The marionette technique for treatment of isolated fourth ventricle

2013 ◽  
Vol 12 (4) ◽  
pp. 339-343 ◽  
Author(s):  
Pierluigi Longatti ◽  
Elisabetta Marton ◽  
Salima Magrini
Keyword(s):  
Surgical Treatment ◽  
Fourth Ventricle ◽  
Third Ventricle ◽  
Operating Rooms ◽  
Simple Method ◽  
Less Invasive ◽  
Isolated Fourth Ventricle ◽  
Ventricular Catheters ◽  
Endoscopic Aqueductoplasty

Isolated fourth ventricle is not uncommon in complex posthemorrhagic or postinfectious hydrocephalus. When the condition is symptomatic, the current surgical treatment is endoscopic aqueductoplasty, followed by endoscope-assisted placement of a catheter in the fourth ventricle. The authors suggest a very simple method of steering the tip of standard ventricular catheters by using materials commonly available in all operating rooms. The main advantage of this method is that it permits less invasive transaqueductal drainage of trapped fourth ventricles, especially in cases of narrow third ventricle, because the scope and catheter are introduced in sequence and not in a double-barreled fashion. Two illustrative cases are reported.

Endoscopic Aqueductoplasty and Interventriculostomy for the Treatment of Isolated Fourth Ventricle in Children

Neurosurgery ◽  
2004 ◽  
Vol 55 (2) ◽  
pp. 372-379 ◽  
Author(s):  
Michael J. Fritsch ◽  
Sven Kienke ◽  
Kim H. Manwaring ◽  
H. Maximilian Mehdorn
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Fourth Ventricle ◽  
Third Ventricle ◽  
Safe Procedure ◽  
Suboccipital Craniotomy ◽  
Microsurgical Fenestration ◽  
Surgical Methods ◽  
Isolated Fourth Ventricle ◽  
The Mean ◽  
Endoscopic Aqueductoplasty

Abstract OBJECTIVE: There are different approaches for the treatment of isolated fourth ventricle in children, including a suboccipital ventriculoperitoneal shunt, suboccipital craniotomy with microsurgical fenestration, and endoscopic fenestration. We discuss the indications, surgical methods, and outcome of 18 patients who underwent endoscopic treatment for isolated fourth ventricle. METHODS: We retrospectively reviewed the medical histories of 18 patients with an isolated fourth ventricle. Surgical procedures included endoscopic aqueductoplasty, endoscopic aqueductoplasty with a stent, endoscopic interventriculostomy (lateral ventricle or third ventricle to fourth ventricle), and endoscopic interventriculostomy with a stent. Operations were performed between July 1997 and June 2002. The mean age of the patients at the time of surgery was 3 years. The mean follow-up was 29 months. All patients had a supratentorial ventriculoperitoneal shunt. RESULTS: Clinical symptoms (impairment of consciousness, tetraparesis, and ataxia) improved in all patients. Reduction of the size of the fourth ventricle was observed in all patients. Seven patients required reoperation because of restenosis (39% revision rate). Restenosis occurred between 2 weeks and 7 months after surgery (average, 3 mo). Four patients underwent reoperation with stent placement, and three patients underwent reaqueductoplasty. We had the following complications: one infection, one asymptomatic subdural hygroma, one transient oculomotor paresis, and one permanent oculomotor paresis (4 [22%] of 18 patients). CONCLUSION: The significant failure rate of fourth ventricle shunts has led to the development of alternative treatment methods. Endoscopic aqueductoplasty or inter-ventriculostomy presents an effective, minimally invasive, and safe procedure for the treatment of isolated fourth ventricle in pediatric patients. Compared with suboccipital craniotomy and microsurgical fenestration, endoscopic aqueductoplasty is less invasive, and compared with fourth ventricle shunts, it is more reliable and effective.

Endoscopic aqueductoplasty and stenting in the treatment of isolated fourth ventricle in children: 20-year institutional experience

2021 ◽  
Author(s):  
Alessia Imperato ◽  
Luz Monserrat Almaguer Ascencio ◽  
Claudio Ruggiero ◽  
Pietro Spennato ◽  
Giuliana Di Martino ◽  
...  
Keyword(s):  
Fourth Ventricle ◽  
Isolated Fourth Ventricle ◽  
Institutional Experience ◽  
Endoscopic Aqueductoplasty

Endoscope-assisted placement of a multiperforated shunt catheter into the fourth ventricle via a frontal transventricular approach

2007 ◽  
Vol 22 (4) ◽  
pp. 1-8 ◽  
Author(s):  
Kristen Upchurch ◽  
Murisiku Raifu ◽  
Marvin Bergsneider
Keyword(s):  
Fourth Ventricle ◽  
Third Ventricle ◽  
Flexible Endoscope ◽  
Catheter Placement ◽  
Cerebral Aqueduct ◽  
Frameless Stereotaxy ◽  
Ventricular Catheter ◽  
Shunt System ◽  
Shunt Catheter ◽  
Isolated Fourth Ventricle

Object Patients with symptomatic isolated fourth ventricle and multicompartmentalized hydrocephalus benefit from operative treatment, but the optimal surgical approach and technique have yet to be established. The authors report on their experience with the treatment of symptomatic adult patients by endoscope-assisted placement of a fourth ventricle shunt catheter via a frontal transventricular approach. Methods The authors describe a retrospective series of four patients treated for isolated fourth ventricle. The surgical technique is described in detail: use of a flexible endoscope with dual-port intraventricular access for direct visualization and for mechanical manipulation of a multiperforated panventricular catheter guided by frameless stereotaxy. The transventricular approach allowed optimal catheter placement within the fourth ventricle. The use of the flexible endoscope permitted the neurosurgeon to use the endoscope as a tool to guide the ventricular catheter tip within the third ventricle and through the cerebral aqueduct. Clinical outcomes demonstrated neurological and radiographically verified improvement in all patients. Conclusions The endoscope-assisted dual-port technique provides a solution to the technical difficulties of fourth ventricle shunt placement. The multiple advantages of this technique include a single ventricular catheter shunt system that equalizes ventricular pressures, a frontal location for the ventricular catheter that facilitates valve placement and programming, and ventricular catheter placement within the fourth ventricle that does not allow the catheter to impinge on the fourth ventricle floor and makes the catheter less prone to obstruction.

Endoscopic aqueductoplasty and placement of a stent in the cerebral aqueduct in the management of isolated fourth ventricle in children

2006 ◽  
Vol 104 (1) ◽  
pp. 21-27 ◽  
Author(s):  
Giuseppe Cinalli ◽  
Pietro Spennato ◽  
Luciano Savarese ◽  
Claudio Ruggiero ◽  
Ferdinando Aliberti ◽  
...  
Keyword(s):  
Fourth Ventricle ◽  
Cerebral Aqueduct ◽  
Isolated Fourth Ventricle ◽  
Endoscopic Aqueductoplasty

Drilling and plombage (core decompression) of a femoral head avascular necrosis

2010 ◽  
Vol 19 (01) ◽  
pp. 36-39 ◽  
Author(s):  
P. Chládek ◽  
V. Havlas ◽  
T. Trc
Keyword(s):  
Surgical Treatment ◽  
Femoral Head ◽  
Core Decompression ◽  
Effective Treatment Option ◽  
Simple Method ◽  
X Ray ◽  
Large Femoral Head ◽  
Press Fit ◽  
Round Shape ◽  
Late Stages

SummaryThe treatment of femoral head necrosis of adults is still rather problematic. Conservative treatment has been reported relatively unsuccessful and surgical treatment does not show convincing results either. The most effective seems to be a surgical treatment in early stages of the disease, however, the diagnosis still remains relatively complicated. For the late stages (2B and above) the most effective treatment option is represented by core decompression and vascular grafting. However, drilling and plombage (especially when using press-fit technique) seems to be successful, although not excellent. The authors describe their own method of drilling and plombage of the necrotic zone of the femoral head in 41 patients with X-ray detected necrotic changes of the femoral head. The pain measured by VAS was seen to decrease after surgery in all patients significantly. The Jacobs score was also observed to have increased (from fair to good outcome). We have not observed any large femoral head collapse after surgery, moreover, in some cases an improvement of the round shape of the femoral head was seen. It is important to mention that in all cases femoral heads with existing necrotic changes (flattening or collapse) were treated. Although the clinical improvement after surgery was not significantly high, the method we describe is a safe and simple method of diminishing pain in attempt to prepare the femoral head for further treatment in a future, without significant restriction of the indication due to necrosis (osteochondroplasty, resurfacing, THR).

scholarly journals Bilateral transtentorial herniation and isolated fourth ventricle: A scientific note

2010 ◽  
Vol 58 (6) ◽  
pp. 953 ◽  
Author(s):  
Laszlo Novak ◽  
Istvan Pataki ◽  
Andrea Nagy ◽  
Ervin Berenyi
Keyword(s):  
Fourth Ventricle ◽  
Transtentorial Herniation ◽  
Scientific Note ◽  
Isolated Fourth Ventricle

scholarly journals A Feline Case of Isolated Fourth Ventricle with Syringomyelia Suspected to be Related with Feline Infectious Peritonitis

2007 ◽  
Vol 69 (7) ◽  
pp. 759-762 ◽  
Author(s):  
Masato KITAGAWA ◽  
Midori OKADA ◽  
Tsuneo SATO ◽  
Kiichi KANAYAMA ◽  
Takeo SAKAI
Keyword(s):  
Fourth Ventricle ◽  
Feline Infectious Peritonitis ◽  
Isolated Fourth Ventricle

Neuroendoscopic Aspiration of Blood Clots in the Cerebral Aqueduct and Third Ventricle During Posterior Fossa Surgery in the Prone Position

2018 ◽  
Vol 17 (2) ◽  
pp. 143-148 ◽  
Author(s):  
Alberto Feletti ◽  
Riccardo Stanzani ◽  
Matteo Alicandri-Ciufelli ◽  
Giuliano Giliberto ◽  
Matteo Martinoni ◽  
...  
Keyword(s):  
Prone Position ◽  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Blood Clot ◽  
Third Ventricle ◽  
Cerebral Aqueduct ◽  
Posterior Fossa Surgery ◽  
The Third ◽  
Blood Clots ◽  
Surgical Field

AbstractBACKGROUNDDuring surgery in the posterior fossa in the prone position, blood can sometimes fill the surgical field, due both to the less efficient venous drainage compared to the sitting position and the horizontally positioned surgical field itself. In some cases, blood clots can wedge into the cerebral aqueduct and the third ventricle, and potentially cause acute hydrocephalus during the postoperative course.OBJECTIVETo illustrate a technique that can be used in these cases: the use of a flexible scope introduced through the opened roof of the fourth ventricle with a freehand technique allows the navigation of the fourth ventricle, the cerebral aqueduct, and the third ventricle in order to explore the cerebrospinal fluid pathways and eventually aspirate blood clots and surgical debris.METHODSWe report on one patient affected by an ependymoma of the fourth ventricle, for whom we used a flexible neuroendoscope to explore and clear blood clots from the cerebral aqueduct and the third ventricle after the resection of the tumor in the prone position. Blood is aspirated with a syringe using the working channel of the scope as a sucker.RESULTSA large blood clot that was lying on the roof of the third ventricle was aspirated, setting the ventricle completely free. Other clots were aspirated from the right foramen of Monro and from the optic recess.CONCLUSIONWe describe this novel technique, which represents a safe and efficient way to clear the surgical field at the end of posterior fossa surgery in the prone position. The unusual endoscopic visual perspective and instrument maneuvers are easily handled with proper neuroendoscopic training.

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