scholarly journals Management of hydrocephalus in the patient with myelomeningocele: an argument against third ventriculostomy

2004 ◽  
Vol 16 (2) ◽  
pp. 1-3 ◽  
Author(s):  
Arthur E. Marlin
Keyword(s):  
Cerebrospinal Fluid ◽  
Patient Population ◽  
Fourth Ventricle ◽  
Signs And Symptoms ◽  
Central Canal ◽  
Third Ventriculostomy ◽  
Csf Diversion

The majority of children with myelomeningocele will have associated hydrocephalus. The management of hydrocephalus can be one of the most trying problems in this patient population. Cerebrospinal fluid (CSF) diversion will be required in these children for the remainder of their lives. Blockage of the outlets of the fourth ventricle and communication of the fourth ventricle with the central canal provides a mechanism for compensation. The signs and symptoms of CSF diversion malfunction, either shunt or third ventriculostomy, can be quite subtle. The objective indications of these malfunctions are less available after third ventriculostomy than when using mechanical shunting. The ease with which the diagnosis of malfunction can be made becomes the major advantage of mechanical shunting over third ventriculostomy.

Shunt technology and endoscopic ventricular surgery

2019 ◽  
pp. 1071-1082
Author(s):  
Ian K. Pople ◽  
William Singleton
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal State ◽  
Rapid Development ◽  
Third Ventriculostomy ◽  
Detailed Understanding ◽  
Real Possibility ◽  
Comprehensive Knowledge ◽  
Csf Diversion ◽  
Neurosurgical Techniques ◽  
Csf Physiology

The management of cerebrospinal fluid (CSF) disorders via CSF diversion is now a complex clinical science, requiring a detailed understanding of CSF physiology in both the normal and diseased brain. Successful treatment of this group of disorders requires a comprehensive knowledge of all the available shunt types, their similarities, differences, and idiosyncrasies. The rapid development of endoscopic neurosurgical techniques makes treating this group of patients without a shunt often a real possibility, and arguably is now a core neurosurgical skill. In this chapter we will summarize the CSF physiology in the normal state, and explain the principles of CSF diversion before going on to describe the various shunt types available. A section will be devoted to endoscopic CSF diversion techniques, including a detailed explanation of third ventriculostomy.

scholarly journals Distribution and Determinants of Endoscopic third ventriculostomy (ETV) at a Specialized Hospital in Dhaka City

2015 ◽  
Vol 1 (1) ◽  
pp. 5-7
Author(s):  
SK Sader Hossain ◽  
Md Abdullah Alamgir ◽  
Ferdous Ara Islam ◽  
Sheikh Mohammed Ekramullah ◽  
Shudipto Kumar Mukharjee ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Endoscopic Third Ventriculostomy ◽  
Aqueductal Stenosis ◽  
Third Ventriculostomy ◽  
Dhaka City ◽  
Local Infection ◽  
Causal Factors ◽  
Specialized Hospital ◽  
Csf Diversion ◽  
Basal Cisterns

Background: Endoscopic third ventriculostomy (ETV) is the process of intra cranial CSF diversion to relieve the pressure inside the ventricles. This allows the cerebrospinal fluid to flow directly to the basal cisterns, thereby shortcutting any obstruction. It is used as an alternative to a cerebral shunt surgery.Objectives: To observe the Endoscopic third ventriculostomy (ETV) with causal factors and outcome.Methodology: The study was conducted in the Department of Neurosurgery in National Institute of Neurosciences (NINS) during the period from June, 2013 to August, 2014. All the study subjects included in the study were selected for endoscopic third ventriculostomy (ETV) following clinical and radiological diagnosis of hydrocephalus or raised ICP irrespective of age, sex and causal factors. The patients were followed post operatively to follow the outcome.Result: ETV was performed among 38 males and 35 females with a mean age of 24.67 years. Three major causal factors for ETV were aqueductal stenosis, posterior fossa SOL and CP angle tumour observed in 25 (34.3%), 22(30.2%), 11(15.1%) cases respectively. The successful ETV was done in 49 (67.1%) patients varied widely by diagnosis and patient age. Other 32.9% had suffered from several complications like local CSF drainage, local infection, meningitis and subarachnoid haemorrhage and treated conservatively.Conclusion: Endoscopic third ventriculostomy (ETV) is a safe and successful procedure in the management obstructive hydrocephalus.J. Natl Inst. Neurosci Bangladesh 2015;1(1):5-7

scholarly journals Primary Isolated Lymphoma of the Fourth Ventricle in an Immunocompetent Patient

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Rakan Bokhari ◽  
Ahmad Ghanem ◽  
Mahmoud Alahwal ◽  
Saleh Baeesa
Keyword(s):  
Fourth Ventricle ◽  
Obstructive Hydrocephalus ◽  
Tumor Resection ◽  
Signs And Symptoms ◽  
Immunocompetent Patient ◽  
Third Ventriculostomy ◽  
Increased Intracranial Pressure ◽  
Complete Tumor Resection ◽  
Initial Line ◽  
Complete Tumor

Primary central nervous lymphoma (PCNSL) is a rare variant of extranodal non-Hodgkin's lymphoma with a especially poor prognosis. The diagnosis is usually encountered in immunodeficient patients but is also encountered, albeit uncommonly, in the immunocompetent. We present a 50-year-old male who developed signs and symptoms of increased intracranial pressure. Imaging revealed the presence of a fourth ventricle mass with obstructive hydrocephalus. First, the patient underwent emergency endoscopic third ventriculostomy followed, few days later, by complete tumor resection via a posterior fossa craniotomy. Postoperative histopathology revealed the lesion to be a PCNSL. He received adjuvant chemotherapy and radiation and remained with no recurrence on regular imaging studies for 18-month followup. We report herein the fourth case of isolated PCNSL lesion to the fourth ventricle in the literature and provide the rationale for our belief that craniotomy and tumor resection, if feasible, should be the initial line of management in similar cases to relieve hydrocephalus and achieve the diagnosis.

scholarly journals On the Pathogenesis of Syringomyelia: A Review

1980 ◽  
Vol 73 (11) ◽  
pp. 798-806 ◽  
Author(s):  
Bernard Williams
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Improvement ◽  
Subarachnoid Space ◽  
Fourth Ventricle ◽  
Central Canal ◽  
Venous Congestion ◽  
Perivascular Spaces ◽  
Spinal Tumours ◽  
Post Traumatic ◽  
Cerebellar Tonsils

Discussion of the pathogenesis of syringomyelia involves considering the origin of the fluid and also the forces which cause that fluid to break down the structure of the cord. When cerebrospinal fluid (CSF) appears to be the destructive element, it commonly enters through a patent central canal running from the fourth ventricle to the inside of the syrinx. In both clinical and experimental situations pressure differences may be measured which suck on the hindbrain, particularly the cerebellar tonsils, producing deformities. These pressure differences may also suck fluid into the syrinx. In other cases, even when a communication does not appear to be patent, the hindbrain abnormalities are usually present and suck effect may usually be demonstrated and its correction be accompanied by clinical improvement. Other sources of fluid within a syrinx include liquefaction of haematomata after traumatic paraplegia and transudation of fluid from intrinsic spinal tumours. Once fluid is present within a cord cavity it may pulsate upwards and downwards in response to fluid movements in the subarachnoid space, the most energetic of which result from venous influences. Such movement, ‘slosh’, may cause the cavities to extend at either end giving rise to upward and downward extension from a post-traumatic cord cyst and sometimes to syringobulbia. Cord ischaemia, venous congestion and transport of fluid along perivascular spaces may all play a part in the maintainance of cord cavities or the progression of the clinical disabilities.

Successful neuroendoscopic third ventriculostomy for hydrocephalus and syringomyelia associated with fourth ventricle outlet obstruction

2000 ◽  
Vol 93 (2) ◽  
pp. 326-329 ◽  
Author(s):  
Takaichi Suehiro ◽  
Takanori Inamura ◽  
Yoshihiro Natori ◽  
Masayuki Sasaki ◽  
Masashi Fukui
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Fourth Ventricle ◽  
Cervical Spinal Cord ◽  
Outlet Obstruction ◽  
Central Canal ◽  
Third Ventriculostomy ◽  
Content Type ◽  
Cine Mr ◽  
Downward Displacement

✓ The authors report the use of neuroendoscopic third ventriculostomy to treat successfully both hydrocephalus and syringomyelia associated with fourth ventricle outlet obstruction. A 27-year-old woman presented with dizziness, headache, and nausea. Magnetic resonance (MR) imaging demonstrated dilation of all ventricles, downward displacement of the third ventricular floor, obliteration of the retrocerebellar cerebrospinal fluid (CSF) space, funnellike enlargement of the entrance of the central canal in the fourth ventricle, and syringomyelia involving mainly the cervical spinal cord. Cine-MR imaging indicated patency of the aqueduct and an absent CSF flow signal in the area of the cisterna magna, which indicated obstruction of the outlets of the fourth ventricle. Although results of radioisotope cisternography indicated failure of CSF absorption, neuroendoscopic third ventriculostomy completely resolved all symptoms as well as the ventricular and spinal cord abnormalities evident on MR images. Neuroendoscopic third ventriculostomy is an important option for treating hydrocephalus in patients with fourth ventricle outlet obstruction.

PRIMARY OBSTRUCTION OF THE FOURTH VENTRICLE OUTLETS

Neurosurgery ◽  
2009 ◽  
Vol 65 (6) ◽  
pp. 1078-1086 ◽  
Author(s):  
Pierluigi Longatti ◽  
Alessandro Fiorindi ◽  
Andrea Martinuzzi ◽  
Alberto Feletti
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Fourth Ventricle ◽  
Endoscopic Third Ventriculostomy ◽  
Cine Magnetic Resonance Imaging ◽  
Third Ventriculostomy ◽  
Resonance Imaging ◽  
Flow Measurements ◽  
First Time

Abstract OBJECTIVE Primary obstruction of the foramina of Magendie and Luschka is an uncommon and still unclear cause of noncommunicating hydrocephalus. The aim of this work is the description, for the first time, of the inner aspect of these velar obstructions of the fourth ventricle outlets and the demonstration of the efficacy of neuroendoscopic treatment. METHODS Of 240 hydrocephalic patients treated in our institution with endoscopic third ventriculostomy, a subgroup of 10 cases with closure of the fourth ventricular outlets without associated Chiari malformation and syringomyelia was selected. In all of these cases, a transaqueductal endoscopic navigation of the fourth ventricle was performed, and the obstructed outlets were inspected. All of the clinical data and, in particular, the videotape records of endoscopic operations, as well as the cine-magnetic resonance imaging scans, were reviewed to evaluate their patency status. RESULTS Various degrees of stenosis were found endoscopically: restriction of the Magendie contour with thick and opaque membrane, transparent spider web-like membrane, and dense membrane with fissures acting as valves. Endoscopic third ventriculostomy was effective in almost all patients, although we noticed an unforeseen high incidence of closure of the stoma. The restored normal cerebrospinal fluid flux after ventriculocisternostomy and magendieplasty was demonstrated by comparative study of cerebrospinal fluid flow measurements by cine-magnetic resonance imaging. CONCLUSION This report demonstrates the effectiveness of neuroendoscopic third ventriculostomy as well as magendiestomy in cases of tetraventricular hydrocephalus attributable to primary obstruction of the outlets of the fourth ventricle and, for the first time, presents direct images of various types of outlet obstructive pathology.

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.

Surgical removal of bilateral papillomas of the choroid plexus of the lateral ventricles with resolution of hydrocephalus

1979 ◽  
Vol 50 (5) ◽  
pp. 677-681 ◽  
Author(s):  
Steven K. Gudeman ◽  
Humbert G. Sullivan ◽  
Michael J. Rosner ◽  
Donald P. Becker
Keyword(s):  
Cerebrospinal Fluid ◽  
Choroid Plexus ◽  
Large Volume ◽  
Surgical Removal ◽  
Tumor Removal ◽  
Content Type ◽  
Lateral Ventricles ◽  
Csf Diversion ◽  
Csf Production ◽  
Fine Print

✓ The authors report a patient with bilateral papillomas of the choroid plexus of the lateral ventricles with documentation of cerebrospinal fluid (CSF) hypersecretion causing hydrocephalus. Special attention is given to the large volume of CSF produced by these tumors (removal of one tumor reduced CSF outflow by one-half) and to the fact that CSF diversion was not required after both tumors were removed. Since tumor removal alone was sufficient to stop the progression of hydrocephalus, we feel that this case supports the concept that elevated CSF production by itself is sufficient to cause hydrocephalus in patients with papillomas of the choroid plexus.

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