth, affecting nearly 500 neonates annually in the UK. Over 50% of infants with IVH develop post-haemorrhagic ventricular dilatation (PHVD), which is associated with significant long-term neurodevelopmental impairment. Current treatment strategies involve the use of temporary CSF diversion, through options such as ventricular access devices (VADs) or ventricular subgaleal shunts (VSGS). Neuroendoscopic lavage (NEL) is an emerging technique that aims to directly reduce the load of intraventricular blood and its breakdown products, potentially reducing the risk of secondary brain injury. The ENLIVEN-UK trial aims to assess whether the addition of NEL to standard temporising device placement improves neurodevelopmental outcomes at 2 years of corrected age compared to temporising device placement alone. Methods ENLIVEN-UK is a national, multicentre, parallel-group, assessor-blinded, superiority randomised controlled trial (RCT) that aims to enrol 100 preterm infants with severe IVH and PHVD across UK paediatric neurosurgical centres. Infants will be randomised in a 1:1 ratio to receive either standard temporising device placement or NEL in addition to temporising device placement. Randomisation will be performed using a secure online system (Sealed Envelope), with outcome assessors and statisticians blinded to treatment allocation. The primary outcome measure will be cognitive quotient (CQ) at 2 years of corrected age, assessed using the Bayley Scales of Infant and Toddler Development (4th edition, Bayley-IV). Secondary outcomes will include motor and language development, the requirement for permanent CSF diversion with a ventriculoperitoneal (VP) shunt, surgical complications, health-related quality of life (EQ-5D-5L, TAPQOL), and healthcare costs. Discussion This study aims to provide level 1 evidence regarding the efficacy and safety of NEL in preterm infants with IVH and PHVD. If successful, this trial has the potential to change the standard of care and improve long-term neurodevelopmental outcomes in this cohort of patients. Trial registration ISRCTN Trial Registration: ISRCTN14018410.

Abstract BACKGROUND Endoscopic endonasal approaches pose the potential risk of olfactory loss. Loss of olfaction and potentially taste can be permanent and greatly affect patients’ quality of life. Treatments for olfactory loss have had limited success. Omega-3 supplementation may be a therapeutic option with its effect on wound healing and nerve regeneration. OBJECTIVE To evaluate the impact on olfaction in patients treated with omega-3 supplementation following endoscopic skull base tumor resection. METHODS In this multi-institutional, prospective, randomized controlled trial, 110 patients with sellar or parasellar tumors undergoing endoscopic resection were randomized to nasal saline irrigations or nasal saline irrigations plus omega-3 supplementation. The University of Pennsylvania Smell Identification Test (UPSIT) was administered preoperatively and at 6 wk, 3 mo, and 6 mo postoperatively. RESULTS Eighty-seven patients completed all 6 mo of follow-up (41 control arm, 46 omega-3 arm). At 6 wk postoperatively, 25% of patients in both groups experienced a clinically significant loss in olfaction. At 3 and 6 mo, patients receiving omega-3 demonstrated significantly less persistent olfactory loss compared to patients without supplementation (P = .02 and P = .01, respectively). After controlling for multiple confounding variables, omega-3 supplementation was found to be protective against olfactory loss (odds ratio [OR] 0.05, 95% CI 0.003-0.81, P = .03). Tumor functionality was a significant independent predictor for olfactory loss (OR 32.7, 95% CI 1.15-929.5, P = .04). CONCLUSION Omega-3 supplementation appears to be protective for the olfactory system during the healing period in patients who undergo endoscopic resection of sellar and parasellar masses.

Abstract BACKGROUND There are currently no published data directly comparing postoperative seizure incidence following endoscopic third ventriculostomy (ETV), with/without choroid plexus cauterization (CPC), to that for ventriculoperitoneal shunt (VPS) placement. OBJECTIVE To compare postoperative epilepsy incidence for ETV/CPC and VPS in Ugandan infants treated for postinfectious hydrocephalus (PIH). METHODS We performed an exploratory post hoc analysis of a randomized trial comparing VPS and ETV/CPC in 100 infants (<6 mo old) presenting with PIH. Minimum follow-up was 2 yr. Variables associated with and the incidence of postoperative epilepsy were compared (intention-to-treat) using a bivariate analysis. Time to first seizure was compared using the Kaplan–Meier method, and the relative risk for the 2 treatments was determined using Mantel-Haenszel hazard ratios. RESULTS Seizure incidence was not related to age (P = .075), weight (P = .768), sex (P = .151), head circumference (P = .281), time from illness to hydrocephalus onset (P = .973), or hydrocephalus onset to treatment (P = .074). Irritability (P = .027) and vision deficit (P = .04) were preoperative symptoms associated with postoperative seizures. Ten (10%) patients died, and 20 (20%) developed seizures over the follow-up period. Overall seizure incidence was 9.4 per 100 person-years (9.4 and 9.5 for ETV/CPC and VPS, respectively; P = .483), with no significant difference in seizure risk between groups (hazard ratio, 1.02; 95% CI: 0.42, 2.45; P = .966). Mean time to seizure onset was 8.5 mo for ETV/CPC and 11.2 mo for VPS (P = .464). As-treated, per-protocol, and attributable-intervention analyses yielded similar results. CONCLUSION Postoperative seizure incidence following treatment of PIH was 20% within 2 yr, regardless of treatment modality. Graphical Abstract Graphical Abstract

Background Chronic subdural hematoma (CSDH), a highly prevalent neurosurgical condition predominantly affecting the elderly, demonstrates an incidence of 58.1/100,000 person-years in individuals ≥ 65 years, escalating to 127/100,000 among octogenarians. Driven by global demographic aging and anticoagulant utilization, its population-level incidence is projected to reach 17.4/100,000 by 2030. The standard surgical intervention—burr hole craniotomy with intraoperative irrigation and closed subdural drainage implantation—carries a documented recurrence rate of 5–33%, where residual hematoma volume constitutes a well-established independent recurrence predictor. Meta-analysis indicates endoscopically guided drainage may reduce recurrence through optimized hematoma evacuation, though robust clinical validation of its therapeutic benefit remains insufficient. Methods This prospective, multicenter, open-label, randomized controlled trial employing blinded endpoint assessment will enroll 770 participants aged 18–90 years with radiologically verified symptomatic CSDH. Eligible patients will be randomized to receive neuroendoscopy-assisted drainage (intervention cohort) or burr hole craniotomy drainage (control cohort), with the primary endpoint defined as the occurrence of recurrent hematoma necessitating reintervention within 3 postoperative months. Secondary outcomes comprise postoperative hematoma volume, thickness, and midline shift; neurological function evaluated using standardized assessment scales; quality-of-life measures quantified via validated instruments; catheter indwelling time for subdural drainage; total hospitalization length of stay; all-cause mortality; and incidence of procedure-associated complications. Discussion This study aims to validate the efficacy and safety of neuroendoscopy-assisted drainage for reducing recurrence rates and improving clinical outcomes in CSDH patients. Trial registration ClinicalTrials.gov, NCT07144423 . Registered on Aug 27, 2025.

Background and purposePreclinical studies suggest that clot removal may mitigate primary and secondary brain injury following intracerebral hemorrhage (ICH). Although the MISTIE trial did not demonstrate an overall outcome benefit, it did demonstrate outcome benefit from effective reduction of clot burden. Minimally invasive endoscopic ICH evacuation may provide an alternative option for clot evacuation.MethodsPatients presenting to a single healthcare system from December 2015 to October 2018 with supratentorial spontaneous ICH were evaluated for minimally invasive endoscopic evacuation. Inclusion and exclusion criteria were prospectively established by a multidisciplinary group in the healthcare system. The prespecified primary analysis was the proportion of patients with modified Rankin Score (mRS) 0–3 at 6 months.ResultsOne hundred patients met the inclusion and exclusion criteria and underwent minimally invasive endoscopic ICH evacuation. The mean (SD) hematoma size was 49.7 (30.6) mL, the mean (SD) evacuation percentage was 88.2 (20.3)%, and 86% of patients had postoperative residual hematoma ≤15 mL. At 6 months the proportion of patients with an mRS of 0–3 was 46%.ConclusionsThis study suggests that minimally invasive endoscopic ICH evacuation may produce favorable long-term functional outcomes. Further evaluation of this technique in a randomized clinical trial is necessary.

Neurosurgical capabilities vary significantly across Latin American and African countries, with advanced centers having state-of-the-art technology while others struggle with basic procedures. This study aims to assess the current state of endoscopic neurosurgery in Latin American and Portuguese or Spanish-speaking African countries (LAPSSAC), focusing on infrastructure and training needs. A 50-question survey was distributed to neurosurgeons across 19 Latin American countries and six Portuguese- or Spanish-speaking African countries between May 19th and June 20th, 2023. The survey covered institutional types, residency programs, availability of endoscopic equipment, types of procedures performed, and interest in additional training. Data from 202 responses representing 216 hospitals were analyzed using descriptive statistics. Most respondents worked in public institutions (69.42%), with 58.42% having residency programs. Essential equipment for endoscopic procedures was available in 83.17% of hospitals, while 71.29% had the necessary tools for ventricular and 61.39% for skull base endoscopy. Ventricular endoscopy was performed in 89.11% of hospitals, compared to 71.78% for skull base procedures. Significant gaps in equipment and training were identified, especially in African countries. Interest in additional training was high, with 83.33% and 92.41% of respondents expressing a need for training in ventricular and skull base endoscopy, respectively. The findings highlight disparities in neurosurgical capabilities, with many centers lacking essential resources for endoscopic procedures. While most hospitals have some basic tools, there remains a need for investment in education and equipment. The study suggests that enhancing international collaborations and targeted investments could address these gaps and improve neurosurgical care in low-resource settings. Significant disparities in neuroendoscopic training and equipment exist across LAPSSAC. Addressing these disparities through strategic investments and international partnerships is essential to improving neurosurgical outcomes in these regions.

With the development of endoscopic technology, neuroendoscopy utilizes its advantages such as good illumination, close range observation, and flexible degrees of freedom. Neuroendoscopic surgery can achieve advantages such as minimally invasive, high clearance rate, low incidence of complications, good brain tissue protection, and fewer surgery-related injuries. However, minimally invasive endoscopic surgery also has inherent limitations, since its narrow surgical channels are prone to collapse and require special instrument support. By summarizing the literature on the use of endoport technology in previous neuroendoscopic surgeries, and providing a detailed introduction and summary of our team’s newly developed simple variable endoport clinical experience, we analyzed the advantages, disadvantages, and precautions of flexible and variable transparent endport technology. After years of development and refinement, fixed endoport technology has been widely used in neuroendoscopic surgery, but it has certain shortcomings. Our team has developed a variable endoport system using simple and easily accessible materials. Although it has shortcomings in support, it provides good compensation for the flexibility of endport length and diameter, which is of great help for multi-instrument operation and bipolar electrocoagulation hemostasis, making surgical hemostasis more reliable. Meanwhile, the flexible and variable transparent endport system can be completely placed within the bone window, with significantly higher mobility than the hard endport system that cannot be completely placed below the bone window. The flexible and variable transparent endport system material is easy to obtain, manufacture, operate, and has extremely low cost, making it suitable for promotion and use in the vast majority of neurosurgery units, including primary hospitals.