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

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.

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

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

<b><i>Introduction:</i></b> 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. <b><i>Case Presentation:</i></b> 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. <b><i>Conclusion:</i></b> 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.

scholarly journals Endoscopic Third Ventriculostomy in Previously Shunted Children

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
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.

scholarly journals Idiopathic fourth ventricle outlet obstruction successfully treated by endoscopic third ventriculostomy: a case report

SpringerPlus ◽  
2015 ◽  
Vol 4 (1) ◽  
Author(s):  
Yukitomo Ishi ◽  
Katsuyuki Asaoka ◽  
Hiroyuki Kobayashi ◽  
Hiroaki Motegi ◽  
Taku Sugiyama ◽  
...  
Keyword(s):  
Case Report ◽  
Fourth Ventricle ◽  
Endoscopic Third Ventriculostomy ◽  
Outlet Obstruction ◽  
Third Ventriculostomy

scholarly journals Implication of image guidance in endoscopic third ventriculostomy: Technical note

2020 ◽  
Vol 11 ◽  
pp. 87
Author(s):  
Muhammad Samir Irfan Wasi ◽  
Salman Yousuf Sharif ◽  
Farhan Gulzar
Keyword(s):  
Fourth Ventricle ◽  
Image Guidance ◽  
Endoscopic Third Ventriculostomy ◽  
Aqueductal Stenosis ◽  
Technical Note ◽  
Guidance System ◽  
Moderate Intensity ◽  
Third Ventriculostomy ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri

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.

Hydrocephalus in mucopolysaccharidosis Type VI successfully treated with endoscopic third ventriculostomy

2013 ◽  
Vol 11 (3) ◽  
pp. 327-330 ◽  
Author(s):  
Ângelo Raimundo da Silva Neto ◽  
Gervina Brady Moreira Holanda ◽  
Maria Cláudia Saldanha Farias ◽  
Gladstone Santos da Costa ◽  
Hougelle Simplício Gomes Pereira
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Fourth Ventricle ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Communicating Hydrocephalus ◽  
Mucopolysaccharidosis Type ◽  
Mucopolysaccharidosis Type Vi ◽  
Mps Vi ◽  
Arylsulfatase B ◽  
Tunnel Syndrome

Mucopolysaccharidosis (MPS) Type VI, or Maroteaux-Lamy syndrome, is characterized by a deficiency of the enzyme arylsulfatase B (ASB). In patients with this disorder, craniocervical compression, carpal tunnel syndrome, and communicating hydrocephalus are common. Traditionally, hydrocephalus occurring in patients with MPS VI has been treated with shunt placements. Considering obstruction of the outlets from the fourth ventricle at the craniocervical transition, the authors decided to treat a female patient with MPS VI via endoscopic third ventriculostomy. She was 12 years old and had refractory headaches. This seems to be the first reported instance of the neuroendoscopic treatment of hydrocephalus in a patient with MPS VI. The pathophysiology is briefly discussed.

Usefulness of Intraoperative Magnetic Resonance Ventriculography During Endoscopic Third Ventriculostomy

Neurosurgery ◽  
2013 ◽  
Vol 73 (4) ◽  
pp. 730-738 ◽  
Author(s):  
Pawel Tabakow ◽  
Marcin Czyz ◽  
Pawel Szewczyk ◽  
Artur Weiser ◽  
Wlodzimierz Jarmundowicz
Keyword(s):  
Magnetic Resonance ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Outlet Obstruction ◽  
Third Ventriculostomy ◽  
Safe Procedure ◽  
Success Rates ◽  
The Third ◽  
Low Field ◽  
Noncommunicating Hydrocephalus

Abstract BACKGROUND: Endoscopic third ventriculostomy (ETV) is the preferred method for the treatment of noncommunicating hydrocephalus. The different success rates of ETV indicate the difficulties in predicting the success of this procedure. OBJECTIVE: To show the usefulness of intraoperative ventriculography performed by the low-field 0.15-T magnetic resonance imager Polestar N20 during ETV. METHODS: The study was conducted in 11 patients with noncommunicating hydrocephalus caused by tumors or cysts of the third ventricle (n = 5), nontumoral stenosis of the sylvian aqueduct (n = 3), and fourth ventricle outlet obstruction (n = 3). Intraoperative magnetic resonance (iMR) ventriculography was performed before and after the ETV. RESULTS: In each case, iMR-ventriculography was a safe procedure and determined the exact site of obstruction of cerebrospinal fluid flow. In all cases, iMR-ventriculography performed after ETV showed with the greatest accuracy the patency of the performed fenestrations, demonstrating in 9 patients good flow of the contrast from the third ventricle to the basal cisterns, restricted flow in 1 patient, and no flow in 1 patient. The results of ventriculography were consistent with the postoperative neurological status of operated-on patients. In 3 patients, the opinion of the surgeons about the patency of endoscopic fenestration, based on intraoperative observation of the third ventricle floor, was inconsistent with the results from iMR-ventriculography. CONCLUSION: Low-field iMR-ventriculography is a safe procedure that can be successfully applied during ETV to determine the site of obstruction in hydrocephalus and the patency of performed ventricle fenestration.

scholarly journals Intraventricular pressure in non-communicating hydrocephalus patients before endoscopic third ventriculostomy

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 909-912
Author(s):  
Werner Tiefenthaler ◽  
Johannes Burtscher ◽  
Patrizia L. Moser ◽  
Ingo H. Lorenz ◽  
Christian Kolbitsch
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Communicating Hydrocephalus ◽  
Intraventricular Pressure ◽  
Positive End Expiratory Pressure

AbstractBackgroundIn patients with non-communicating hydrocephalus impairment of cerebral compliance can occur pre- but also intraoperatively.MethodologyIn such patients (n = 6) undergoing endoscopic third ventriculostomy (ETV), the present study aimed to investigate the effect of ETCO2 (e.g 40 mmHg and 60 mmHg) and positive end-expiratory pressure (PEEP) (e.g. 6 cm and 12 cm H2O) on intraventricular pressure (IVP).FindingsBefore but not after ETV, hypercapnia in contrast to PEEP increased IVP(before ETV(PEEP-6/ ETCO2-40: 2.6 ± 2.4 mmHg) vs. (PEEP-6/ ETCO2-60: 12 ± 6.4 mmHg*); (PEEP-12/ ETCO2-40: 4.2 ± 4.1 mmHg) vs. (PEEP-12/ ETCO2-60: 13.7 ± 7.6 mmHg*), * significant, P ≤ 0.05;after ETV(PEEP-6/ ETCO2-40: 2.0 ± 1.2 mmHg) vs. (PEEP-6/ ETCO2-60: 4.4 ± 3.1 mmHg); (PEEP-12/ ETCO2-40: 1.6 ± 1.3 mmHg) vs. (PEEP-12/ ETCO2-60: 6.6 ± 2.6 mmHg), * significant, P ≤ 0.05).ConclusionPatients with non-communicating hydrocephalus showed that hypercapnia but not PEEP increases significantly IVP before but not after ETV.

Delayed Stoma Failure in Adult Communicating Hydrocephalus After Initial Successful Treatment by Endoscopic Third Ventriculostomy

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. E1210-E1211 ◽  
Author(s):  
Andrew J. Fabiano ◽  
Kristina Doyle ◽  
Walter Grand
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Endoscopic Third Ventriculostomy ◽  
Brain Magnetic Resonance Imaging ◽  
Normal Pressure ◽  
Symptom Improvement ◽  
Third Ventriculostomy ◽  
Communicating Hydrocephalus ◽  
Stoma Closure ◽  
Ventricular Dilation ◽  
Memory Problems

Abstract OBJECTIVE To describe 2 cases of delayed endoscopic third ventriculostomy (ETV) failure in 2 adult patients initially successfully treated for normal pressure hydrocephalus by ETV. The cause of ETV failure was stoma closure, and this was documented in both instances by direct endoscopic inspection. CLINICAL PRESENTATION In the first case, a 67-year-old woman presented with progressive gait disturbance, incontinence, and memory problems. Brain magnetic resonance imaging exhibited ventricular dilation, including the fourth ventricle, disproportionate to cortical atrophy. In the second case, a 55-year-old man presented with progressive gait disturbance, urinary incontinence, memory problems, and headaches. Brain magnetic resonance imaging exhibited communicating hydrocephalus. INTERVENTION The first patient underwent an ETV with subsequent improvement in all symptom areas. Three years and 2 months later, she experienced a return of original symptoms and ventricular dilation on brain computed tomography, compared with previous postoperative scans. Direct endoscopic inspection of the third ventricular floor revealed stoma closure secondary to fibrotic scar. The patient subsequently underwent ventriculoperitoneal shunt placement that resulted in symptom improvement. The patient in the second case underwent an ETV that resulted in marked symptom improvement in all areas. Four years and 3 months later, he experienced a return of gait difficulties and headaches. Direct endoscopic inspection showed a lack of cerebrospinal fluid pulsations through the third ventricular stoma and dense arachnoid adhesions around the basilar artery. A repeat ETV was unsuccessful. Subsequent ventriculoperitoneal shunt placement resulted in symptom improvement. CONCLUSION ETV may provide an effective treatment for patients with normal pressure hydrocephalus, a form of communicating hydrocephalus. Stoma closure can be a mechanism of delayed ETV failure in normal pressure hydrocephalus, consistent with reports of ETV failure in pediatric obstructive hydrocephalus.

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