Efficacy and Safety of Endoscopic Transventricular Lamina Terminalis Fenestration for Hydrocephalus

Abstract BACKGROUND: Endoscopic third ventriculostomy (ETV) has become the procedure of choice in the treatment of obstructive hydrocephalus. In certain cases, standard ETV might not be technically possible or may engender significant risk. OBJECTIVE: To present an alternative through the lamina terminalis (LT) by a transventricular, transforaminal approach with flexible neuroendoscopy and to discuss the indications, technique, neuroendoscopic findings, and outcomes. METHODS: Between 1994 and 2010, all patients who underwent endoscopic LT fenestration as an alternative to ETV were analyzed and prospectively followed up. The decision to perform an LT fenestration was made intraoperatively. RESULTS: Twenty-five patients, ranging in age from 7 months to 76 years (mean, 28.1 years), underwent endoscopic LT fenestration. Patients had obstructive hydrocephalus secondary to neurocysticercosis (11 patients), neoplasms (6 patients), congenital aqueductal stenosis (3 patients), and other (5 patients). Thirteen patients (52%) had had at least 1 ventriculoperitoneal shunt that malfunctioned; 6 patients (24%) had undergone a previous endoscopic procedure. Intraoperative findings that led to an LT fenestration were the following: ETV not feasible to perform, basal subarachnoid space not sufficient, or adhesions in the third ventricle. No perioperative complications occurred. The mean follow-up period was 63.76 months. Overall, 19 patients (76%) had resolutions of symptoms, had no evidence of ventriculomegaly, and did not require another procedure. Six (24%) required a ventriculoperitoneal shunt. CONCLUSION: Endoscopic transventricular transforaminal LT fenestration with flexible neuroendoscopy is feasible with a low incidence of complications. It is a good alternative to standard ETV. Adequate intraoperative assessment of ETV success is necessary to identify patients who will benefit.

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Interhemispheric Transcallosal Transforaminal Approach and Microscopic Third Ventriculostomy for Intraventricular Craniopharyngioma Associated with Asymmetric Hydrocephalus: Case Report and Literature Review

Folia Medica ◽

10.2478/folmed-2018-0049 ◽

2019 ◽

Vol 61 (1) ◽

pp. 143-147

Author(s):

Ivo Kehayov ◽

Vladimir Nakov ◽

Borislav Kitov ◽

Hristo Zhelyazkov ◽

Toma Spiriev

Keyword(s):

Literature Review ◽

Obstructive Hydrocephalus ◽

Third Ventricle ◽

Visual Field Loss ◽

Anterior Communicating Artery ◽

Third Ventriculostomy ◽

Transforaminal Approach ◽

The Right ◽

Total Tumor Removal ◽

Selection Of

Abstract We report on a case of a solid adamantinomatous variant of craniopharyngioma located entirely within the third ventricle causing asymmetric obstructive hydrocephalus in a 43-year-old male patient. The patient complaints included intermittent severe headache and progressive bilateral visual field loss. Initially, the lesion was accessed via the bifrontal interhemispheric translamina terminalis approach but total removal was not possible due to short anterior communicating artery which limited the exposure. In the second stage, we used the right interhemispheric transcallosal transforaminal approach and achieved total tumor removal followed by microscopic third ventriculostomy. The present article discusses the selection of appropriate surgical approach based on concise literature review that provides favorable surgical management of these rare lesions.

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Spontaneous third ventriculostomy: definition by endoscopy and cerebrospinal fluid dynamics

Journal of Neurosurgery ◽

10.3171/2008.5.jns08286 ◽

2009 ◽

Vol 111 (3) ◽

pp. 628-631 ◽

Cited By ~ 6

Author(s):

Amit Parmar ◽

Kristian Aquilina ◽

Michael R. Carter

Keyword(s):

Fluid Dynamics ◽

Cerebrospinal Fluid ◽

Obstructive Hydrocephalus ◽

Third Ventricle ◽

Aqueductal Stenosis ◽

Third Ventriculostomy ◽

Chronic Obstructive ◽

Cerebrospinal Fluid Dynamics ◽

The Third ◽

And Function

Chronic obstructive hydrocephalus is known to cause ventricular diverticula and, rarely, spontaneous ventriculostomy. The authors present the case of a patient in whom a spontaneous third ventriculostomy was identified with long-standing hydrocephalus secondary to aqueductal stenosis. To their knowledge, this is the first report in which a spontaneous stoma in the floor of the third ventricle was evaluated using endoscopy and cerebrospinal fluid dynamics studies. Both studies confirmed that the spontaneous stoma is similar in structure and function to surgical third ventriculostomy.

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Endoscopic Third Ventriculostomy in Infants Less than One Year of Age: A Short Series of 14 Cases

Pediatric Neurosurgery ◽

10.1159/000513359 ◽

2021 ◽

Vol 56 (2) ◽

pp. 105-109

Author(s):

Sarita Chowdhary ◽

Shyamendra Pratap Sharma ◽

Pranaya Panigrahi ◽

Manoj Kumar Yadav ◽

Shiv Prasad Sharma

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Aqueductal Stenosis ◽

Csf Shunt ◽

Third Ventriculostomy ◽

Occipital Encephalocele ◽

Shunt Implantation ◽

Permanent Morbidity ◽

One Year

Background: Endoscopic third ventriculostomy (ETV) is currently considered as an alternative to cerebrospinal fluid (CSF) shunt systems in the treatment of obstructive hydrocephalus. This procedure allows the CSF to drain in the basal cisterns and reabsorbed by arachnoid granulations, and avoiding implantation of exogenous material. Aims and Objectives: The purpose of this study was to assess the success rate of ETV in infants less than 1 year of age with congenital noncommunicating hydrocephalus. Material and Methods: This study was a 2-year prospective study from August 2017 to July 2019. ETVs were performed in 14 patients younger than 1 year with diagnosis of noncommunicating hydrocephalous. A failure was defined as the need for shunt implantation after ETV. Phase-contrast MRI of the brain was done after 6 months to see patency of ETV fenestration and CSF flow through ventriculostomy. Results: ETV was tried in 18 patients and successfully performed in 14 patients. Out of the 14 patients, shunt implantation after ETV was performed in 3 patients (failed ETV). In the successful cases, etiology was idiopathic aqueductal stenosis in 8, shunt complications in 2, and 1 case was a follow-up case of occipital encephalocele; the mean age was 7.7 months (range 3–12). In the 3 failed cases, etiology was aqueductal stenosis, mean age was 7.6 months (range 3–11). In all ETVs, failed patients MPVP shunting was done. Follow-up of nonshunted patients was done from 6 to 24 months (mean 15 months). There was no mortality or permanent morbidity noted following ETV. Conclusion: ETV is a good surgical procedure for less than 1-year-old children.

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Ventriculoperitoneal Shunt versus Endoscopic Third Ventriculostomy in the treatment of Obstructive Hydrocephalus in Pediatric Midline Posterior Fossa tumors

QJM ◽

10.1093/qjmed/hcab108.011 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohammed Tarek ◽

Hamdy Ibrahim ◽

H Jalalod'din ◽

SR Tawadros

Keyword(s):

Posterior Fossa ◽

Ventriculoperitoneal Shunt ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Clinical Findings ◽

Third Ventriculostomy ◽

Posterior Fossa Tumors ◽

Shunt Insertion ◽

Vp Shunt ◽

Csf Diversion

Abstract Background Treatment of secondary hydrocephalus due to posterior fossa tumors in these children is still a matter of controversy, although preoperative ventriculo-peritoneal shunt (VP shunt) insertion before tumor excision is widely accepted among neurosurgeons but many attempts are rising to minimize permanent VP shunt insertion and associated complications and introducing third endoscopic ventriculostomy (ETV) as one of the options of 2ry hydrocephalus. Objectives Comparing the post-operative clinical success with resolution of the manifestations and post-operative complications between endoscopic third ventriculostomy and ventriculoperitoneal shunt as different modes of CSF diversion in children with 2ry hydrocephalus due to midline posterior fossa tumors. Methods The following electronic databases were searched from June 2009 to june2019: PubMed, Google scholar search engine. Cochrane database of systematic reviews, EMBASE and science Direct, using the keywords ―hydrocephalus; posterior fossa tumors; pediatrics; ventriculoperitoneal shunt; endoscopic third ventriculostomy‖. Studies were eligible if they contain the target keywords in title or abstract, addressing the Pediatric age group with 2ry hydrocephalus due to de novo posterior fossa tumor manifested by signs of increase the intra cranial tension including persistent headache and vomiting, blurred vision, 6th nerve palsy, papilledema in fundus examination, acute DCL and 2ry hydrocephalus confirmed by brain imaging. Exclusion criteria included studies including age group below 1yr or above 18 yr, or patients with recurrent post fossa tumors and operated before or patients presented by failed previously attempt of CSF diversion. Results: A total of 1255 citations were screened for eligibility,6 studies were included in our systematic review discussing, comparing and evaluating the durability of ETV versus VP shunt in treatment the 2ry hydrocephalusdue to pediatric posterior fossa tumor.. Overall study population reached 474 patients. the overall clinical findings at presentation and postoperative outcomes regarding the clinical findings improvement, radiological improvement and postoperative complications between ETV and VP shunt are compared and showing that ETV should be considered as an alternative procedure to VP shunt in controlling severe hydrocephalus related to posterior fossa tumors to relieve symptoms quickly during the preoperative period when patients should wait for their definite tumor excision. Conclusion The shorter duration of surgery, the lower incidence of morbidity, the absence of mortality, the lower incidence of procedure failure of endoscopic third ventriculostomy as compared to ventriculoperitoneal shunt, and the significant advantage of not becoming shunt dependent make endoscopic third ventriculostomy to be recommended as the first choice in the treatment of pediatric patients with marked obstructive hydrocephalus due to posterior fossa tumors. It is a preliminary, simple, safe, effective, physiological, minimally invasive procedure for the relief of elevated intracranial pressure before direct tumor removal.

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Stereotactic third ventriculostomy in patients with nontumoral adolescent/adult onset aqueductal stenosis and symptomatic hydrocephalus

Journal of Neurosurgery ◽

10.3171/jns.1991.75.6.0865 ◽

1991 ◽

Vol 75 (6) ◽

pp. 865-873 ◽

Cited By ~ 120

Author(s):

Patrick J. Kelly

Keyword(s):

Obstructive Hydrocephalus ◽

Aqueductal Stenosis ◽

Primary Treatment ◽

Target Point ◽

Third Ventriculostomy ◽

Computer Assisted ◽

Adult Onset ◽

Absorption Mechanism ◽

Content Type ◽

Cerebrospinal Fluid Absorption

✓ Sixteen consecutive patients with obstructive hydrocephalus due to nontumoral aqueductal stenosis of adolescent or adult onset underwent computerized tomography-guided stereotactic third ventriculostomy. Computer-assisted angiographic target-point cross-registration was used in surgical planning to reduce morbidity. The procedure was used as primary treatment in five previously unshunted patients and in 11 patients who had previously received shunts and who presented when their shunts became obstructed (five patients), became infected (five patients), or required multiple revisions (one patient). At the time of third ventriculostomy, shunt hardware was removed in patients with infected shunts and the distal element of the shunt was ligated in all patients with obstructed shunts except one, who later required repeat third ventriculostomy; the distal shunt was ligated at that time. Follow-up data (range 1 to 5 years, mean 3½ years, after surgery) showed that only one of the 16 patients had undergone a shunting procedure after the third ventriculostomy. The other 15 patients are asymptomatic and shunt-independent. In previously shunt-dependent patients, the peripheral subarachnoid space and cerebrospinal fluid absorption mechanism remained patent in spite of shunts placed earlier. Therefore, in patients with obstructive hydrocephalus due to aqueductal stenosis of adolescent or adult onset, stereotactic third ventriculostomy should be seriously considered as primary surgical management in previously unshunted patients and in shunt-dependent patients with obstructed or infected shunts.

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Endoscopic third ventriculostomy in obstructive hydrocephalus due to giant basilar artery aneurysm

Journal of Neurosurgery ◽

10.3171/2008.7.jns0887 ◽

2009 ◽

Vol 110 (1) ◽

pp. 14-18 ◽

Cited By ~ 19

Author(s):

Joachim M. K. Oertel ◽

Yvonne Mondorf ◽

Michael R. Gaab

Keyword(s):

Basilar Artery ◽

Endoscopic Treatment ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Third Ventricle ◽

Clinical Signs ◽

Artery Aneurysm ◽

Third Ventriculostomy ◽

Upward Displacement ◽

Age Range

Obstructive hydrocephalus due to giant basilar artery (BA) aneurysm is a rare finding, and endoscopic treatment has not been reported. Here the authors present their experience with endoscopic third ventriculostomy (ETV) in obstructive hydrocephalus due to giant BA aneurysm. Between December 2000 and March 2007, 3 patients (2 men and 1 woman; age range 32–80 years) underwent an ETV for the treatment of obstructive hydrocephalus caused by a giant BA aneurysm. All 3 patients presented with cephalgia, nausea, vomiting, and a variable decrease in consciousness. An obstructive hydrocephalus caused by a giant BA aneurysm was found in each case as the underlying pathological entity. Intraoperatively, a narrowing of the third ventricle by upward displacement of the tegmentum was found in all 3 patients. A standard ETV was performed and included an inspection of the prepontine cisterns. The endoscopic treatment was successful in all patients with respect to clinical signs and radiological ventricular enlargement. No complications were observed. In all, the endoscopic ventriculostomy was proven to be a successful treatment option in obstructive hydrocephalus even if it is caused by untreated giant BA aneurysm.

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Hyponatremia following endoscopic third ventriculostomy: a report of 5 cases and analysis of risk factors

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.4.peds1222 ◽

2012 ◽

Vol 10 (1) ◽

pp. 39-43 ◽

Cited By ~ 5

Author(s):

Shih-Shan Lang ◽

Joel A. Bauman ◽

Michael W. Aversano ◽

Matthew R. Sanborn ◽

Arastoo Vossough ◽

...

Keyword(s):

Risk Factors ◽

Endoscopic Third Ventriculostomy ◽

Third Ventricle ◽

Aqueductal Stenosis ◽

Third Ventriculostomy ◽

Fogarty Catheter ◽

Mr Images ◽

Saline Irrigation ◽

Pituitary Dysfunction ◽

Tectal Glioma

Object Electrolyte and endocrinological complications of endoscopic third ventriculostomy (ETV) are infrequent but serious events, likely due to transient hypothalamic-pituitary dysfunction. While the incidence of diabetes insipidus is relatively well known, hyponatremia is not often reported. The authors report on a series of 5 patients with post-ETV hyponatremia. Methods The records of patients undergoing ETV between 2008 and 2010 were reviewed. All ETVs were performed with a rigid neuroendoscope via a frontal bur hole, standard third ventricle floor blunt perforation, Fogarty catheter dilation, and intermittent normal saline irrigation. Postoperative MR images were evaluated for endoscope tract injury as well as the trajectory from the bur hole center to the fenestration site. Results Thirty-two patients (20 male and 12 female) underwent ETV. Their median age was 6 years (range 3 weeks–28 years). Hydrocephalus was most commonly due to nontumoral aqueductal stenosis (43%), nontectal tumor (25%), or tectal glioma (13%). Five patients (16%) had multicystic/loculated hydrocephalus. Five patients (16%) developed hyponatremia between 1 and 8 days following ETV, including 2 patients with seizures (1 of whom was still hospitalized at the time of the seizure and 1 of whom was readmitted as a result of the seizure) and 3 patients who were readmitted because of decline in their condition following routine discharge. No hypothalamic injuries were noted on imaging. Univariate risk factors consisted of age of 2 years or less (p = 0.02), presence of cystic lesions (p = 0.02), and ETV trajectory angle 10° or more from perpendicular (p = 0.001). Conclusions Endoscopic third ventriculostomy is a well-tolerated procedure but can result in serious complications. Hyponatremia is rare and may be more likely in younger patients or those with cystic loculations. Patients with altered craniometry may be at particular risk with a rigid endoscopic approach requiring greater manipulation of subforniceal or hypothalamic structures.

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Obstructive hydrocephalus caused by an abnormal vein in the aqueduct

Journal of Neurosurgery ◽

10.3171/jns.1991.75.6.0960 ◽

1991 ◽

Vol 75 (6) ◽

pp. 960-962 ◽

Cited By ~ 10

Author(s):

Akira Watanabe ◽

Ryoji Ishii ◽

Masaki Kamada ◽

Yasuo Suzuki ◽

Kazuhiro Hirano ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Computerized Tomography ◽

Ventriculoperitoneal Shunt ◽

Obstructive Hydrocephalus ◽

Aqueductal Stenosis ◽

Resonance Imaging ◽

Content Type ◽

Fine Print

✓ A case is reported of aqueductal stenosis caused by an abnormal draining vein and demonstrated by computerized tomography and magnetic resonance imaging. Placement of a ventriculoperitoneal shunt relieved the patient's progressive headaches.

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INTRAOPERATIVE DIRECT THIRD VENTRICULOSTOMY AND AQUEDUCTAL STENTING IN DEEP-SEATED MIDLINE BRAIN TUMOR SURGERY

Neurosurgery ◽

10.1227/01.neu.0000338260.05545.84 ◽

2009 ◽

Vol 64 (2) ◽

pp. 256-267 ◽

Cited By ~ 7

Author(s):

David I. Pitskhelauri ◽

Alexander N. Konovalov ◽

Valeri N. Kornienko ◽

Natalia K. Serova ◽

Nikita V. Arutiunov ◽

...

Keyword(s):

Brain Tumors ◽

Obstructive Hydrocephalus ◽

Third Ventricle ◽

Pineal Region ◽

Third Ventriculostomy ◽

Success Rates ◽

Tumor Removal ◽

The Third ◽

Total Tumor Removal ◽

Ventricular Shunting

Abstract OBJECTIVE Surgical resection of deep-seated midline brain tumors does not always resolve obstruction of cerebrospinal fluid pathways, and an additional operation—ventricular shunting—is required. To prevent postoperative obstructive hydrocephalus, we combine tumor removal and internal ventricular shunting in 1 stage. METHODS Between 2000 and 2006, 82 patients with deep-seated midline brain tumors (tumors of the third ventricle, pineal region, thalamus, upper brainstem, and superior half of the fourth ventricle) underwent 84 tumor resections with intraoperative internal ventricular shunting. Two types of intraoperative shunting were performed: direct third ventriculostomy with fenestration of the premammillary membrane of the third ventricle floor and Liliequist's membrane, 53 operations; and aqueductal stenting, 30 operations. In 1 patient, third ventriculostomy and aqueductal stenting were performed simultaneously. RESULTS As most of the tumors had an infiltrative growth pattern, gross total tumor removal was achieved in only 31% of patients in this series. There were no fatal outcomes related to the surgery. Follow-up data were collected in 73 patients (89%) and ranged from 2 to 68 months (median, 16 months). Additional shunting because of inadequate function of stoma or stent was performed in 13 patients at various times after surgery (median, 30 days). The Kaplan-Meier survival analysis demonstrated that at 12 and 24 months the intraoperative direct third ventriculostomy success rates were 67 and 61%, respectively; aqueductal stenting success rates were 93% at both 12 and 24 months. CONCLUSION Intraoperative direct third ventriculostomy and aqueductal stenting under direct visual control were found to be reliable methods of hydrocephalus management in patients with deep-seated midline brain tumors.

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Amenorrhea complicating endoscopic third ventriculostomy in the pediatric age group

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.6.peds1137 ◽

2011 ◽

Vol 8 (3) ◽

pp. 325-328 ◽

Cited By ~ 6

Author(s):

Steven W. Hwang ◽

George Al-Shamy ◽

William E. Whitehead ◽

Daniel J. Curry ◽

Robert Dauser ◽

...

Keyword(s):

Adolescent Girls ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Third Ventricle ◽

Third Ventriculostomy ◽

Endocrine Regulation ◽

Endocrine Dysfunction ◽

Laboratory Findings ◽

Pediatric Age Group ◽

Hypothalamic Pituitary Axis

Endoscopic third ventriculostomy (ETV) is an accepted option in the treatment of obstructive hydrocephalus in children and is considered by many pediatric neurosurgeons to be the treatment of choice in this population. The procedure involves perforation of the floor of the third ventricle, specifically, the tuber cinereum, which is part of the hypothalamic-pituitary axis of cerebral endocrine regulation. Endocrine dysfunction, such as amenorrhea, weight gain, and precocious puberty, which are recognized only months to years after the procedure, may be underreported because patients and physicians may not relate the endocrine sequelae to the ETV. Few detailed reports of endocrinerelated complications following ETV exist to better understand these issues. In this study, the authors add to the literature with case descriptions of and correlative laboratory findings in 2 adolescent girls who underwent ETV for obstructive hydrocephalus and in whom amenorrhea subsequently developed.

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