Technique of fontanelle and persutural ventriculoscopy and endoscopic ventricular surgery in infants

The author describes a new type of neurosurgical operating telescope which makes possible the foundation of endoneurosurgery. Illumination through a fibre-optic bundle and image transmission through a series of coated air lenses in glass are based on Hopkins optical systems. The telescope is 2.6 mm in external diameter. The operating sheath introduced around the telescope by means of split obturators which dilate the telescope track, enlarges the external diameter of the instrument to 4.5 mm. Up to four special instruments (electrode, aspirating cannula, accessory light, perfusing cannula, scissors) or a grasping forceps can be introduced through the instrument sheath. The instrument can be introduced, using a sharp trocar, through the fontanelle or lambdoid suture in infants and through a burr hole in children. It has been used for third ventriculoscopy and choroid plexus coagulation. The latter has been carried out successfully through the anterior fontanelle and the lambdoid suture, bilaterally in 2-4 stages. Complications - one meningitis - have been the exception.