title: A new approach for observing cerebral cisterns and ventricles via a percutaneous lumbosacral route by using fine, flexible fiberscopes.
abstract: OBJECTIVE
  To establish a new method for the diagnosis of central nervous system diseases, the authors visualized the cerebral cisterns and ventricles via a percutaneous lumbosacral route by using newly developed fine, flexible fiberscopes.
  
  
  METHODS
  Fine, flexible fiberscopes, 0.9 and 1.4 mm in diameter, were introduced up to the cerebral cisterns and ventricles through a percutaneous lumbosacral route in awake patients with chronic headache and/or neck pain or those undergoing spinal surgery and in whom MR imaging did not disclose any particular abnormalities in the brain. A lumbosacral subarachnoid puncture was made with a modified method of a continuous epidural block.
  
  
  RESULTS
  In 25 of 31 patients tested, the cerebellomedullary and/or pontine/interpeduncular cisterns were easily and safely reached, and the brainstem structures were visualized. Advancement of the fiberscope beyond the spinal level was abandoned in 6 patients with adhesive spinal arachnoiditis, because the fiberscopes encountered resistance seemingly caused by arachnoid adhesions. Further advancement of the fiberscopes up to the fourth and third ventricles was successfully achieved in 2 patients. A number of arachnoid filaments were found in the cerebellomedullary cistern in 4 patients: 2 with chronic spinal arachnoiditis, 1 with a spinal arachnoid cyst, and 1 with posttraumatic pain syndrome. None of the patients reported pain or any major complication except a postspinal headache and light fever, which were encountered in 4 and 1 patient, respectively.
  
  
  CONCLUSIONS
  The approach to the supraspinal structures via the lumbosacral route by using a fine, flexible fiberscope may provide a new, minimally invasive, and safe way to observe the cerebral cisterns and/or brainstem regions.
authors.affiliation: Department of Human Sciences, Ube Frontier University Graduate School, Ube, Yamaguchi, Japan. koki-shimoji@nifty.com
authors.forename: Koki
authors.initials: K
authors.lastname: Shimoji
authors.forename: Mai
authors.initials: M
authors.lastname: Ogura
authors.forename: Sanae
authors.initials: S
authors.lastname: Gamou
authors.forename: Seki
authors.initials: S
authors.lastname: Yunokawa
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Sakamoto
authors.forename: Satoru
authors.initials: S
authors.lastname: Fukuda
authors.forename: Shigeho
authors.initials: S
authors.lastname: Morita
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D001100:Arachnoiditis / Q000473:pathology; D001933:Brain Stem / Q000473:pathology; D002531:Cerebellum / Q000473:pathology; D002552:Cerebral Ventricles / Q000473:pathology*; D002648:Child; D002946:Cisterna Magna / Q000473:pathology*; D019723:Endoscopes; D004868:Equipment Failure; D005260:Female; D020546:Fourth Ventricle / Q000473:pathology; D006261:Headache / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology*; D012680:Sensitivity and Specificity; D013115:Spinal Canal / Q000473:pathology*; D013346:Subarachnoid Space; D020542:Third Ventricle / Q000473:pathology; D055815:Young Adult