Jerry Grant
31 statements · 1 topic · summaries given as host listed separately
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Keep your field wet, I think is important. Keep it moist. You don't wanna pass. I, I've also seen trouble passing a dry, very dry. Endoscope past, for example, some of these perforators where it can stick
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Craniopharyngioma
you can't see behind your scope. I think that's a critical point of any of these kind of endoscopic assist or controlled environments, spatial awareness is critical to really be on top of that
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Craniopharyngioma
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Jerry's statements about Craniopharyngioma 31 statements
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Endoscopic Assist for Pediatric Tumors, Vascular, and Hydrocephalus:...
Statement
Endoscopic-assist uses the endoscope to augment visualization during microscopic craniotomy, whereas endoscopic-controlled uses the endoscope as the sole visualization (e.g., transnasal pituitary).
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Quotation
you really need a rigid endoscope holding arm of some sort. It's not something you wanna be holding in there because it kind of takes your hand out of you.
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A rigid endoscope holding arm is necessary for endoscopic-assist cases to free the surgeon's hands and maintain spatial awareness in the limited craniotomy field.
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Rigid scopes are preferred over flexible scopes in endoscopic-assist settings due to superior optics and lower risk of damage during extraction.
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you can really cause damage and Uh, this is something that we're always worried about is getting in and getting out, I think are the riskiest times for these scopes.
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Statement
Insertion and removal of the endoscope are the riskiest phases; the surgeon must watch the scope under the microscope rather than the endoscopic screen to avoid injury to the frontal lobe, olfactory nerves, optic chiasm, or carotid.
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Quotation
you can't see behind your scope. I think that's a critical point of any of these kind of endoscopic assist or controlled environments, spatial awareness is critical to really be on top of that
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Spatial awareness is critical in endoscopic-assist because the surgeon cannot see behind the scope; structures posterior to the scope tip are invisible.
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I'm, essentially, when I'm putting the scope in, I'm using the microscope. I'm watching that scope go down. I'm not even paying attention to what the endoscopic screen is, is looking at.
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Angled rigid scopes (30° and 70°) allow visualization around corners and beneath structures (e.g., optic chiasm) that would otherwise require retraction or repositioning.
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For sellar/suprasellar craniopharyngiomas, approach selection (transnasal vs. cranial) depends on patient age, sphenoid ossification, nares size, and pituitary function.
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Endoscopic assist from a subfrontal or transciliary approach can reproduce the view obtained transnasally, allowing visualization beneath the optic chiasm and into the third ventricle.
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Direct endoscopic visualization of the hypothalamic-capsule interface during craniopharyngioma resection reduces the risk of hypothalamic injury compared to blind pulling of the capsule.
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we've become more conservative, right over the years of how we handle the hypothalamic portion, these parts that go way up into that third ventricle.
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Over the years, surgeons have become more conservative in managing the hypothalamic portion of craniopharyngiomas that extend into the third ventricle, often leaving capsule behind.
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Grant's series includes approximately 120 transciliary approaches to the anterior cranial fossa.
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The transciliary eyebrow incision with small orbitotomy and zygomatic work provides a low corridor to the anterior cranial fossa, suitable for endoscopic-assist or endoscopic-controlled approaches.
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The transciliary approach allows access to the pituitary stalk for biopsy (e.g., for thickened stalk lesions such as germinoma, Langerhans cell histiocytosis, or lymphocytic hypophysitis) without moving the chiasm or carotid.
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Endoscopic assist provides better illumination and magnification in deep corridors where the microscope's light and optics are limited.
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The 0° endoscope is used initially for illumination and direct visualization, then 30° and 70° scopes are used to look around corners; higher angles require greater spatial awareness.
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Future developments in 3D endoscope technology and augmented reality may improve spatial understanding and optics in endoscopic-assist surgery.
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Grant does not routinely use endoscopic assist for primary shunt placement but uses it routinely for shunt revisions.
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For shunt revisions in slit-ventricle patients, 1mm rigid endoscopes allow the surgeon to follow the old shunt tract, visualize the ventricle, and place a new catheter without dissecting into white matter.
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Endoscopic assist for shunt revision avoids the need for image guidance (e.g., BrainLab, Stealth) by providing direct visualization along the old tract.
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In endoscopic-assist cases, the rigid endoscope is used purely as an optical device, not for instrument passage.
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Grant does not use a sheath for endoscopic-assist cases (open craniotomy) but does use a sheath for endoscopic-controlled intraventricular cases to protect the cortex during insertion and removal.
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you can see sometimes changes in the vasculature as you're right up against these areas, and you put it against your hand, you realize how hot they get.
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Statement
Endoscope tips heat up during use and should not be placed directly against the carotid or other vascular structures to avoid thermal injury.
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Quotation
Keep your field wet, I think is important. Keep it moist. You don't wanna pass. I, I've also seen trouble passing a dry, very dry. Endoscope past, for example, some of these perforators where it can stick
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Statement
The surgical field should be kept moist during endoscope insertion to prevent the scope from sticking to perforators or other structures.
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Summaries Jerry gave as host · 1 summary
Recaps of other experts' statements, not Jerry's own clinical position.
Summaries Jerry gave as host · Craniopharyngioma 1 summary
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Endoscopic Assist for Pediatric Tumors, Vascular, and Hydrocephalus:...
Host summary
Jerry Grant summarizing a resource: Studies suggest a potentially higher infection risk with endoscopic assist for primary shunt placement, though the evidence is not definitive.
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