Implication of image guidance in endoscopic third ventriculostomy: Technical note

Background: Endoscopic third ventriculostomy (ETV) is an advanced surgical procedure and plays a major role in the management of hydrocephalus. The complications associated with this procedure are grave and unforgiving. Image guidance system (IGS) can help reduce these complications. This technical note describes the technique for utilizing image guidance in carrying out ETV with safety and efficacy. Methods: The authors have performed ETV on more than 75 cases. We describe a step-by-step technique for the implication of image guidance while performing ETV including the trajectory planning, coregistration, approach, and third ventricular floor perforation. For illustration, we present the case of a 54-year-old female with moderate-intensity headache and central vertigo for 2 months presented with no significant findings on examination. Magnetic resonance imaging (MRI) showed dilated lateral and third ventricles with normal sized fourth ventricle. A diagnosis of aqueductal stenosis was made and ETV was performed under image guidance. Results: Since 2012, we performed 78 cases of ETV with the help of image guidance. None of the patients had any episode of intraoperative hemorrhage. Two patients (2.56%) had fornix contusions. Conclusion: Image guidance can help reduce complications and is becoming an essential tool in performing ETV. IGS ETV technique may benefit young neurosurgeons the most and can help them overcome the learning curve with safety.

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Isolated Spontaneous Midbrain Hemorrhage in a 14-Year-Old Boy

Journal of Neurological Surgery Reports ◽

10.1055/s-0036-1597616 ◽

2017 ◽

Vol 78 (01) ◽

pp. e5-e8

Author(s):

Kim-Long Nguyen ◽

Hyunyoung Kim ◽

Laszlo Nagy

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Vascular Malformations ◽

Third Ventriculostomy ◽

Bleeding Diathesis ◽

Resonance Imaging ◽

Hyperactivity Disorder ◽

Migraine Headaches ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

Noncontrast Computed Tomography

AbstractIsolated spontaneous midbrain hemorrhages are rare because they are usually secondary to hemorrhages from inferior structures such as the pons and cerebellum, or superior structures such as the thalamus and putamen. While the etiologies are largely unidentified, the most common ones are vascular malformations and bleeding diathesis with hypertension being relatively uncommon. We report midbrain hemorrhage in a 14-year-old boy with a long-standing history of frequent migraine headaches and attention deficit/hyperactivity disorder (ADHD). Neurologic examinations, noncontrast computed tomography (CT) scans, and magnetic resonance imaging (MRI) suggested that the lesion likely affected the dorsal part of the midbrain. The neurologic symptoms improved following endoscopic third ventriculostomy (ETV) with the placement of external ventricular drains (EVDs). In this report, anatomical correlations to the case are discussed and previous reports of midbrain hemorrhages are reviewed.

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Parinaud syndrome as an unusual presentation of intracranial hypotension

Surgical Neurology International ◽

10.25259/sni_483_2019 ◽

2020 ◽

Vol 11 ◽

pp. 98

Author(s):

Alexandra Rose Lyons ◽

Sarah Louise Olson

Keyword(s):

Intracranial Hypotension ◽

Aqueductal Stenosis ◽

Third Ventriculostomy ◽

Resonance Imaging ◽

Opening Pressure ◽

Postural Headache ◽

Dural Enhancement ◽

Magnetic Resonance Imaging Mri ◽

Vertical Gaze ◽

Gaze Palsy

Background: Vertical gaze palsy is a rare clinical manifestation of intracranial hypotension. The typical features of intracranial hypotension include a postural headache, dural enhancement, and low cerebrospinal fluid (CSF) opening pressure. Case Description: We describe a case of a shunt-dependent middle-aged female with aqueductal stenosis who developed recurrent presentations of upgaze palsy with postural headaches, confirmed low opening pressure, and slit ventricles on magnetic resonance imaging (MRI) due to shunt overdrainage. Her ophthalmoplegia and headaches improved following third ventriculostomy and with increasing the shunt opening pressure to prevent excess CSF drainage. Conclusion: Intracranial hypotension should be considered part of the differential diagnosis for patients presenting with an upgaze palsy.

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Delayed Fourth Ventricle Outlet Obstruction after Fourth Ventricle Tumor Removal Successfully Treated with Endoscopic Third Ventriculostomy in a Pediatric Patient

10.31487/j.gscr.2020.01.06 ◽

2020 ◽

pp. 1-4

Author(s):

Pau Capilla-Guasch ◽

Félix Pastor-Escartín ◽

Pau Capilla-Guasch ◽

Vicent Quilis-Quesada ◽

Esteban Vega Torres ◽

...

Keyword(s):

Fourth Ventricle ◽

Endoscopic Third Ventriculostomy ◽

Clinical Status ◽

Outlet Obstruction ◽

Third Ventriculostomy ◽

Communicating Hydrocephalus ◽

Safe Procedure ◽

Who Grade ◽

Magnetic Resonance Imaging Mri ◽

Mri Study

Introduction: Fourth ventricle outlet obstruction (FVOO) at the level of Magendie’s and Luschka’s foramina is a rare cause of non-communicating hydrocephalus. Case Report: We present a case of a 15-year-old woman successfully operated on a fourth ventricle WHO grade 1 pilocytic astrocytoma developing a delayed FVOO five months after surgery, when the patient experienced progressive headache, nausea and gate disturbances. Magnetic resonance imaging (MRI) study showed a tetra-ventricular hydrocephalus, with enlargement and bulging of both lateral recesses and Luschka’s foramina. An endoscopic third ventriculostomy (ETV) was successfully performed. Postoperative computed tomography (CT) and MRI studies showed a significant improvement of the hydrocephalus. Conclusion: FVOO is a rare cause of hydrocephalus. Posterior fossa and fourth ventricle microsurgical procedures can produce a delayed FVOO leading to an unexpected deterioration of the clinical status of the patient. The ETV is an effective and safe procedure to treat this unusual condition.

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Bilateral occlusion of the foramina of Monro after third ventriculostomy

Journal of Neurosurgery ◽

10.3171/2012.2.jns111735 ◽

2012 ◽

Vol 116 (6) ◽

pp. 1333-1336 ◽

Cited By ~ 7

Author(s):

Ehab El Refaee ◽

Joerg Baldauf ◽

Henry W. S. Schroeder

Keyword(s):

Magnetic Resonance Imaging ◽

Endoscopic Third Ventriculostomy ◽

Rare Complication ◽

Third Ventricle ◽

Aqueductal Stenosis ◽

Third Ventriculostomy ◽

Resonance Imaging ◽

Foramen Of Monro ◽

Neurological Improvement ◽

Occlusive Hydrocephalus

Occlusion of both foramina of Monro following third ventriculostomy is a very rare complication. The authors present the case of a 30-year-old female who underwent endoscopic third ventriculostomy (ETV) for occlusive hydrocephalus due to aqueductal stenosis. Thirty months after the ETV, she reported recurrent headaches. Magnetic resonance imaging demonstrated bilateral enlargement of the lateral ventricles with a collapsed third ventricle caused by bilateral stenosis of the foramina of Monro. Left-sided endoscopic foraminoplasty and stenting of the left foramen of Monro were performed with immediate neurological improvement.

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The Use of an Aspirating/Resecting Device to Reduce Stoma Closure Following Endoscopic Third Ventriculostomy for Aqueductal Stenosis

Operative Neurosurgery ◽

10.1227/neu.0000000000000920 ◽

2015 ◽

Vol 11 (4) ◽

pp. 512-517 ◽

Cited By ~ 1

Author(s):

C Rory Goodwin ◽

Eric W Sankey ◽

Ignacio Jusué-Torres ◽

Benjamin D Elder ◽

Thomas A Kosztowski ◽

...

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Surgical Intervention ◽

Obstructive Hydrocephalus ◽

Aqueductal Stenosis ◽

Third Ventriculostomy ◽

Stoma Closure ◽

Resonance Imaging ◽

Gradient Echo ◽

Low Rate ◽

Symptom Recurrence

Abstract BACKGROUND Endoscopic third ventriculostomy (ETV) is commonly used to treat obstructive hydrocephalus. Closure of the stoma can be associated with symptom recurrence and need for further surgical intervention. OBJECTIVE To describe the use of a side-cutting aspiration device for treatment of aqueductal stenosis in patients undergoing ETV. METHODS A retrospective review of 30 consecutive adults with aqueductal stenosis treated with ETV using an adjunct side-cutting aspiration device between 2011 and 2013 was performed. Patients included in the study ranged from 35 to 64 years of age. ETV success was determined by the absence of stoma closure (aqueductal and cisternal flow assessed by high-resolution, gradient-echo magnetic resonance imaging), post-ETV symptom recurrence, and need for subsequent surgical intervention. RESULTS Patients treated by using a side-cutting aspirator had no observed stoma closure (0%) and a 10% (n = 3) rate of post-ETV symptom recurrence. Three patients (10%) demonstrated a need for surgical revision following initial ETV with the side-cutting aspirator. CONCLUSION Adult patients with obstructive hydrocephalus secondary to aqueductal stenosis exhibited a low rate of stoma closure with the use of a side-cutting aspiration device, and a rate of complications comparable to the known literature. Likewise, patients treated with a side-cutting aspirator may have lower symptom recurrence post-ETV and require fewer revisions in comparison with the known literature. As such, a side-cutting aspirator may be considered as a useful adjunct to traditional ETV for the treatment of obstructive hydrocephalus secondary to aqueductal stenosis.

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PRIMARY OBSTRUCTION OF THE FOURTH VENTRICLE OUTLETS

Neurosurgery ◽

10.1227/01.neu.0000360133.29217.44 ◽

2009 ◽

Vol 65 (6) ◽

pp. 1078-1086 ◽

Cited By ~ 34

Author(s):

Pierluigi Longatti ◽

Alessandro Fiorindi ◽

Andrea Martinuzzi ◽

Alberto Feletti

Keyword(s):

Magnetic Resonance Imaging ◽

Cerebrospinal Fluid ◽

Magnetic Resonance ◽

Fourth Ventricle ◽

Endoscopic Third Ventriculostomy ◽

Cine Magnetic Resonance Imaging ◽

Third Ventriculostomy ◽

Resonance Imaging ◽

Flow Measurements ◽

First Time

Abstract OBJECTIVE Primary obstruction of the foramina of Magendie and Luschka is an uncommon and still unclear cause of noncommunicating hydrocephalus. The aim of this work is the description, for the first time, of the inner aspect of these velar obstructions of the fourth ventricle outlets and the demonstration of the efficacy of neuroendoscopic treatment. METHODS Of 240 hydrocephalic patients treated in our institution with endoscopic third ventriculostomy, a subgroup of 10 cases with closure of the fourth ventricular outlets without associated Chiari malformation and syringomyelia was selected. In all of these cases, a transaqueductal endoscopic navigation of the fourth ventricle was performed, and the obstructed outlets were inspected. All of the clinical data and, in particular, the videotape records of endoscopic operations, as well as the cine-magnetic resonance imaging scans, were reviewed to evaluate their patency status. RESULTS Various degrees of stenosis were found endoscopically: restriction of the Magendie contour with thick and opaque membrane, transparent spider web-like membrane, and dense membrane with fissures acting as valves. Endoscopic third ventriculostomy was effective in almost all patients, although we noticed an unforeseen high incidence of closure of the stoma. The restored normal cerebrospinal fluid flux after ventriculocisternostomy and magendieplasty was demonstrated by comparative study of cerebrospinal fluid flow measurements by cine-magnetic resonance imaging. CONCLUSION This report demonstrates the effectiveness of neuroendoscopic third ventriculostomy as well as magendiestomy in cases of tetraventricular hydrocephalus attributable to primary obstruction of the outlets of the fourth ventricle and, for the first time, presents direct images of various types of outlet obstructive pathology.

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Fourth Ventricle Outlet Obstruction and Diverticular Enlargement of Luschka Foramina in a Child with Down Syndrome

Pediatric Neurosurgery ◽

10.1159/000511088 ◽

2020 ◽

pp. 1-4

Author(s):

Valentina Orlando ◽

Pietro Spennato ◽

Maria De Liso ◽

Vincenzo Trischitta ◽

Alessia Imperato ◽

...

Keyword(s):

Down Syndrome ◽

Fourth Ventricle ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Radiological Finding ◽

Outlet Obstruction ◽

Third Ventriculostomy ◽

Viable Option ◽

Case Presentation

Introduction: Hydrocephalus is not usually part of Down syndrome (DS). Fourth ventricle outlet obstruction is a rare cause of obstructive hydrocephalus, difficult to diagnose, because tetraventricular dilatation may suggest a communicant/nonobstructive hydrocephalus. Case Presentation: We describe the case of a 6-year-old boy with obstructive tetraventricular hydrocephalus, caused by Luschka and Magendie foramina obstruction and diverticular enlargement of Luschka foramina (the so-called fourth ventricle outlet obstruction) associated with DS. He was treated with endoscopic third ventriculostomy (ETV) without complications, and a follow-up MRI revealed reduction of the ventricles, disappearance of the diverticula, and patency of the ventriculostomy. Conclusion: Diverticular enlargement of Luschka foramina is an important radiological finding for obstructive tetraventricular hydrocephalus. ETV is a viable option in tetraventricular obstructive hydrocephalus in DS.

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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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Endoscopic Third Ventriculostomy in Previously Shunted Children

Minimally Invasive Surgery ◽

10.1155/2013/584567 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 6

Author(s):

Eva Brichtova ◽

Martin Chlachula ◽

Tomas Hrbac ◽

Radim Lipina

Keyword(s):

Success Rate ◽

Fourth Ventricle ◽

Pediatric Patients ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Surgical Revision ◽

Clinical State ◽

Third Ventriculostomy ◽

Safe Procedure ◽

Shunt Implantation

Endoscopic third ventriculostomy (ETV) is a routine and safe procedure for therapy of obstructive hydrocephalus. The aim of our study is to evaluate ETV success rate in therapy of obstructive hydrocephalus in pediatric patients formerly treated by ventriculoperitoneal (V-P) shunt implantation. From 2001 till 2011, ETV was performed in 42 patients with former V-P drainage implantation. In all patients, the obstruction in aqueduct or outflow parts of the fourth ventricle was proved by MRI. During the surgery, V-P shunt was clipped and ETV was performed. In case of favourable clinical state and MRI functional stoma, the V-P shunt has been removed 3 months after ETV. These patients with V-P shunt possible removing were evaluated as successful. In our group of 42 patients we were successful in 29 patients (69%). There were two serious complications (4.7%)—one patient died 2.5 years and one patient died 1 year after surgery in consequence of delayed ETV failure. ETV is the method of choice in obstructive hydrocephalus even in patients with former V-P shunt implantation. In case of acute or scheduled V-P shunt surgical revision, MRI is feasible, and if ventricular system obstruction is diagnosed, the hydrocephalus may be solved endoscopically.

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Dandy–Walker syndrome associated with syringomyelia in an adult: a case report and literature review

Journal of International Medical Research ◽

10.1177/0300060518808961 ◽

2019 ◽

Vol 47 (4) ◽

pp. 1771-1777

Author(s):

Nan Zhang ◽

Zhenyu Qi ◽

Xuewen Zhang ◽

Fangping Zhong ◽

Hui Yao ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Endoscopic Third Ventriculostomy ◽

Rare Condition ◽

Third Ventriculostomy ◽

Resonance Imaging ◽

Adult Case ◽

History Of ◽

Memory Deterioration

Dandy–Walker syndrome associated with syringomyelia is a rare condition, with few reports of adult cases. We describe an adult case of Dandy–Walker syndrome with concomitant syringomyelia. A 33-year-old man presented with a 3-month history of walking instability, numbness in the hands, memory deterioration, and urinary incontinence. A physical examination showed a positive Romberg sign. Brain computed tomography and magnetic resonance imaging showed hydrocephalus, a cyst in the posterior fossa, absence of the cerebellar vermis, hypoplasia of the corpus callosum and cerebella, and syringomyelia. All of these symptoms were consistent with the diagnosis of Dandy–Walker syndrome. Surgery involving arachnoid adhesiolysis and endoscopic third ventriculostomy was performed. At the 6-month follow-up, the symptoms were completely relieved. Magnetic resonance imaging showed that syringomyelia was greatly reduced and the hydrocephalus remained unchanged. Dandy–Walker syndrome with concomitant syringomyelia in adults is exceedingly rare. Early diagnosis and appropriate surgical treatment of this condition should be highlighted. Combined arachnoid adhesiolysis and endoscopic third ventriculostomy may be an effective approach.

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