Limited Efficacy of Endoscopic Third Ventriculostomy for Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage

✓ In recent years, endoscopic third ventriculostomy has become a well-established procedure for the treatment of various forms of noncommunicating hydrocephalus. Endoscopic third ventriculostomy is considered to be an easy and safe procedure. Complications have rarely been reported in the literature. The authors present a case in which the patient suffered a fatal subarachnoid hemorrhage (SAH) after endoscopic third ventriculostomy.This 63-year-old man presented with confusion and drowsiness and was admitted in to the hospital in poor general condition. Computerized tomography scanning revealed an obstructive hydrocephalus caused by a tumor located in the cerebellopontine angle. An endoscopic third ventriculostomy was performed with the aid of a Fogarty balloon catheter. Some hours postoperatively, the patient became comatose. Computerized tomography scanning revealed a severe perimesencephalic—peripontine SAH and progressive hydrocephalus. Despite emergency external ventricular drainage, the patient died a few hours later.Although endoscopic third ventriculostomy is considered to be a simple and safe procedure, one should be aware that severe and sometimes fatal complications may occur. To avoid vascular injury, perforation of the floor of the third ventricle should be performed in the midline, halfway between the infundibular recess and the mammillary bodies, just behind the dorsum sellae.

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Fatal subarachnoid hemorrhage after endoscopic third ventriculostomy

Neurosurgical FOCUS ◽

10.3171/foc.1999.6.4.7 ◽

1999 ◽

Vol 6 (4) ◽

pp. E6 ◽

Cited By ~ 6

Author(s):

Henry W. S. Schroeder ◽

Rolf W. Warzok ◽

Jamal A. Assaf ◽

Michael R. Gaab

Keyword(s):

Subarachnoid Hemorrhage ◽

Computerized Tomography ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Third Ventricle ◽

Balloon Catheter ◽

External Ventricular Drainage ◽

Third Ventriculostomy ◽

Safe Procedure ◽

Tomography Scanning

In recent years, endoscopic third ventriculostomy has become a well-established procedure for the treatment of various forms of noncommunicating hydrocephalus. Endoscopic third ventriculostomy is considered to be an easy and safe procedure. Complications have rarely been reported in the literature. The authors present a case in which the patient suffered a fatal subarachnoid hemorrhage (SAH) after endoscopic third ventriculostomy. This 63-year-old man presented with confusion and drowsiness and was admitted in to the hospital in poor general condition. Computerized tomography scanning revealed an obstructive hydrocephalus caused by a tumor located in the cerebellopontine angle. An endoscopic third ventriculostomy was performed with the aid of a Fogarty balloon catheter. Some hours postoperatively, the patient became comatose. Computerized tomography scanning revealed a severe perimesencephalic-peripontine SAH and progressive hydrocephalus. Despite emergency external ventricular drainage, the patient died a few hours later. Although endoscopic third ventriculostomy is considered to be a simple and safe procedure, one should be aware that severe and sometimes fatal complications may occur. To avoid vascular injury, perforation of the floor of the third ventricle should be performed in the midline, halfway between the infundibular recess and the mamillary bodies, just behind the dorsum sellae.

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THIRD VENTRICULOSTOMY THROUGH THE FENESTRATED LAMINA TERMINALIS DURING MICRONEUROSURGICAL CLIPPING OF INTRACRANIAL ANEURYSMS

Neurosurgery ◽

10.1227/01.neu.0000338433.81852.75 ◽

2009 ◽

Vol 64 (3) ◽

pp. 430-435 ◽

Cited By ~ 13

Author(s):

Hanna Lehto ◽

Reza Dashti ◽

Ayşe Karataş ◽

Mika Niemelä ◽

Juha A. Hernesniemi

Keyword(s):

Subarachnoid Hemorrhage ◽

Intracranial Pressure ◽

Intracranial Aneurysms ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Third Ventricle ◽

Senior Author ◽

Third Ventriculostomy ◽

Lamina Terminalis ◽

High Grade ◽

Safe Alternative

Abstract OBJECTIVE Fenestration of the lamina terminalis (LT) is an alternative means of cerebrospinal fluid (CSF) drainage during acute or emergency surgery of ruptured intracranial aneurysms in patients with high-grade subarachnoid hemorrhage. External ventricular drainage allows drainage of CSF and also measurement of intracranial pressure after the surgery. Catheterization of the third ventricle via the fenestrated LT after clipping the aneurysm is an alternative to conventional ventriculostomies. This method has been used by the senior author (JAH) since 2001. The authors describe their experience with this technique, which can be used safely in selected cases of high-grade subarachnoid hemorrhage. METHODS Seventy-eight patients with aneurysmal subarachnoid hemorrhage underwent third ventriculostomy via the LT between March 2001 and December 2005. Clinical and radiological data of these consecutive patients were retrospectively reviewed. RESULTS There were no procedure-related complications. Eight patients (10%) later required a conventional ventriculostomy, 7 because of catheter occlusion and 1 because of catheter displacement. In 7 patients (9%), a positive CSF culture was found. CONCLUSION Ventriculostomy via the fenestrated LT performed during aneurysm surgery is a practical way for later CSF removal and intracranial pressure monitoring. The catheter can be applied via the same craniotomy without the need for an additional intervention. No procedure-related complications were observed in the present series. This technique can be suggested as a safe alternative to a classical ventriculostomy.

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The Pathogenesis of Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage

International Journal of Molecular Sciences ◽

10.3390/ijms22095050 ◽

2021 ◽

Vol 22 (9) ◽

pp. 5050

Author(s):

Lu-Ting Kuo ◽

Abel Po-Hao Huang

Keyword(s):

Subarachnoid Hemorrhage ◽

Molecular Mechanisms ◽

Transforming Growth Factor ◽

Aneurysmal Subarachnoid Hemorrhage ◽

External Ventricular Drain ◽

Endovascular Coiling ◽

Third Ventriculostomy ◽

Chronic Hydrocephalus ◽

Cellular Mechanisms ◽

Surgical Interventions

Hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH) and reportedly contributes to poor neurological outcomes. In this review, we summarize the molecular and cellular mechanisms involved in the pathogenesis of hydrocephalus following aSAH and summarize its treatment strategies. Various mechanisms have been implicated for the development of chronic hydrocephalus following aSAH, including alterations in cerebral spinal fluid (CSF) dynamics, obstruction of the arachnoid granulations by blood products, and adhesions within the ventricular system. Regarding molecular mechanisms that cause chronic hydrocephalus following aSAH, we carried out an extensive review of animal studies and clinical trials about the transforming growth factor-β/SMAD signaling pathway, upregulation of tenascin-C, inflammation-dependent hypersecretion of CSF, systemic inflammatory response syndrome, and immune dysregulation. To identify the ideal treatment strategy, we discuss the predictive factors of shunt-dependent hydrocephalus between surgical clipping and endovascular coiling groups. The efficacy and safety of other surgical interventions including the endoscopic removal of an intraventricular hemorrhage, placement of an external ventricular drain, the use of intraventricular or cisternal fibrinolysis, and an endoscopic third ventriculostomy on shunt dependency following aSAH were also assessed. However, the optimal treatment is still controversial, and it necessitates further investigations. A better understanding of the pathogenesis of acute and chronic hydrocephalus following aSAH would facilitate the development of treatments and improve the outcome.

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Effect of Microscopic Third Ventriculostomy (Lamina Terminalis Fenestration) on Shunt-needed Hydrocephalus in Patients with Aneurysmal Subarachnoid Hemorrhage

Prague Medical Report ◽

10.14712/23362936.2021.2 ◽

2021 ◽

Vol 122 (1) ◽

pp. 14-24

Author(s):

Alireza Tabibkhooei ◽

Maziar Azar ◽

Morteza Taheri ◽

Hossein Ghalaenovi ◽

Arash Fattahi ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Fluid Dynamic ◽

Controlled Trial ◽

External Ventricular Drainage ◽

Third Ventriculostomy ◽

Lamina Terminalis ◽

Shunt Insertion ◽

Cross Sectional ◽

Aneurysm Occlusion

There are reports that in patients with aSAH (aneurysmal subarachnoid hemorrhage), LTF (lamina terminalis fenestration) reduces the rate of shunt-needed hydrocephalus via facilitation of CSF (cerebrospinal fluid) dynamic, diminished leptomeningeal inflammation, and decreased subarachnoid fibrosis. Regarding the conflicting results, this study was conducted to evaluate the effects of LTF on decreased shunt-needed hydrocephalus in patients with aSAH. A cross-sectional retrospective study was carried out to survey all patients with confirmed aSAH operated from March 2011 to September 2016 in an academic vascular center (Rasool Akram Hospital in Tehran, Iran). Of a total of 151 patients, 72 patients were male and 79 were female. The mean age of the participants was 51 years. A transiently CSF diversion (EVD – external ventricular drainage) was performed (the acute hydrocephalus rate) on 21 patients (13.9%). In 36 patients (23.8%), aneurysm occlusion with LTF and in 115 patients (76.2%) only aneurysm occlusion surgery was performed. In hydrocephalus follow-up after surgery, 13 (12%) patients needed shunt insertion (the rate of shunt-needed hydrocephalus). The statistical analysis demonstrated no significant relation between LTF and shunt-needed hydrocephalus. Confirmation of the hypothesis that LTF may decrease the rate of shunt-needed hydrocephalus can significantly decrease morbidity, mortality, and treatment costs of shunting (that is a simple, but a potentially dangerous procedure). So, it is advised to plan and perform an RCT (randomized controlled trial) that can remove the confounding factors, match the groups, and illustrate the exact effect of LTF on shunt-needed hydrocephalus.

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