Letter to the editor: Extensive dilatation of third ventricle masking the diagnosis of aqueductal stenosis

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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Efficacy and Safety of Endoscopic Transventricular Lamina Terminalis Fenestration for Hydrocephalus

Neurosurgery ◽

10.1227/neu.0b013e31825b1e8d ◽

2012 ◽

Vol 71 (2) ◽

pp. 464-473 ◽

Cited By ~ 12

Author(s):

Leonardo Rangel-Castilla ◽

Steven W. Hwang ◽

Andrew Jea ◽

Jaime Torres-Corzo

Keyword(s):

Ventriculoperitoneal Shunt ◽

Perioperative Complications ◽

Obstructive Hydrocephalus ◽

Third Ventricle ◽

Significant Risk ◽

Good Alternative ◽

Aqueductal Stenosis ◽

Third Ventriculostomy ◽

Lamina Terminalis ◽

Transforaminal Approach

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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Communicating hydrocephalus as a cause of aqueductal stenosis

Journal of Neurosurgery ◽

10.3171/jns.1979.51.6.0812 ◽

1979 ◽

Vol 51 (6) ◽

pp. 812-818 ◽

Cited By ~ 46

Author(s):

G. Robert Nugent ◽

Ossama Al-Mefty ◽

Sam Chou

Keyword(s):

Clinical Features ◽

Clinical Picture ◽

Third Ventricle ◽

Aqueductal Stenosis ◽

Communicating Hydrocephalus ◽

High Grade ◽

Content Type ◽

Complete Occlusion ◽

The Third ◽

Fine Print

✓ Eleven cases of presumed aqueductal stenosis with onset of symptoms after the first decade were reviewed. Ten patients had complete occlusion and one a high-grade stenosis. In 10, the dilated lateral ventricles caused a marked inferior displacement of the third ventricle. Postshunting diagnostic studies on six of these patients revealed ascent of the third ventricle, and in three of these the aqueduct was shown to be patent. It appears that in some cases of advanced communicating hydrocephalus the descending third ventricle kinks or pinches shut the aqueduct, adding an obstructive component which accelerates the clinical picture. The mechanism and clinical features of this process are discussed.

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Predictors of endoscopic third ventriculostomy ostomy status in patients who experience failure of endoscopic third ventriculostomy with choroid plexus cauterization

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.2.peds18743 ◽

2019 ◽

Vol 24 (1) ◽

pp. 41-46

Author(s):

Andrew T. Hale ◽

Amanda N. Stanton ◽

Shilin Zhao ◽

Faizal Haji ◽

Stephen R. Gannon ◽

...

Keyword(s):

Choroid Plexus ◽

Endoscopic Third Ventriculostomy ◽

Third Ventricle ◽

Aqueductal Stenosis ◽

Third Ventriculostomy ◽

Time To Failure ◽

Chi Square ◽

Significant Difference ◽

Chi Square Test ◽

Choroid Plexus Cauterization

OBJECTIVEAt failure of endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC), the ETV ostomy may be found to be closed or open. Failure with a closed ostomy may indicate a population that could benefit from evolving techniques to keep the ostomy open and may be candidates for repeat ETV, whereas failure with an open ostomy may be due to persistently abnormal CSF dynamics. This study seeks to identify clinical and radiographic predictors of ostomy status at the time of ETV/CPC failure.METHODSThe authors conducted a multicenter, retrospective cohort study on all pediatric patients with hydrocephalus who failed initial ETV/CPC treatment between January 2013 and October 2016. Failure was defined as the need for repeat ETV or ventriculoperitoneal (VP) shunt placement. Clinical and radiographic data were collected, and ETV ostomy status was determined endoscopically at the subsequent hydrocephalus procedure. Statistical analysis included the Mann-Whitney U-test, Wilcoxon rank-sum test, t-test, and Pearson chi-square test where appropriate, as well as multivariate logistic regression.RESULTSOf 72 ETV/CPC failures, 28 patients (39%) had open-ostomy failure and 44 (61%) had closed-ostomy failure. Patients with open-ostomy failure were older (median 5.1 weeks corrected age for gestation [interquartile range (IQR) 0.9–15.9 weeks]) than patients with closed-ostomy failure (median 0.2 weeks [IQR −1.3 to 4.5 weeks]), a significant difference by univariate and multivariate regression. Etiologies of hydrocephalus included intraventricular hemorrhage of prematurity (32%), myelomeningocele (29%), congenital communicating (11%), aqueductal stenosis (11%), cyst/tumor (4%), and other causes (12%). A wider baseline third ventricle was associated with open-ostomy failure (median 15.0 mm [IQR 10.3–18.5 mm]) compared to closed-ostomy failure (median 11.7 mm [IQR 8.9–16.5 mm], p = 0.048). Finally, at the time of failure, patients with closed-ostomy failure had enlargement of their ventricles (frontal and occipital horn ratio [FOHR], failure vs baseline, median 0.06 [IQR 0.00–0.11]), while patients with open-ostomy failure had no change in ventricle size (median 0.01 [IQR −0.04 to 0.05], p = 0.018). Previous CSF temporizing procedures, intraoperative bleeding, and time to failure were not associated with ostomy status at ETV/CPC failure.CONCLUSIONSOlder corrected age for gestation, larger baseline third ventricle width, and no change in FOHR were associated with open-ostomy ETV/CPC failure. Future studies are warranted to further define and confirm features that may be predictive of ostomy status at the time of ETV/CPC failure.

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THE BOBBLE-HEAD DOLL SYNDROME: A "TIC" WITH A NEUROPATHOLOGIC BASIS

PEDIATRICS ◽

10.1542/peds.40.2.250 ◽

1967 ◽

Vol 40 (2) ◽

pp. 250-253

Author(s):

Gerhard Nellhaus

Keyword(s):

Movement Disorder ◽

Marked Reduction ◽

Third Ventricle ◽

Aqueductal Stenosis ◽

Large Cyst ◽

The Third ◽

Head Bobbing

A third patient with the "bobble-head doll syndrome" was reported. This is a "tic-like" movement disorder described thus far only in children. Its chief features are a 2 to 3 per second up-and-down or to-and-fro bobbing of the head, sometimes also of the trunk, which could be inhibited voluntarily and disappeared in sleep. Each child had chronic, slowly-progressive hydrocephaly, including marked enlargement of the third ventricle. In the patient presented here this was due to aqueductal stenosis, probably acquired; in the two patients presented previously a large cyst was found in the region of the third ventricle. Because surgical relief of hydrocephaly resulted in disappearance, or at least marked reduction of the head-bobbing, recognition of this "tic" with a neuropathologic basis is of therapeutic importance.

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Letter to the Editor Regarding “Postexercise Death Due to Hemorrhagic Colloid Cyst of Third Ventricle: Case Report and Literature Review”

World Neurosurgery ◽

10.1016/j.wneu.2021.06.006 ◽

2021 ◽

Vol 153 ◽

pp. 149-152

Author(s):

Mousa Taghipour ◽

Mohammad Jamali ◽

Sanaz Taherpour ◽

Negar Safaei ◽

Samar Rahimi ◽

...

Keyword(s):

Case Report ◽

Literature Review ◽

Third Ventricle ◽

Colloid Cyst ◽

Letter To The Editor

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A neuroanatomical basis for the bobble-head doll syndrome

Journal of Neurosurgery ◽

10.3171/jns.1974.41.6.0720 ◽

1974 ◽

Vol 41 (6) ◽

pp. 720-723 ◽

Cited By ~ 18

Author(s):

R. Harris Russo ◽

Glenn W. Kindt

Keyword(s):

Thalamic Nucleus ◽

Third Ventricle ◽

Motor Pattern ◽

Aqueductal Stenosis ◽

Thalamic Nuclei ◽

Content Type ◽

The Relationship ◽

Fine Print

✓ A case of the bobble-head doll syndrome in association with aqueductal stenosis is presented. The relationship between the dilated third ventricle and adjacent thalamic nuclei as well as the somatotopic motor pattern of the dorsomedial thalamic nucleus is discussed.

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Etiology and cranial CT scan profile of nontumoral hydrocephalus in a tertiary black African hospital

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.1.peds10481 ◽

2011 ◽

Vol 7 (4) ◽

pp. 397-400 ◽

Cited By ~ 5

Author(s):

Olufemi Idowu ◽

Adebayo Olumide

Keyword(s):

Pediatric Population ◽

Third Ventricle ◽

Aqueductal Stenosis ◽

Female Ratio ◽

Black African ◽

The Mean ◽

Walker Malformation ◽

A Prospective Study ◽

Evans Ratio ◽

Mantle Thickness

Object Hydrocephalus is a common condition in the pediatric population. The cause of hydrocephalus, Evans ratio, ventricular index, and cerebral mantle thickness are some of the factors associated with poor surgical outcome. This study was conducted to evaluate the profile of these factors in the authors' patient population. Methods The authors conducted a prospective study from the August 1, 2006, to May 30, 2010. The consecutive patients were all 6 years of age or younger. The demographic information, cause of hydrocephalus, and cranial computerized measurements were taken (including widths of the frontal/occipital horns, third ventricle, and cerebral mantle thickness) and entered into the procedural forms. Results One hundred thirty-seven patients presented to the unit over the stipulated period. The male/female ratio was 1.1:1. The median age at presentation was 4 months (mean 7.3 months, range 4 days to 6 years). Myelomeningocele-associated hydrocephalus, aqueductal stenosis, and postmeningitic hydrocephalus accounted for 30.7%, 22.6%, and 17.5%, respectively, of the cases. The mean Evans ratio was 0.56 (range 0.43–0.70), the mean ventricular index was 197.18 (range 135.0–245.3), and the mean cerebral mantle was 10.8 mm (10–14 mm). Conclusions This study shows that the congenital form of hydrocephalus is the predominant variety in the authors' population. Myelomeningocele-associated hydrocephalus, aqueductal stenosis, Dandy-Walker malformation, and postmeningitic hydrocephalus are common causes of hydrocephalus.

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