Spontaneous third ventriculostomy: definition by endoscopy and cerebrospinal fluid dynamics

2009 ◽  
Vol 111 (3) ◽  
pp. 628-631 ◽  
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.

Case report: Flattening of the tectal plate in obstructive hydrocephalus with auto-ventriculostomy

2021 ◽  
pp. 197140092110366
Author(s):  
Michael Städt ◽  
Markus Holtmannspötter ◽  
Johannes Schwab ◽  
Florian Eff ◽  
Heinz Voit-Höhne
Keyword(s):  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Aqueductal Stenosis ◽  
Chronic Obstructive ◽  
Chronic Hydrocephalus ◽  
Contrast Imaging ◽  
The Third ◽  
Tectal Plate ◽  
Flow Through ◽  
Fluid Pulsation

Background Obstructive hydrocephalus in adulthood can be caused by stenosis in the aqueductal area. Chronic changes lead to a dilatation of the lateral ventricles and ballooning of infratentorial recesses. In rare cases a rupture of the floor of the third ventricle (so-called spontaneous ventriculostomy) has been described in the literature. Case presentation: We present two cases of chronic obstructive hydrocephalus due to aqueductal stenosis in adult patients. Magnetic resonance imaging included phase-contrast-imaging and revealed significant flow through the floor of the third ventricle in keeping with spontaneous ventriculostomy. In addition to other typical changes associated with chronic hydrocephalus, a distinct flattening of the tectal plate could be identified in one case. Conclusion We present two cases of spontaneous ventriculostomy in patients with chronic hydrocephalus. To our knowledge, flattening of the tectal plate has not yet been described in the literature and may be caused by continuous cerebrospinal fluid-pulsation.

Neuroepithelial (colloid) cyst of the third ventricle in identical twins

1986 ◽  
Vol 65 (3) ◽  
pp. 401-403 ◽  
Author(s):  
Abdel Wahab M. Ibrahim ◽  
Hisham Farag ◽  
Mohammed Naguib ◽  
Ezzeldin Ibrahim
Keyword(s):  
Cerebrospinal Fluid ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Colloid Cyst ◽  
Content Type ◽  
The Third ◽  
Colloid Cysts ◽  
Fluid Pathway ◽  
Ocular Signs ◽  
Fine Print

✓ Colloid cysts of the third ventricle are described in middle-aged twin brothers. One of them presented with recurrent attacks of headache. In this patient the cyst had reached a size large enough to obstruct the cerebrospinal fluid pathway, resulting in hydrocephalus. The twin brother, although asymptomatic, was suspected of the anomaly and investigated because of the similarity of his ocular signs. The diagnosis was confirmed by computerized tomography in both the patient and his brother. The latter proved to have a smaller colloid cyst situated anteriorly in the third ventricle with no obstructive hydrocephalus. The patient was successfully operated on, while the brother is still under observation. Both brothers have had bilateral cataracts, retinal detachments, and left lateral rectus palsies. The familial occurrence of colloid cysts and their association with these ocular findings have apparently not been described before.

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

Neurosurgery ◽  
2009 ◽  
Vol 64 (2) ◽  
pp. 256-267 ◽  
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.

Efficacy and Safety of Endoscopic Transventricular Lamina Terminalis Fenestration for Hydrocephalus

Neurosurgery ◽  
2012 ◽  
Vol 71 (2) ◽  
pp. 464-473 ◽  
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.

Use of a simple intraoperative hydrostatic pressure test to assess the relationship between mobility of the ventricular stoma and success of third ventriculostomy

2005 ◽  
Vol 103 (5) ◽  
pp. 848-852 ◽  
Author(s):  
Mahmoud Hamdy Kamel ◽  
Michael Kelleher ◽  
Kristian Aquilina ◽  
Chris Lim ◽  
John Caird ◽  
...  
Keyword(s):  
Predictive Value ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Fluid Pressure ◽  
Third Ventriculostomy ◽  
Content Type ◽  
The Third ◽  
The Relationship ◽  
Ventricular Reservoir ◽  
Fine Print

Object. Neuroendoscopists often note pulsatility or flabbiness of the floor of the third ventricle during endoscopic third ventriculostomy (ETV) and believe that either is a good indication of the procedure's success. Note, however, that this belief has never been objectively measured or proven in a prospective study. The authors report on a simple test—the hydrostatic test—to assess the mobility of the floor of the third ventricle and confirm adequate ventricular flow. They also analyzed the relationship between a mobile floor (a positive hydrostatic test) and prospective success of ETV. Methods. During a period of 3 years between July 2001 and July 2004, 30 ETVs for obstructive hydrocephalus were performed in 22 male and eight female patients. Once the stoma had been created, the irrigating Ringer lactate solution was set at a 30-cm height from the external auditory meatus, and the irrigation valve was opened while the other ports on the endoscope were closed. The ventricular floor ballooned downward and stabilized. The irrigation valve was then closed and ports of the endoscope were opened. The magnitude of the upward displacement of the floor was then assessed. Funneling of the stoma was deemed to be a good indicator of floor mobility, adequate flow, and a positive hydrostatic test. All endoscopic procedures were recorded using digital video and recordings were subsequently assessed separately by two blinded experienced neuroendoscopists. Patients underwent prospective clinical follow up during a mean period of 11.2 months (range 1 month–3 years), computerized tomography and/or magnetic resonance imaging studies of the brain, and measurements of cerebrospinal fluid pressure through a ventricular reservoir when present. Failure of ETV was defined as the subsequent need for shunt implantation. The overall success rate of the ETV was 70% and varied from 86.9% in patients with a mobile stoma and a positive hydrostatic test to only 14.2% in patients with a poorly mobile floor and a negative test (p < 0.05). The positive predictive value of the hydrostatic test was 86.9%, negative predictive value 85.7%, sensitivity 95.2%, and specificity 66.6%. Conclusions. The authors concluded that the hydrostatic test is an easy, brief test. A positive test result confirms a mobile ventricular floor and adequate flow through the created ventriculostomy. Mobility of the stoma is an important predictor of ETV success provided that there is no obstruction at the level of the arachnoid granulations or venous outflow. A thin, redundant, mobile third ventricle floor indicates a longstanding pressure differential between the third ventricle and the basal cisterns, which is a crucial factor for ETV success. A positive hydrostatic test may avert the need to insert a ventricular reservoir, thus avoiding associated risks of infection.

Three-dimensional constructive interference in steady-state magnetic resonance imaging in obstructive hydrocephalus: relevance for endoscopic third ventriculostomy and clinical results

2008 ◽  
Vol 109 (5) ◽  
pp. 931-938 ◽  
Author(s):  
Mathias Kunz ◽  
Gernot Schulte-Altedorneburg ◽  
Eberhard Uhl ◽  
Robert Schmid-Elsaesser ◽  
Karsten Schöller ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Endoscopic Third Ventriculostomy ◽  
Clinical Course ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Three Dimensional ◽  
Third Ventriculostomy ◽  
Constructive Interference ◽  
The Third ◽  
Flow Void

Object Endoscopic third ventriculostomy is the treatment of choice in patients with obstructive hydrocephalus caused by aqueductal stenosis. The authors examined the clinical course and results of surgical treatment for obstructive hydrocephalus with pre- and postoperative refined constructive interference in steady-state (CISS) MR imaging. Methods Forty patients with obstructive hydrocephalus underwent pre- and postoperative 3D-CISS imaging and clinical evaluation. Radiological findings were correlated with intraoperative observations of the thickness and transparency of the floor of the third ventricle and the patient's postoperative clinical course. Results Three-dimensional CISS MR imaging provides precise visualization of the basilar/posterior cerebral artery, its distance to the clivus, the diameter of the foramen of Monro, and the extension of and thickness of the floor of the third ventricle. In 71% of patients a flow void was detectable postoperatively on the ventriculostomy. In this group 81.5% had strong and 14.8% moderate clinical benefit, and 3.7% required secondary shunt placement. In the remaining 29% of the patients without a visible flow void, strong improvement was seen in 54.5%, moderate improvement in 18.2%, and stoma failure occurred in 27.3% (p = 0.094). Radiological measurements of the thickness of the third ventricle floor correlated with intraoperative findings (r = 0.35, p = 0.029). Comparison of outcomes showed a statistically significant tendency for a better outcome in patients with thin and easily perforated third ventricle floors (p = 0.04). Conclusions Endoscopic ventriculostomy in patients with obstructive hydrocephalus is safe and mostly successful, and 3D-CISS MR imaging seems to be a valuable diagnostic method for precisely identifying the anatomy of relevant structures. Furthermore, 3D-CISS MR imaging allows judgment of the thickness of the third ventricle floor and display of the ventriculostomy/flow void, which are predictive for intraoperative course and clinical outcome.

scholarly journals Endoscopic third ventriculostomy

2005 ◽  
Vol 19 (6) ◽  
pp. 1-4 ◽  
Author(s):  
George I. Jallo ◽  
Karl F. Kothbauer ◽  
I. Rick Abbott
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Significant Advance ◽  
Third Ventriculostomy ◽  
Successful Completion ◽  
Traditional Treatment ◽  
The Third ◽  
Technological Advances ◽  
Third Ventricle Floor

The traditional treatment for all forms of hydrocephalus has been the implantation of ventricular shunt systems; however, these systems have inherent tendencies toward complications such as malfunction and infection. A significant advance in the treatment of hydrocephalus has been the evolution of endoscopy. The recent technological advances in this field have led to a renewed interest in endoscopic third ventriculostomy as the treatment of choice for obstructive hydrocephalus. Although several different endoscopes are available, the authors favor a rigid one to perform a blunt fenestration of the third ventricle floor. This description of the technique stresses the nuances for successful completion of this procedure.

Death after Late Failure of Endoscopic Third Ventriculostomy: A Potential Solution

Neurosurgery ◽  
2003 ◽  
Vol 53 (2) ◽  
pp. 384-386 ◽  
Author(s):  
Ralph J. Mobbs ◽  
Marianne Vonau ◽  
Mark A. Davies
Keyword(s):  
Cerebrospinal Fluid ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Third Ventriculostomy ◽  
Ventricular Catheter ◽  
Needle Puncture ◽  
Potential Solution ◽  
The Third ◽  
Late Failure ◽  
Endoscopic Fenestration

Abstract OBJECTIVE Late failure after successful third ventriculostomy is rare, and death caused by failure of a previously successful third ventriculostomy has been reported on four occasions. We describe a simple innovation that adds little morbidity and has the potential to reduce the advent of death after late failure of endoscopic third ventriculostomy. METHODS After endoscopic fenestration of the floor of the third ventricle, a ventricular catheter and subcutaneous reservoir are placed via the endoscope path. With acute blockage and neurological deterioration, cerebrospinal fluid can be removed via needle puncture of the reservoir until consultation with a neurosurgeon. RESULTS From 1979 to 2003, more than 240 endoscopic third ventriculostomies have been performed at our institution, with one death after late failure. The revised technique was devised after this death and has been performed on 21 patients to date. CONCLUSION The addition of a reservoir adds little time and morbidity to the procedure and offers the potential to sample cerebrospinal fluid, measure intracranial pressure, and reduce mortality associated with late failure of endoscopic third ventriculostomy.

scholarly journals COMPUTATIONAL INVESTIGATION ON CSF FLOW ANALYSIS IN THE THIRD VENTRICLE AND AQUEDUCT OF SYLVIUS

2011 ◽  
Vol 12 (3) ◽  
Author(s):  
Edi Azali Hadzri ◽  
Kahar Osman ◽  
Mohamed Rafiq Abdul Kadir ◽  
Azian Abdul Aziz
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Cerebrospinal Fluid ◽  
Flow Rate ◽  
Third Ventricle ◽  
Region Of Interest ◽  
Csf Flow ◽  
The Third ◽  
Aqueduct Of Sylvius ◽  
Computational Fluid Dynamics Cfd

In this study, a three dimensional (3D) model of the third ventricle and aqueduct of Sylvius derived from MRI scans was constructed by using Computational Fluid Dynamics (CFD) modeling. Cerebrospinal fluid(CSF) can be modeled as a Newtonian Fluid and its flow through the region of interest (ROI) was visualized using Engineering Fluid Dynamics (EFD).The constructed ROI was regarded as rigid walled and only steady state flow was able to be defined due to the limitations of current software. Different flow rate was simulated at the Foramen of Monro and a small stenosis was modeled at the middle of the aqueduct of Sylvius at a fixed location. This was made corresponding to normal patients with variation of CSF flow rate physiologically and abnormal patients with tumor causing obstruction to or within the aqueduct of Sylvius, respectively. Due to the small dimensions of the ROI geometry, gravity and complex external gravity that acted upon it was considered to be neglected. The results show as the flow rate increase, the pressure drop of CSF in the ROI proportionally increased. For normal CSF flow rate, the presence of stenosis in the aqueduct demonstrates a significant increased pressure drop.ABSTRAK-Dalam kajian ini, model tiga dimensi (3D) untuk ventrikel ketiga dan akueduk Sylvius, yang terhasil daripada pengimejan resonans magnetik telah dikonstruksi menggunakan Permodelan Perkomputeran Dinamik Bendalir (Computational Fluid Dynamics (CFD)). Cecair serebrospinal (Cerebrospinal fluid (CSF)) dimodelkan sebagai bendalir Newtonan dan alirannya melalui kawasan kepentingan (region of interest (ROI)) digambarkan menggunakan Dinamik Bendalir Kejuruteraan (Engineering Fluid Dynamics (EFD)). Kawasan kepentingan yang dikonstruksi dianggap sebagai dinding tegar dan hanya aliran keadaan tunak yang dapat ditakrifkan berdasarkan pengehadan perisian komputer terkini. Kadar aliran yang berbeza disimulasikan di foramen monro dan laluan stenosis yang kecil dimodelkan di tengah-tengah akueduk Sylvius di satu lokasi yang telah ditetapkan. Kaedah ini dijalankan terhadap pesakit normal dengan variasi pada kadar aliran CSF, serta pesakit abnormal yang mempunyai tumor, penyebab sekatan terhadap atau melinkungi akueduk Sylvius. Disebabkan oleh ukuran geometri ROI kecil, tarikan graviti dan graviti luar kompleks yang bertindak ke atasnya diabaikan. Keputusan menunjukkan bahawa apabila kadar aliran meningkat, susutan tekanan CSF di dalam ROI meningkat dengan berkadar. Untuk kadar aliran CSF yang normal, kehadiran stenosis di dalam akueduk membuktikan pertambahan susutan tekanan yang ketara.

MULTIFOCAL COMPLEX GLIONEURONAL TUMOR IN AN ELDERLY MAN

Neurosurgery ◽  
2009 ◽  
Vol 64 (6) ◽  
pp. E1193-E1195 ◽  
Author(s):  
Jian-Qiang Lu ◽  
Bernd W. Scheithauer ◽  
Pranshu Sharma ◽  
James N. Scott ◽  
Ian F. Parney ◽  
...  
Keyword(s):  
Obstructive Hydrocephalus ◽  
External Ventricular Drain ◽  
Third Ventricle ◽  
Glioneuronal Tumor ◽  
Third Ventriculostomy ◽  
Magnetic Resonance Imaging Scan ◽  
Dysembryoplastic Neuroepithelial Tumor ◽  
Histological Features ◽  
The Third ◽  
Glioneuronal Tumors

Abstract OBJECTIVE The clinicopathological spectra of a dysembryoplastic neuroepithelial tumor (DNT) and a rosette-forming glioneuronal tumor (RGNT) are expanding. We report here the autopsy findings of a case of complex glioneuronal tumor with combined histological features of both a DNT and an RGNT. CLINICAL PRESENTATION A 79-year-old man presented with a 1-month history of confusion and gait difficulties. A magnetic resonance imaging scan revealed obstructive hydrocephalus attributed to a mass in the posterior third ventricle. INTERVENTION A third ventriculostomy was performed. Postoperatively, the mass remained unchanged in size for more than 14 months. Thirty-eight months after his initial manifestations, he experienced minor head trauma and was then hospitalized. Despite placement of an external ventricular drain and other supportive treatment, he deteriorated and died. A full autopsy was performed, with emphasis on the brain. The mass lesion and a few independent microfoci situated primarily around the third ventricle showed histological features of pilocytic astrocytoma with recurrent hemorrhage. Far more numerous were microfoci with histological features of a DNT, including floating neurons, as well as typical RGNT-associated, synaptophysin-positive rosettes and perivascular pseudorosettes. CONCLUSION The advanced age of the patient, the coexisting histological features of the DNT and RGNT, and the distinctive anatomic distribution of the lesions, being centered on the third ventricle, may lend insight into the histogenetic relationship of a DNT, an RGNT, and mixed glioneuronal tumors.

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