scholarly journals Endoscopic fenestration at the splenial-habenular junctional area for symptomatic cavum and tumor at the foramen of Monro: case reports and anatomical review

2015 ◽  
Vol 122 (3) ◽  
pp. 504-510 ◽  
Author(s):  
Zamzuri Idris ◽  
Jason Raj Johnson ◽  
Jafri Malin Abdullah
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Case Reports ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Third Ventriculostomy ◽  
Csf Flow ◽  
Foramen Of Monro ◽  
The Third ◽  
Quadrigeminal Cistern ◽  
Endoscopic Fenestration

The splenial-habenular junctional area is an alternative site for neuroendoscopic fenestration to divert CSF flow into the quadrigeminal cistern in cases in which endoscopic third ventriculostomy is not amenable. In some patients with obstructive hydrocephalus, the splenium of the corpus callosum can be elevated from the habenular complex. This exposes the membranous connection between the splenium and habenula, which can be fenestrated to divert the CSF flow into the quadrigeminal cistern. This technique can be performed in patients in whom the foramen of Monro or the third ventricle is blocked by a lesion. Here, the authors present 3 complex cases that were managed by neuronavigation-guided transventricular transcavum endoscopic fenestration of the splenial-habenular junctional area. These cases may increase the knowledge and understanding of the anatomy of this region.

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.

Endoscopic ventriculocystocisternostomy of a quadrigeminal cistern arachnoid cyst

1999 ◽  
Vol 90 (6) ◽  
pp. 1125-1128 ◽  
Author(s):  
Nakamasa Hayashi ◽  
Shunro Endo ◽  
Eiji Tsukamoto ◽  
Shuji Hohnoki ◽  
Toru Masuoka ◽  
...  
Keyword(s):  
Arachnoid Cyst ◽  
Third Ventricle ◽  
Posterior Wall ◽  
Third Ventriculostomy ◽  
Coronal Suture ◽  
Content Type ◽  
The Third ◽  
Quadrigeminal Cistern ◽  
Endoscopic Fenestration ◽  
Fine Print

✓ The authors present the case of an elderly patient with a quadrigeminal arachnoid cyst who was successfully treated with endoscopic fenestration through the posterior wall of the third ventricle via the anterior horn of the lateral ventricle. This 71-year-old man suffered from progressive gait instability and disorientation. Radiological examination revealed hydrocephalus caused by a quadrigeminal arachnoid cyst. The patient underwent endoscopic fenestration of the quadrigeminal cistern arachnoid cyst and third ventriculostomy via one burr hole placed at the coronal suture. This method is less invasive and is effective for quadrigeminal cistern arachnoid cyst and accompanying hydrocephalus.

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 A bi-foraminal craniometric-guided approach to endoscopic third ventriculostomy and biopsy of a pineal tumour

2021 ◽  
Vol 12 ◽  
pp. 582
Author(s):  
Panduranga Seetahal-Maraj ◽  
Patrick Knight ◽  
Narindra Ramnarine
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Third Ventriculostomy ◽  
Tumor Biopsy ◽  
Foramen Of Monro ◽  
Pineal Tumour ◽  
Pineal Tumors ◽  
Endoscopic Techniques ◽  
Intracranial Lesions

Background: Pineal tumors are very rarely encountered, with an incidence of <1% of intracranial lesions in adults. Life-threatening hydrocephalus due to obstruction of the third ventricle can result from the location of these tumours. Endoscopic third ventriculostomy (ETV) and tumor biopsy is a safe and feasible strategy, particularly if the tumor appears benign. This mitigates the high risks of uncontrollable venous bleeding from open and stereotactic biopsies. While typically performed using either ipsilateral single or dual bur holes, the location of the tumor may require modifications to the standard endoscopic techniques. Case Description: A 55-year-old male presented with signs of intracranial hypertension and was found to have obstructive hydrocephalus due to a pineal tumour. The tumour displayed a right-sided dominance when the pre-operative imaging was assessed, which would risk forniceal injury if biopsied via a right-sided burr hole. Craniometric measurements revealed a superior trajectory to the tumour via the left foramen of Monro. A biforaminal approach was performed, with a traditional ETV using a right coronal bur hole and biopsy via a left frontal bur hole. This minimized forniceal stretching and allowed a safe biopsy. Conclusion: The bi-foraminal approach has not been widely described in the literature but can potentially avoid morbidity with biopsy in patients with right-sided pineal tumours. We believe this technique should be considered, particularly in low-resource settings where neuroendoscopy is not commonly done, and where the use of ipsilateral single or dual-bur holes may lead to forniceal injury.

Use of the NeuroBalloon catheter for endoscopic third ventriculostomy

2013 ◽  
Vol 11 (3) ◽  
pp. 302-306 ◽  
Author(s):  
Raphael Guzman ◽  
Arjun V. Pendharkar ◽  
Michel Zerah ◽  
Christian Sainte-Rose
Keyword(s):  
Surgical Technique ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Balloon Catheter ◽  
Critical Factor ◽  
Third Ventriculostomy ◽  
Technical Challenge ◽  
The Third ◽  
Single Balloon

Endoscopic third ventriculostomy (ETV) has become the procedure of choice for treatment of obstructive hydrocephalus. While patient selection is the most critical factor in determining the success of an ETV procedure, the technical challenge lies in the proper site of fenestration and the successful creation of a patent stoma. Positioning of a single balloon catheter at the level or below the floor of the third ventricle to achieve an optimal ventriculostomy can at times be challenging. Here, the authors describe the use of a double-barrel balloon catheter (NeuroBalloon catheter), which facilitates positioning across, as well as dilation of, the floor of the third ventricle. The surgical technique and nuances of using the NeuroBalloon catheter and the experience in more than 1000 cases are described. The occurrence of vascular injury was less than 0.1%, and the risk of balloon rupture was less than 2%. The authors found that the placement and deployment of this balloon catheter facilitate the creation of an adequate ventriculostomy in a few simple steps.

scholarly journals Anterior endoscopic transcortical approach to a pineal region cavernous hemangioma

2021 ◽  
Vol 5 (1) ◽  
pp. V15
Author(s):  
Jiuhong Li ◽  
Jiaojiang He ◽  
Lunxin Liu ◽  
Liangxue Zhou
Keyword(s):  
Cavernous Hemangioma ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Pineal Region ◽  
Postoperative Adhesion ◽  
Third Ventriculostomy ◽  
Back Side ◽  
Coronal Suture ◽  
The Third ◽  
Transcortical Approach

A 57-year-old female presented with headache and dizziness for 3 months. Preoperative MRI revealed a lesion located at the pineal region and back side of the third ventricle, accompanied by hydrocephalus. The infratentorial supracerebellar approach may cause visuomotor, acousticomotor, and hearing disturbances. With the patient in a supine position, the authors used a frontal linear incision that was 3 cm anterior to the coronal suture and 2 cm away from the midline and an anterior endoscopic transcortical approach, which could achieve endoscopic third ventriculostomy, alleviating and preventing hydrocephalus due to postoperative adhesion and resection of the lesion at the same time. The pathological diagnosis was cavernous hemangioma. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID215.

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.

Endoscopic Fenestration of Cavum Septum Pellucidum Cysts to the Third Ventricle: Technical Note

2020 ◽  
Vol 19 (4) ◽  
pp. E434-E439
Author(s):  
Alexandre Simonin ◽  
Omar Bangash ◽  
Arjun S Chandran ◽  
Erik Uvelius ◽  
Christopher Lind
Keyword(s):  
Surgical Procedure ◽  
Clinical Presentation ◽  
Third Ventricle ◽  
Technical Note ◽  
Septum Pellucidum ◽  
Imaging Studies ◽  
Foramen Of Monro ◽  
Cavum Septum Pellucidum ◽  
The Third ◽  
Endoscopic Fenestration

Abstract BACKGROUND AND IMPORTANCE Cavum septum pellucidum (CSP) and cavum vergae (CV) cysts are common incidental findings on imaging studies. However, they may rarely present with symptoms related to the obstruction of the foramen of Monro by the cyst leaflets. There is no consensus regarding the management of symptomatic CSP and CV cysts. We present an original transcavum interforniceal endoscopic fenestration technique. The step-by-step surgical procedure and two illustrative cases are presented. CLINICAL PRESENTATION A 31-yr-old male and a 24-yr-old woman presented with symptomatic CSP and CV cysts. For both patients, neuronavigation was used to plan the procedure. An endoscope was introduced into the cyst through a right frontal burr-hole. After an examination of the endoscopic anatomy, a communication between the cyst and the third ventricle was performed using an endoscopic forceps. In both cases, directly after the fenestration, cerebrospinal fluid (CSF) passed through the communication, and the collapse of the cyst was appreciated. Symptoms were relieved in both patients, and neuropsychological assessment improved. Postoperative imaging showed a reduction in the cyst bulge, and patent foramen of Monro. CONCLUSION Endoscopic fenestration of CSP and CV cysts to the third ventricle through an interforniceal navigated approach is a feasible and efficient surgical procedure. Theoretical advantages include a single tract through noneloquent brain, a perpendicular trajectory to the membrane for fenestration, and a large CSF space beyond the fenestration point.

Histological analysis of the third ventricle floor in hydrocephalic and nonhydrocephalic brains: application to neuroendocrine complications following third ventriculostomy procedures

2012 ◽  
Vol 9 (2) ◽  
pp. 178-181 ◽  
Author(s):  
R. Shane Tubbs ◽  
Eyas M. Hattab ◽  
Marios Loukas ◽  
Joshua J. Chern ◽  
Melissa Wellons ◽  
...  
Keyword(s):  
Histological Analysis ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Neuronal Cell ◽  
Third Ventriculostomy ◽  
Endocrine Dysfunction ◽  
The Third ◽  
Neuronal Cell Bodies ◽  
Potential Association ◽  
Significant Difference

Object Endocrine dysfunction following endoscopic third ventriculostomy (ETV) is rare, but it has been reported. In the present study the authors sought to determine the histological nature of the floor of the third ventricle in hydrocephalic brains to better elucidate this potential association. Methods Five adult cadaveric brains with hydrocephalus were examined. Specifically, the floors of the third ventricle of these specimens were studied histologically. Age-matched controls without hydrocephalus were used for comparison. Results Although it was thinned in the hydrocephalic brains, the floor of the third ventricle had no significant difference between the numbers of neuronal cell bodies versus nonhydrocephalic brains. Conclusions Although uncommon following ETV, endocrine dysfunction has been reported. Based on the present study, this is most likely to be due to the injury of normal neuronal cell bodies found in this location, even in very thinned-out tissue.

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