What is the incidence of intraventricular tumors and cysts in the United States?
of all Central Nervous System Tumors are Intraventricular1
What challenges have been encountered with conventional surgical approaches?
- IV Tumors and Cysts Removed via Transcranial Microsurgery
- Higher morbidity which leads to more frequent complications compared to an endoscopic approach2
- Brain retraction and brain tissue sacrifice2-3
- IV Tumors and Cysts Removed via Ventriculoscope
- Ability to achieve gross total resection4, especially for vascular, large and fibrous lesions.5
- Extreme bleeding and loss of visualization may occur when twisting/pulling attached cyst off ventricular wall (swiveling technique)
- Increased operating times and operative fatigue6
- Inability to harvest all tissue
- ETV and Endoscopic Septal Fenestration Performed with Balloon Catheter
- Risk of premature closure of stoma7 and small stoma size8
- Frayed edges9
How does an intraventicular approach using the Myriad NOVUS overcome these challenges?
Challenges Addressed using Myriad NOVUS with Ventriculoscope vs. Transcranial Microsurgery
Myriad NOVUS offers the following benefits:
- Only automated resection tool that fits down the channel of a ventriculoscope.
- Cutting capability allows surgeons to address more fibrous lesions.
- Automated variable aspiration controlled by the surgeon with direct visualization of suction aperture and tissue being resected.8
- Advancement knob allows surgeon to extend aperture without moving the handpiece and provides user with the ability to safely reach deeper into the cavity.
- Multifunction design of the Myriad NOVUS allows for minimal instrument exchange, facilitating effective tumor resection through minimal access corridors.
- Non-heat generating device allows cannula shaft to be placed on adjacent tissues while in operation without damage to tissue or critical structures.
Challenges Addressed using Myriad NOVUS with Ventriculoscope vs. Ventriculoscope without Myriad NOVUS
- Myriad NOVUS adds automation to ventriculoscope where it wasn’t available before which may enable higher GTR rates.
- Myriad NOVUS is ideal resection tool when using the ventriculoscope due to the side mouth aperture.
- This has shown safety and effectiveness in removing large and fibrous lesions without impeding visualization.5
- Myriad NOVUS offers the following benefits:
- Mechanically resects tissue with clean cuts which does not disturb substrate tissue.
- Safe near adjacent neurovascular structures.9
- Negligible thermal damage.8
- Visualization of resection site with side mouth aperture.
- Protects healthy and eloquent tissue with foot plate which allows only the aperture to be placed in contact with the intended tissue to be removed.
- Ability to dial down the aspiration level on the console to build a comfort level with the Myriad NOVUS’s aspiration capabilities.10
- NFS offers the following benefits:
- Provides controlled irrigation from the warming bath to the surgical site.
- Enables hemostasis management by maintaining a consistent elevated temperature throughout the surgical procedure to aid in coagulation.
- “Another possible mechanism of the hemostatic effect could be that the increase in temperature increases the speed of the clotting cascade.”11
- Refills automatically with fluid after each syringe compression.
- Eliminates the need to constantly exchange syringes.
- Enables better visualization with constant fluid flow.
- Maintains a clear fluid environment at the surgical site and visualization of the target tissue to the aperture of the Myriad NOVUS.
- Myriad NOVUS offers the following benefits:
- Potentially decreased operating time and operative fatigue due to automation.6
- Multifunction design allows for minimal instrument exchange.12
- Can be mechanically attached to the ventriculoscope which improves the ergonomics of the procedure for the surgeon and frees surgeon’s other hand for other tasks.
- 360-degree aperture rotation allows movement of the aperture without the need to rotate the wrist, offering ergonomic control and minimizing fatigue.
- One minute set-up time.
- NFS offers the following benefit:
- Automatically refills eliminating the need to constantly exchange syringes and reduces the introduction of air bubbles to the field.
- Closed-capture system provides real-time, immediate refrigeration for desired thermal conditions.
- Ability to infuse/perfuse tissue creates the desired biological environment, which may aid tissue hydration.
- Heterogeneity of abnormalities can be accounted for due to increased quantity of tissue obtained.
- Enables the ability to capture and annotate tissue with correlation to specific intratumoral location for potential further advancement in personalized medicine.
Challenges Addressed using Myriad NOVUS with Ventriculoscope vs. Balloon Catheter for ETVs and Septal Fenestrations
- Automated variable aspiration controlled by the surgeon with direct visualization of suction aperture.9
- Ability to dial down the aspiration level on the console to build a comfort level with the Myriad NOVUS.10
- Myriad NOVUS mechanically resects tissue with clean cuts which does not disturb substrate tissue.
- Once surgeon removes his foot from foot pedal, the aspiration stops immediately and Myriad NOVUS remains in open mouth position.
Patients have larger ETV defect size (28.21mm vs 11.25mm) on follow-up when NICO Myriad was used5
Dlouhy BJ, Dahdaleh NS, Greenlee JDW. Emerging technology in intracranial neuroendoscopy: application of the NICO Myriad NOVUS. Neurosurg Focus. 2011; 30(4):E6. https://thejns.org/focus/view/journals/neurosurg-focus/30/4/article-pE6.xml
Trelles M, Ahmed AK, Mitchell CH, Josue-Torres I, Rigamonti D, Blitz AM. Natural history of endoscopic third ventriculostomy in adults: serial evaluation with high-resolution CISS. American Journal of Neuro Radiology. 2019; 39(12):2231-2236. https://doi.org/10.3174/ajnr.A5861
Goodwin CR, Sankey EW, Jusue-Torres I, et al. The use of an aspirating/resecting device to reduce stoma closure following endoscopic third ventriculostomy for aqueductal stenosis. Operative Neurosurgery. 2015; 11(4): 512-517. https://doi.org/10.1227/NEU.0000000000000920
- Gaab MR. Colloid Cysts: Endoscopic or Microsurgical Resection? World Neurosurg. 2014; 82, 6:1017-1019. http://dx.doi.org/10.1016/j.wneu.2014.08.016
- Eliyas JK, Glynn R, Kulwin CG, et al. Minimally-invasive trans-sulcal resection of Intra-ventricular and Peri-ventricular lesions through a tubular retractor system: Multi-centric experience and results. World Neurosurgery. 2016; 90: 556-564. http://dx.doi.org/10.1016/j.wneu.2015.12.100
- Sheikh AB, Mendelson ZS, Liu JK. Endoscopic Versus Microsurgical Resection of Colloid Cysts: A Systematic Review and Meta-Analysis of 1278 Patients. World Neurosurg. 2014; 82, 6:1187-1197. http://dx.doi.org/10.1016/j.wneu.2014.06.024
- Mohanty A, Thompson BJ, Patterson J. Initial experience with endoscopic side cutting aspiration system in pure neuroendoscopic excision of large intraventricular tumors. World Neurosurgery. 2013; 80(5): 655 e.15-655 e.21. https://dx.doi.org/10.1016/j.wneu.2012.11.070
- Mohanty A. The current role of endoscopes in intracranial tumor surgery. J Neurosci Rural Practice. 2013; 4(1): 3-5.
- Trelles M, Ahmed AK, Mitchell CH, Josue-Torres I, Rigamonti D, Blitz AM. Natural history of endoscopic third ventriculostomy in adults: serial evaluation with high-resolution CISS. American Journal of Neuro Radiology. 2019; 39(12):2231-2236.
- Goodwin CR, Sankey EW, Jusue-Torres I, et al. The use of an aspirating/resecting device to reduce stoma closure following endoscopic third ventriculostomy for aqueductal stenosis. Operative Neurosurgery. 2015; 11(4): 512-517.
- Dlouhy BJ, Dahdaleh NS, Greenlee JDW. Emerging technology in intracranial neuroendoscopy: application of the NICO Myriad NOVUS. Neurosurg Focus. 2011; 30(4):E6. https://thejns.org/focus/view/journals/neurosurg-focus/30/4/article-pE6.xml
- Nduom EKE, Sribnick EA, Ormond DR, Hadjipanayis CG. Neuroendoscopic resection of intraventricular tumors and cysts through a working channel with a variable aspiration tissue resector: a feasibility and safety study. Minimally Invasive Surgery. 2013; 2013:8 pages. https://dx.doi.org/10.1155/2013/471805
- Stangerup S, Dommerby H, Siim C, et al. New Modification of Hot-Water Irrigation in the Treatment of Posterior Epistaxis. Arch Otolaryngol Head Neck Surg. 1999; 125(6): 686-690. doi:10.1001/archotol.125.6.686
- McLaughlin N, Filho LFSD, Prevedello DM, Kelly DF, Carrau RL, Kassam AB. Side-cutting aspiration device for endoscopic and microscopic tumor removal. J Neurol Surg B. 2013; 73:11-20. https://dx.doi.org/10.1055/s-0032-1304834