Endoscopic third ventriculostomy in obstructive hydrocephalus due to giant basilar artery aneurysm

2009 ◽  
Vol 110 (1) ◽  
pp. 14-18 ◽  
Author(s):  
Joachim M. K. Oertel ◽  
Yvonne Mondorf ◽  
Michael R. Gaab
Keyword(s):  
Basilar Artery ◽  
Endoscopic Treatment ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Clinical Signs ◽  
Artery Aneurysm ◽  
Third Ventriculostomy ◽  
Upward Displacement ◽  
Age Range

Obstructive hydrocephalus due to giant basilar artery (BA) aneurysm is a rare finding, and endoscopic treatment has not been reported. Here the authors present their experience with endoscopic third ventriculostomy (ETV) in obstructive hydrocephalus due to giant BA aneurysm. Between December 2000 and March 2007, 3 patients (2 men and 1 woman; age range 32–80 years) underwent an ETV for the treatment of obstructive hydrocephalus caused by a giant BA aneurysm. All 3 patients presented with cephalgia, nausea, vomiting, and a variable decrease in consciousness. An obstructive hydrocephalus caused by a giant BA aneurysm was found in each case as the underlying pathological entity. Intraoperatively, a narrowing of the third ventricle by upward displacement of the tegmentum was found in all 3 patients. A standard ETV was performed and included an inspection of the prepontine cisterns. The endoscopic treatment was successful in all patients with respect to clinical signs and radiological ventricular enlargement. No complications were observed. In all, the endoscopic ventriculostomy was proven to be a successful treatment option in obstructive hydrocephalus even if it is caused by untreated giant BA aneurysm.

Indocyanine Green Angiography in Endoscopic Third Ventriculostomy

2013 ◽  
Vol 73 (suppl_1) ◽  
pp. ons67-ons73 ◽  
Author(s):  
Dorothee Wachter ◽  
Timo Behm ◽  
Kajetan von Eckardstein ◽  
Veit Rohde
Keyword(s):  
Indocyanine Green ◽  
Basilar Artery ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Third Ventriculostomy ◽  
The Third ◽  
Vessel Injury ◽  
Icg Angiography ◽  
Noncommunicating Hydrocephalus ◽  
Intraoperative Visualization

Abstract BACKGROUND: Endoscopic third ventriculostomy (ETV) has become a well-established method for the treatment of noncommunicating hydrocephalus with a high success rate and a relatively low morbidity rate. However, vessel injury has been repeatedly reported, often with a fatal outcome. Vessel injury is considered to be the most threatening complication. The use of indocyanine green (ICG) angiography has become an established tool in vascular microneurosurgery. OBJECTIVE: We report our initial experience with endoscopic ICG angiography in ETV for intraoperative visualization of the basilar artery and its perforators to reduce the risk of vascular injury. METHODS: Eleven patients with noncommunicating hydrocephalus underwent ETV. Before opening of the third ventricular floor, ICG angiography was performed using a prototype neuroendoscope for intraoperative visualization of ICG fluorescence. RESULTS: In 10 patients, ETV and ICG angiography were successfully performed. In 1 case, ICG angiography failed. Even in the presence of an opaque floor of the third ventricle (n = 5), ICG angiography clearly demonstrated the course of the basilar artery and its major branches and was considered useful. CONCLUSION: ICG angiography has the potential to become a useful adjunct in ETV for better visualization of vessel structures, especially in the presence of aberrant vasculature, a nontranslucent floor of the third ventricle, or in case of reoperations.

Amenorrhea complicating endoscopic third ventriculostomy in the pediatric age group

2011 ◽  
Vol 8 (3) ◽  
pp. 325-328 ◽  
Author(s):  
Steven W. Hwang ◽  
George Al-Shamy ◽  
William E. Whitehead ◽  
Daniel J. Curry ◽  
Robert Dauser ◽  
...  
Keyword(s):  
Adolescent Girls ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Third Ventriculostomy ◽  
Endocrine Regulation ◽  
Endocrine Dysfunction ◽  
Laboratory Findings ◽  
Pediatric Age Group ◽  
Hypothalamic Pituitary Axis

Endoscopic third ventriculostomy (ETV) is an accepted option in the treatment of obstructive hydrocephalus in children and is considered by many pediatric neurosurgeons to be the treatment of choice in this population. The procedure involves perforation of the floor of the third ventricle, specifically, the tuber cinereum, which is part of the hypothalamic-pituitary axis of cerebral endocrine regulation. Endocrine dysfunction, such as amenorrhea, weight gain, and precocious puberty, which are recognized only months to years after the procedure, may be underreported because patients and physicians may not relate the endocrine sequelae to the ETV. Few detailed reports of endocrinerelated complications following ETV exist to better understand these issues. In this study, the authors add to the literature with case descriptions of and correlative laboratory findings in 2 adolescent girls who underwent ETV for obstructive hydrocephalus and in whom amenorrhea subsequently developed.

scholarly journals Fatal subarachnoid hemorrhage after endoscopic third ventriculostomy

1999 ◽  
Vol 6 (4) ◽  
pp. E6 ◽  
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.

scholarly journals Combined rigid and flexible endoscopy for tumors in the posterior third ventricle

2015 ◽  
Vol 122 (6) ◽  
pp. 1341-1346 ◽  
Author(s):  
Jonathan Roth ◽  
Shlomi Constantini
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Choroid Plexus Papilloma ◽  
Flexible Endoscopy ◽  
Endoscopic Biopsy ◽  
Third Ventriculostomy ◽  
Low Grade ◽  
Rigid Endoscope ◽  
Ventricular Tumors

OBJECT Tumors leading to occlusion of the sylvian aqueduct include those of pineal, thalamic, and tectal origins. These tumors cause obstructive hydrocephalus and thus necessitate a CSF diversion procedure such as an endoscopic third ventriculostomy (ETV), often coupled with an endoscopic biopsy (EBX). Lesions located posterior to the massa intermedia pose a technical challenge, as the use of a rigid endoscope for performing both an ETV and EBX is limited. The authors describe their experience using a combined rigid and flexible endoscopic procedure through a single bur hole for both procedures in patients with posterior third ventricular tumors. METHODS Since January 2012, patients with posterior third ventricular tumors causing hydrocephalus underwent dual ETV and EBX procedures using the combined rigid-flexible endoscopic technique. Following institutional review board approval, data from clinical, radiological, surgical, and pathological records were retrospectively collected. RESULTS Six patients 3.5–53 years of age were included. Lesion locations included pineal (n = 3), fourth ventricle (n = 1), aqueduct (n = 1), and tectum (n = 1). The ETV and EBX were successful in all cases. Pathologies included pilocytic astrocytoma, pineoblastoma, ependymoma Grade II, germinoma, low-grade glioneural tumor, and atypical choroid plexus papilloma. One patient experienced an immediate postoperative intraventricular hemorrhage necessitating evacuation of the clots and resection of the tumor, eventually leading to the patient's death. CONCLUSIONS The authors recommend using a combined rigid-flexible endoscope for endoscopic third ventriculostomy and biopsy to approach posterior third ventricular tumors (behind the massa intermedia). This technique overcomes the limitations of using a rigid endoscope by reaching 2 distant regions.

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.

scholarly journals Endoscopic third ventriculostomy in adult patients

2005 ◽  
Vol 19 (6) ◽  
pp. 1-6 ◽  
Author(s):  
Amin Amini ◽  
Richard H. Schmidt
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Surgical Techniques ◽  
Adult Patients ◽  
Doppler Imaging ◽  
Third Ventriculostomy ◽  
Term Outcome ◽  
Long Term Outcome

Endoscopic third ventriculostomy (ETV) has gained popularity and has become the treatment of choice for certain pediatric and adult hydrocephalic conditions. The authors report their experience with 36 adult patients and evaluate the long-term outcome and safety of ETV. They discuss several improvements to the surgical techniques that they have developed based on their experience, including the use of intraoperative Doppler imaging before fenestration to trace the location of vessels underlying the floor of the third ventricle. They also report the use of a Rickham reservoir and endoventricular stent in selected cases and discuss the indications for their use. In cases of obstructive hydrocephalus due to congenital or acquired aqueductal stenosis in adults, the success rate of ETV in avoidance of shunt placement is 72%. Twenty-two percent of the patients in this series in whom ETV was initially successful later experienced closure of the fenestration and recurrent symptoms at a mean interval of 3.75 years. Thus, in patients who undergo this treatment, long-term periodic follow-up review should be performed.

scholarly journals Endoscopic third ventriculostomy before surgery of third ventricle and posterior fossa tumours decreases the risk of secondary hydrocephalus and early postoperative complications

2021 ◽  
Author(s):  
Pawel Tabakow ◽  
Artur Weiser ◽  
Malgorzata Burzynska ◽  
Przemyslaw Blauciak
Keyword(s):  
Postoperative Complications ◽  
Posterior Fossa ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Controlled Study ◽  
Third Ventriculostomy ◽  
Early Postoperative Complications ◽  
Tumour Removal ◽  
Early Results

AbstractEndoscopic third ventriculostomy (ETV) is an effective treatment for obstructive hydrocephalus (HCP) at the level of third or fourth ventricle. To date, there is no consensus regarding its role as intervention preceding the operation of tumour removal. The aim of this prospective open-label controlled study is to assess if ETV prevents secondary HCP after tumour removal and if ETV influences the early results of tumour surgery. The study was performed on 68 patients operated for tumours of the third ventricle and posterior fossa. In 30 patients, ETV was performed several days before tumour removal, while in 38 patients, the tumour was removed during a one-stage procedure without ETV. Patients who did not receive ETV before the tumour removal procedure had a higher probability of developing postoperative HCP (n = 12, p = 0.03). They also demonstrated a substantially higher rate of early postoperative complications (n = 20, p = 0.002) and a lower Karnofsky score (p = 0.004) than patients in whom ETV was performed before tumour removal. The performance of external ventricular drainage in the non-ETV group did not prevent secondary HCP (p = 0.68). Postoperative cerebellar swelling (p = 0.01), haematoma (p = 0.04), cerebrospinal fluid leak (p = 0.04) and neuroinfection (p = 0.04) were the main risk factors of persistent HCP. Performance of ETV before tumour removal is not only beneficial for control of acute HCP but also prevents the occurrence of secondary postoperative HCP and may also minimize early postoperative complications.

scholarly journals Effectiveness of Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus of Different Etiology in Terms of Reduction of Ventricle Diameter

1969 ◽  
Vol 11 (4) ◽  
pp. 185-190
Author(s):  
Hamayun Tahir ◽  
Muhammad Ayaz ◽  
Mumtaz Ali ◽  
Naseer Hassan ◽  
Syed Nasir Shah ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Case Series ◽  
Ventricular Volume ◽  
Third Ventriculostomy ◽  
Endoscopic Techniques ◽  
Case Series Study ◽  
3Rd Ventricle ◽  
The Difference

Background: Endoscopic techniques are now gaining insight into the management of various neurosurgical pathologies,including Endoscopic third ventriculostomy (ETV), which is a well-accepted technique for obstructive hydrocephalus of variousetiologies.Objective: To determine the effectiveness of endoscopic third ventriculostomy in obstructive hydrocephalus in terms of reductionof third ventricle diameter (width).Material and Method: This descriptive case series study was conducted at the Department of Neuro Surgery, Lady ReadingHospital, from January 2019 to December 2020. A total of 195 patients between age 1- 60 years meeting the inclusion criteriaunderwent endoscopic third ventriculostomy by a single expert neurosurgeon. Effectiveness of endoscopic third ventriculostomywas measured to reduce at least 1 mm or more from the baseline third ventricle diameter (width) after two months of surgery.Results: In our study, 127 (65.12%) patients were male, while 68 (34.87%) were Females. Mean, and S.D. forAge was as 30.05Years + 17.46.The Mean Baseline 3rd Ventricle Diameter was 5.218mm +1.1, whereas on 60th postoperative Day Follow Up, themean 3rd Ventricle Diameter was recorded as 4 .35mm +1.25. The difference in means between the two groups was 0.864 (pvalue<0.0001), which is statistically significant. Effectiveness of Endoscopic Third Ventriculostomy was recorded on 105 (53.84%)patients, whereas in 90 (46.15%) patients, Obstructive Hydrocephalus remained unchanged.Conclusion: Calculated volumetric measurements (e.g., width) from C.T. scans after successful third ventriculostomy can displaya demonstrable reduction in ventricular volume and help evaluate patients postoperatively.Keywords: ETV, Hydrocephalus, stereotactic.

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