Biportal Endoscopic Management of Third Ventricle Tumors in Patients with Occlusive Hydrocephalus: Technical Note

Abstract BACKGROUND AND IMPORTANCE Cavum septum pellucidum (CSP) and cavum vergae (CV) cysts are common incidental findings on imaging studies. However, they may rarely present with symptoms related to the obstruction of the foramen of Monro by the cyst leaflets. There is no consensus regarding the management of symptomatic CSP and CV cysts. We present an original transcavum interforniceal endoscopic fenestration technique. The step-by-step surgical procedure and two illustrative cases are presented. CLINICAL PRESENTATION A 31-yr-old male and a 24-yr-old woman presented with symptomatic CSP and CV cysts. For both patients, neuronavigation was used to plan the procedure. An endoscope was introduced into the cyst through a right frontal burr-hole. After an examination of the endoscopic anatomy, a communication between the cyst and the third ventricle was performed using an endoscopic forceps. In both cases, directly after the fenestration, cerebrospinal fluid (CSF) passed through the communication, and the collapse of the cyst was appreciated. Symptoms were relieved in both patients, and neuropsychological assessment improved. Postoperative imaging showed a reduction in the cyst bulge, and patent foramen of Monro. CONCLUSION Endoscopic fenestration of CSP and CV cysts to the third ventricle through an interforniceal navigated approach is a feasible and efficient surgical procedure. Theoretical advantages include a single tract through noneloquent brain, a perpendicular trajectory to the membrane for fenestration, and a large CSF space beyond the fenestration point.

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SIMULTANEOUS PERFORMANCE OF ENDOSCOPIC VENTRICULOCISTERNOSTOMY OF THE THIRD VENTRICLE FLOOR, AQUEDUCTOPLASTY, FENESTRATION OF THE SUPRACEREBELLAR CYST IN OCCLUSIVE HYDROCEPHALUS IN A CHILD IN THE FIRST MONTH OF LIFE

PEDIATRIA Journal named after G N SPERANSKY ◽

10.24110/0031-403x-2021-100-5-194-198 ◽

2021 ◽

Vol 100 (5) ◽

pp. 194-198

Author(s):

A.A. Sufianov ◽

◽

R.R. Rustamov ◽

Iu.A. Iakimov ◽

R.A. Sufianov ◽

...

Keyword(s):

High Efficiency ◽

Third Ventricle ◽

Infectious Complications ◽

Microsurgical Anatomy ◽

Neurosurgical Department ◽

Shunt System ◽

The Third ◽

Occlusive Hydrocephalus ◽

Third Ventricle Floor

The article presents a clinical case of the simultaneous execution of endoscopic ventriculocisternostomy of the third ventricle floor (ETV), aqueductoplasty, fenestration of the supracerebellar cyst in occlusive hydrocephalus using a semi-rigid needle neuroendoscope. The authors describe a child who, at the age of 1 month, was admitted to Neurosurgical Department No. 1 of the Federal Center for Neurosurgery of the Ministry of Health of the Russian Federation in Tyumen with a diagnosis of congenital internal occlusive hydrocephalus, subcompensated course. MRI scan of the brain: triventricular occlusive asymmetric hydrocephalus is visualized, adhesions in the upper parts of the aqueduct, supracerebellar arachnoid cyst were visualised. ETV, aqueductoplasty, fenestration of the supracerebellar cyst were performed. There were no postoperative neurological, endocrine and infectious complications. The observation period after surgery is 7 years from today. Conclusion: preoperative MRI analysis of the structures of the third ventricular floor, interventricular and prepontine cisterns is important for understanding endoscopic, microsurgical anatomy and surgical planning. The use of modern improved endoscopic instruments, low-traumatic performance of all stages of the operation allow to restore cerebrospinal fluid circulation and achieve high efficiency in the treatment of occlusive hydrocephalus in the long-term period. This, in turn, relieves patients of the shunt-dependent state, constant correction of the dysfunctions of the shunt system and long-term, and often ineffective, treatment performed by neurologists and pediatricians.

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Microscope-assisted endoscopic interlaminar ligation of spinal arteriovenous fistulas: technical note

Journal of Neurosurgery Spine ◽

10.3171/2015.12.spine15366 ◽

2016 ◽

Vol 25 (3) ◽

pp. 394-397 ◽

Cited By ~ 3

Author(s):

Chen Wang ◽

Chien-Min Chen ◽

Fang Shen ◽

Xiao-Dong Fang ◽

Guang-Yu Ying ◽

...

Keyword(s):

Technical Note ◽

Endoscopic Management ◽

Short Term ◽

Endoscopic Techniques ◽

Arteriovenous Fistulas ◽

Interlaminar Approach ◽

Dural Arteriovenous Fistulas ◽

Spinal Arteriovenous Malformations ◽

Spinal Dural Arteriovenous Fistulas

Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal arteriovenous malformations, and microsurgical ligation is the treatment modality most frequently used for these lesions. Developments in endoscopic techniques have made endoscopy an even less invasive alternative to routine microsurgical approaches in spine surgery, but endoscopic management of SDAVF or other intradural spinal lesions has not been reported to date. The authors describe the use of a microscope-assisted endoscopic interlaminar approach for the ligation of the proximal draining vein of an L-1 SDAVF in a 58-year-old man. A complete cure was confirmed by postoperative angiography. The postoperative course was uneventful, and short-term follow-up showed improvements in the patient's neurological function. The authors conclude that the endoscopic interlaminar approach with microscope assistance is a safe, minimally invasive, innovative technique for the surgical management of SDAVFs in selected patients.

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