Endoscopic surgery is a modern minimally invasive approach for the treatment of hydrocephalus and brain cysts. This technique allows pathological conditions to be corrected with minimal tissue trauma, which accelerates recovery and reduces the risk of complications.
Hydrocephalus
Hydrocephalus is a condition characterized by excessive accumulation of cerebrospinal fluid (CSF) within the ventricular system of the brain, leading to increased intracranial pressure.
Indications for endoscopic surgery in hydrocephalus
- Obstructive hydrocephalus. Blockage of CSF pathways (for example, at the level of the cerebral aqueduct of Sylvius).
- Post-infectious or post-traumatic hydrocephalus. Cicatricial changes interfering with normal CSF circulation.
- Associated intracranial cysts causing secondary hydrocephalus.
Brain cysts
Brain cysts are fluid-filled cavities that may compress brain tissue or disrupt normal cerebrospinal fluid circulation.
Indications for surgical treatment of brain cysts
- Symptomatic cysts causing headaches, seizures, visual disturbances, or motor deficits.
- Progressively enlarging cysts.
- Cysts leading to hydrocephalus.
Endoscopic treatment techniques
Endoscopic third ventriculostomy (ETV)
- Purpose: creation of an alternative CSF outflow pathway from the third ventricle to the basal cisterns.
- Indications: treatment of obstructive hydrocephalus as an alternative to shunt implantation.
- Advantages: avoidance of permanent shunt systems and restoration of physiological CSF circulation.
Endoscopic cyst fenestration
- Purpose: creation of an opening in the cyst wall to allow drainage of fluid into the ventricular system or subarachnoid space.
- Indications: treatment of arachnoid cysts, ependymal cysts, and pineal cysts.
- Advantages: relief of brain compression and correction of CSF circulation disturbances.
Endoscopic cyst excision
- Purpose: complete or subtotal removal of the cyst.
- Indications: cysts associated with neurological deficits or recurrent seizures.
Endoscopic shunting
- Purpose: placement of an internal CSF diversion system.
- Indications: cases in which endoscopic third ventriculostomy is not feasible or insufficient.
Surgical procedure
- Anesthesia. The operation is performed under general anesthesia.
- Access. A small burr hole or limited craniotomy (approximately 2β3 cm) is created.
- Endoscopic intervention. Introduction of the endoscope into the ventricular system or cyst cavity, followed by fenestration or creation of a new CSF outflow pathway.
- Intraoperative control. Verification of patency of the newly created pathway or adequacy of cyst decompression.
- Completion. Placement of a temporary drain if required and closure of the skin incision.
Advantages of endoscopic surgery
- Low invasiveness. Minimal incision and reduced blood loss.
- Short recovery period. Faster return to daily activities.
- High precision. Accurate correction of pathology without damage to surrounding healthy tissue.
- Reduced infection risk. Less use of foreign materials such as permanent shunts.
- Cosmetic benefit. Minimal visible postoperative scars.
Rehabilitation after endoscopic surgery
- Early postoperative period. Inpatient observation for 1β3 days with monitoring of CSF dynamics and neurological status.
- Activity restrictions. Avoidance of physical exertion and sudden head movements for 2β4 weeks.
- Follow-up imaging. MRI or CT scans at 1 and 3 months after surgery.
- Rehabilitation measures. Physiotherapy and exercises aimed at improving cognitive and motor functions if residual symptoms are present.
Endoscopic surgery for hydrocephalus and brain cysts in Belarus is a safe and effective treatment option that minimizes surgical risks and promotes rapid recovery. Due to its minimally invasive nature and high precision, this approach has become the preferred method for managing many cerebrospinal fluid circulation disorders and intracranial cystic lesions.
