Neuroendoscopy

What is neuroendoscopy? 

Neuroendoscopy is a minimally invasive procedure used by doctors to perform therapeutic or diagnostics procedures in the spine, brain, or peripheral nervous system. These parts may not be reached via traditional surgery.

Neuroendoscopy allows your healthcare team to remove tumors without having to make a large incision in your skull.

Tumors can be removed in one of the following ways, based on their location:

In case of a craniofacial condition or brain tumor, an endoscope is maneuvered via small incisions on top of your head.

In case of diseases affecting the base of your skull, the doctor will maneuver the endoscope via the nose.

When treating spinal disorders, the endoscope is maneuvered through small incisions made in your back.

When performed correctly, neuroendoscopy is less painful and the risk for complications is greatly reduced.

The risk of scarring after a neuroendoscopy procedure is minimal while recovery is faster compared to conventional brain surgery.

Who can have a neuroendoscopy?

If you have the following brain tumors, your doctors will most likely recommend a neuroendoscopy:

• Pituitary tumors – These are abnormal growths in your pituitary gland. They affect the ability of the pituitary gland to secrete hormones

• Skull base tumors – These are the tumors located at the base of your skull. Most skull-based tumors are benign, meaning they cannot spread to other parts of your body. They require treatment to avoid serious damage to the base of your skull.

• Pineal region tumor – The pineal gland is located in the middle of your head. The pineal gland releases the hormone melatonin that controls the sleep-wake cycle

Other tumors treated using neuroendoscopy

• Ventricular tumors

• Cerebrospinal fluid leaks

• Chordomas

• Meningioma

• Bone cancers

• Neck and head tumors

• Nervous system cysts

• Skull and facial bone fractures

Your surgeon may also recommend neuroendoscopy to take tissue samples of cerebrospinal fluid (CSF).

This fluid protects and supports your spinal cord and fluid.

Getting ready for neuroendoscopy 

Your primary care physician will organize consultive meetings with the surgical team before the procedure.

During these sessions, your surgeon will explore the benefits and risk that comes with a neuroendoscopy.

The healthcare team will also assess your overall health to determine if you are fit for this procedure.

If you have any concerns or questions regarding the procedure, make sure you raise them during this meeting.

You will be asked to sign a consent form allowing the surgical team to go ahead with the procedure.

Read through this form carefully and only sign after you have fully understood what it entails.

The surgical team may order one or more of the following diagnostic tests to confirm or rule out specific conditions:

• Biopsy or tissue sampling

• MRI, PET-CT scans, and other imaging tests

• Tests to assess your hearing and vision

• Lumbar puncture

• Neuro-cognitive assessment to determine various brain functions

Before the procedure  

You will most likely get admitted to the healthcare facility the night before neuroendoscopy. 

If you are on any medication, let your doctor know of this. Unless you are taking blood thinning medication, your doctor will ask you to continue taking these as normal. 

Your doctor will order various tests to determine your overall health status before the procedure.

Some tests you could undergo include an electrocardiogram (ECG) and blood work.

Your nurse or doctor will take you through the test you need to undertake. 

You may have to wear stockings to minimize the risk of blood clots. You are likely to be less mobile after neuroendoscopy and stockings promote blood circulation during this period. 

You will need to take a bath or shower on the eve of a neuroendoscopy. The healthcare team may give you a special antiseptic soap for this.

The healthcare team will inform you when to stop drinking or eating.

Since neuroendoscopy is conducted under general anesthesia, you may not eat or drink anything a few hours before the procedure. 

During the procedure  

A neuroendoscopy is performed in an operating theater. The surgical nurse will get you ready for the procedure.

The surgical nurse will help you put on a hospital gown and wheel you to the operating table. 

Your anesthetist puts a cannula through a vein situated in the back of your hand.

The anesthetic medication is administered through this small tube.

The surgeon makes a burr hole into your skull. The endoscope is attached to an eyepiece and monitor that gives your surgeon a clear view of the inside of your brain.  

The surgeon places an endoscope through this hole and carefully guides it into the brain’s fluid chambers. 

The surgeon uses tiny scissors and forceps attached to the end of the endoscope to collect tissue samples.

Once the biopsy has been done, you will be wheeled to the recovery room for several hours. 

After the procedure 

When you wake up after the procedure, you will probably feel drowsy because of the effects of the anesthetic. This should improve with time.

Some patients find it hard to drink or eat anything for some time after neuroendoscopy. 

When you are fully awake, the surgical nurse will wheel you to the ward where the healthcare team will continue to monitor your progress for several hours.

In case you feel uncomfortable after the procedure, your doctor can recommend medication to manage such pain.

Your doctor will allow you to go home after neuroendoscopy when you are ready.

The time you spend in the ward varies as some patients take more time to recover than others. 

It is not safe for you to drive after neuroendoscopy.

Ask your spouse, a member of the family, or a friend to drive you home once you get discharged.

What are the benefits of neuroendoscopy 

Neuroendoscopy is associated with the following benefits:

• Precision – The procedure allows your neurosurgeon to access parts of your brain that cannot be accessed by conventional surgical procedures with a high level of precision

• Less invasive – Since neuroendoscopy involves small incisions on your skull, it is, therefore, a less invasive procedure

• Less pain – Neuroendoscopy is less painful than traditional brain surgery

• Quicker recovery – Patients who have undergone a neuroendoscopy recover more quickly than those who have gone through traditional brain surgery

• The risk of infection is greatly reduced

• The risk for brain trauma is reduced owing to less disruption of the surrounding muscles and tissues

•  A neuroendoscopy procedure leads to a shorter hospital stay

Risks/complications 

A neuroendoscopy is a safe medical procedure. However, like any other medical procedure, there could be several risks involved. They include:

• Infection – You could get an infection on the site of incision. Check out for signs of infection including fever. Your doctor will prescribe antibiotics for such an infection

• Bleeding – You could have bleeding during or after the procedure due to intracranial pressure

• Swelling and bruising – You could get swelling or bruising on the part of the brain where the surgeon makes the burr hole

Bruising or swelling could also happen on the part of your hand where the cannula is inserted.

Your doctor will prescribe steroids before and after the procedure. These drugs assist with managing the swelling.

Neuroendoscopy may also present with the following postoperative complications:

• Delayed awakening – Some patients present with a delayed emergence in neurological consciousness. This could be due to continuous high pressure inside the endoscope or injuries to the brain structures during the procedure

• Electrolyte abnormalities – Neuroendoscopy surgery can lead to various electrolyte imbalances

• Hypothermic disorders may cause diabetes insipidus or unwanted antidiuretic hormone secretion

• Respiratory problems – patients who have undergone neuroendoscopy surgery require close monitoring by the healthcare team as they are highly predisposed to developing sudden respiratory disturbances

• Seizures – Some patients may present with postoperative seizures because of electrolyte disturbances or intraventricular hemorrhage

Other complications associated with neuroendoscopy are:

• Stroke, coma, or seizure

• Brain functions such as coordination, speech, memory, and balance can be impaired permanently or temporarily

• Anesthesia-related complications

Cost of neuroendoscopy in India  

It costs between Rs. 10,00,000 and Rs. 15,00,000 for a neuroendoscopy procedure in India.

The cost is different for different patients depending on:

• The patient’s overall health: If the patient has an underlying health condition, they may require extra medical attention during neuroendoscopy and this is reflected by a higher cost of the procedure

• Hospital charges: The cost of nursing care, room, and extra medical services provided to the patient during their hospital stay will affect the overall cost of neuroendoscopy

• Type of surgery performed: The type of surgery performed will depend on the location and size of tumor

• Surgeon’s fees: Different neurosurgeons may charge different fees to perform neuroendoscopy based on the number of years they have been practicing

• Admission fee: Pre and post-operative care: The medications tests and care provided before and following neuroendoscopy will increase the cost of this procedure

• Medication: Any medication administered during the procedure and over the recovery period will also be included in the overall cost of the procedure

• Diagnostic tests: This includes the cost of tests ordered by your healthcare provider such as CT and MRI scans as part of diagnosing or monitoring the health condition

• Follow-up care and rehabilitation: You may have to pay extra for post-surgery appointments and rehabilitation services

References

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