Abstract：
OBJECTIVE: One of the critical steps for the success of intraventricular neuroendoscopic procedures is the entry into the third ventricle and passage of the endoscopy system through the foramen of Monro (FM). A diameter larger than that of the instrument used is considered a prerequisite for safely performing the technique, as damage to this structure can lead to alterations in the fornix and vascular structures. When the foramen diameter is narrow and there is no obstruction/stenosis, the role of foraminoplasty in reducing the risk of complications has not been adequately assessed in the literature.
METHODS: A review of endoscopic procedures conducted at our center since 2018 was undertaken. Cases in which preoperative imaging indicated a FM diameter < 6 mm and foraminoplasty technique was applied were examined to determine the technical and functional success of the procedure. The technical success was determined by completing the neuroendoscopic procedure with the absence of macroscopic lesions in the various structures comprising the foramen and without complications in the follow-up imaging tests. Functional success was defined as the absence of cognitive/memory alterations during the 3-month postoperative follow-up. Additionally, a review of the various forms of foraminoplasty described in the literature is conducted.
RESULTS: In our cohort, six patients were identified with a preoperative FM diameter < 6 mm without obstruction or stenosis. Foraminoplasty was planned for these cases to facilitate various intraventricular neuroendoscopic procedures. In all instances, the technique was successfully performed without causing macroscopic damage to the structures comprising the foramen. Follow-up visits included various cognitive tests to assess potential sequelae related to microscopic damage to the fornix. None of the patients exhibited anomalies.
CONCLUSIONS: Foraminoplasty in patients with a narrow FM without signs of stenosis/obstruction is a useful technique to reduce the risk of complications during the passage of the endoscopy system through this structure, enabling the safe performance of neuroendoscopic procedures.
METHODS: A review of endoscopic procedures conducted at our center since 2018 was undertaken. Cases in which preoperative imaging indicated a FM diameter < 6 mm and foraminoplasty technique was applied were examined to determine the technical and functional success of the procedure. The technical success was determined by completing the neuroendoscopic procedure with the absence of macroscopic lesions in the various structures comprising the foramen and without complications in the follow-up imaging tests. Functional success was defined as the absence of cognitive/memory alterations during the 3-month postoperative follow-up. Additionally, a review of the various forms of foraminoplasty described in the literature is conducted.
RESULTS: In our cohort, six patients were identified with a preoperative FM diameter < 6 mm without obstruction or stenosis. Foraminoplasty was planned for these cases to facilitate various intraventricular neuroendoscopic procedures. In all instances, the technique was successfully performed without causing macroscopic damage to the structures comprising the foramen. Follow-up visits included various cognitive tests to assess potential sequelae related to microscopic damage to the fornix. None of the patients exhibited anomalies.
CONCLUSIONS: Foraminoplasty in patients with a narrow FM without signs of stenosis/obstruction is a useful technique to reduce the risk of complications during the passage of the endoscopy system through this structure, enabling the safe performance of neuroendoscopic procedures.
摘要：
目的：脑室内神经内窥镜手术成功的关键步骤之一是进入第三脑室并使内窥镜系统通过门罗孔（FM）。直径大于所用仪器的直径被认为是安全执行该技术的先决条件。因为这种结构的损伤会导致穹窿和血管结构的改变。当孔直径狭窄且没有阻塞/狭窄时，文献中尚未充分评估椎间孔成形术在降低并发症风险方面的作用.
方法：回顾了自2018年以来在我们中心进行的内镜手术。对术前成像显示FM直径<6mm并应用椎间孔成形术技术的情况进行了检查，以确定该手术的技术和功能成功。技术上的成功是通过完成神经内镜手术来确定的，在包括孔的各种结构中没有宏观病变，并且在后续影像学检查中没有并发症。功能成功被定义为在术后3个月随访期间没有认知/记忆改变。此外,对文献中描述的各种形式的椎间孔成形术进行了综述。
结果：在我们的队列中，6例患者术前FM直径<6mm,无梗阻或狭窄.计划对这些病例进行椎间孔成形术，以促进各种脑室内神经内窥镜手术。在所有情况下,该技术成功实施，没有对包含孔的结构造成宏观损伤。随访包括各种认知测试，以评估与穹窿微观损伤相关的潜在后遗症。没有患者表现出异常。
结论：狭窄FM患者无狭窄/阻塞迹象的椎间孔成形术是一种有用的技术，可降低内窥镜系统通过该结构期间并发症的风险，使神经内窥镜程序的安全性能。
方法：回顾了自2018年以来在我们中心进行的内镜手术。对术前成像显示FM直径<6mm并应用椎间孔成形术技术的情况进行了检查，以确定该手术的技术和功能成功。技术上的成功是通过完成神经内镜手术来确定的，在包括孔的各种结构中没有宏观病变，并且在后续影像学检查中没有并发症。功能成功被定义为在术后3个月随访期间没有认知/记忆改变。此外,对文献中描述的各种形式的椎间孔成形术进行了综述。
结果：在我们的队列中，6例患者术前FM直径<6mm,无梗阻或狭窄.计划对这些病例进行椎间孔成形术，以促进各种脑室内神经内窥镜手术。在所有情况下,该技术成功实施，没有对包含孔的结构造成宏观损伤。随访包括各种认知测试，以评估与穹窿微观损伤相关的潜在后遗症。没有患者表现出异常。
结论：狭窄FM患者无狭窄/阻塞迹象的椎间孔成形术是一种有用的技术，可降低内窥镜系统通过该结构期间并发症的风险，使神经内窥镜程序的安全性能。
