Neuroendoscopic aqueductal stent placement procedure for isolated fourth ventricle after ventricular shunt placement

2000 ◽  
Vol 92 (6) ◽  
pp. 1036-1039 ◽  
Author(s):  
Masahiro Shin ◽  
Akio Morita ◽  
Shuichiro Asano ◽  
Keisuke Ueki ◽  
Takaaki Kirino
Keyword(s):  
Stent Placement ◽  
Surgical Procedure ◽  
Fourth Ventricle ◽  
Rare Complication ◽  
Ventricular Catheter ◽  
Foramen Of Monro ◽  
Content Type ◽  
Shunt Placement ◽  
Progressive Cerebellar Ataxia ◽  
Isolated Fourth Ventricle

✓ Isolated fourth ventricle (IFV) is a rare complication in patients who undergo shunt placement, and it is not easily corrected by surgical procedures. The authors report a case of IFV that was successfully treated with an aqueductal stent placed under direct visualization by using a neuroendoscope. This 36-year-old suffered meningitis after partial resection of a brainstem pilocytic astrocytoma, and subsequently developed hydrocephalus for which a ventriculoperitoneal shunt was placed. Nine months later, the patient presented with progressive cerebellar ataxia, and magnetic resonance imaging revealed slitlike supratentorial ventricles and a markedly enlarged fourth ventricle, which were compatible with the diagnosis of IFV. The surgical procedure described was performed under visualization through a styletlike slim optic fiberscope inserted into a ventricular catheter. The catheter, with the endoscope inside it, was passed through the foramen of Monro and then through the aqueduct to reach the enlarged fourth ventricle, where membranous occlusion of the foramen of Magendie was clearly visualized. The tip of the catheter was placed in the fastigium of the fourth ventricle. After the procedure, the size of the fourth ventricle was reduced and the patient's symptoms improved. Thus, it is concluded that endoscopic aqueductal stent placement is a simple and safe surgical procedure for treatment of IFV.

Isolated fourth ventricle as a complication of ventricular shunting

1978 ◽  
Vol 49 (6) ◽  
pp. 910-913 ◽  
Author(s):  
John C. Hawkins ◽  
Harold J. Hoffman ◽  
Robin P. Humphreys
Keyword(s):  
Computerized Tomography ◽  
Fourth Ventricle ◽  
Obstructive Hydrocephalus ◽  
Normal Function ◽  
Shunt Malfunction ◽  
Cerebellar Dysfunction ◽  
Content Type ◽  
Isolated Fourth Ventricle ◽  
Ventricular Shunting ◽  
Fine Print

✓ Signs of cerebellar dysfunction combined with signs suggestive of shunt malfunction developed in three children with obstructive hydrocephalus. Shunt function was normal. In all cases, the cerebellar signs persisted and computerized tomography scans revealed enlargement of the fourth ventricle. Shunting of the fourth ventricle returned the patients to normal function.

Cerebrospinal fluid edema: a rare complication of shunt operations for hydrocephalus

1982 ◽  
Vol 57 (5) ◽  
pp. 697-700 ◽  
Author(s):  
Yasuhiro Chiba ◽  
Hiroshi Takagi ◽  
Fumoto Nakajima ◽  
Satoshi Fujii ◽  
Takao Kitahara ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
White Matter ◽  
Rare Complication ◽  
Shunt Revision ◽  
Ventricular Catheter ◽  
Shunt Operation ◽  
Low Density ◽  
Content Type ◽  
Low Density Area ◽  
Fine Print

✓ Three cases are presented in which a rare complication occurred after a shunt operation for hydrocephalus. On postoperative computerized tomography (CT) scans, extensive low-density areas appeared in the white matter along the ventricular catheter. After shunt revision, gradual resolution or disappearance of the low-density area was clearly demonstrated on CT. In one patient, a collection of cerebrospinal fluid (CSF) was confirmed at operation and appeared to lie in the extracellular spaces of the white matter. The phenomenon is considered to be localized CSF edema, different from porencephaly.

Endoscopic Aqueductal Stenting via the Fourth Ventricle under Navigating System Guidance: Technical Note

2005 ◽  
Vol 56 (suppl_1) ◽  
pp. ONS-E206-ONS-E206 ◽  
Author(s):  
Hideo Hamada ◽  
Nakamasa Hayashi ◽  
Masanori Kurimoto ◽  
Shunro Endo
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Initial Treatment ◽  
Fourth Ventricle ◽  
Technical Note ◽  
New Method ◽  
Cerebellar Hemisphere ◽  
Shunt Placement ◽  
Isolated Fourth Ventricle ◽  
Ventricular Hemorrhage ◽  
Reasonable Choice

Abstract OBJECTIVE: We report three patients with symptomatic isolated fourth ventricle after ventriculoperitoneal shunt placement for hydrocephalus associated with ventricular hemorrhage. All three patients were treated successfully with our new method of endoscopic aqueductal stenting under navigating system guidance. METHODS: A therapeutic rigid endoscope was inserted through the thin cerebellar hemisphere, and endoscopic aqueductal stenting was performed via the enlarged fourth ventricle under navigating system guidance. RESULTS: All three patients underwent successful procedures with good outcomes. CONCLUSION: Our method of aqueductal stenting is a reasonable choice for initial treatment of patients with isolated fourth ventricle, and it entails less invasive neurosurgery.

scholarly journals Combined approach of multiloculated hydrocephalus and isolated fourth ventricle

2020 ◽  
Vol 2 (2(May-August)) ◽  
pp. e292020
Author(s):  
Lucas de Souza Rodrigues dos Santos ◽  
Leo Gordiano Matias ◽  
Fernando Luís Maeda ◽  
Humberto Belem De Aquino ◽  
Enrico Ghizoni
Keyword(s):  
Fourth Ventricle ◽  
Late Onset ◽  
External Ventricular Drain ◽  
Ventricular Catheter ◽  
Skin Closure ◽  
Combined Approach ◽  
Left Lateral Ventricle ◽  
Multiloculated Hydrocephalus ◽  
Isolated Fourth Ventricle ◽  
Myelomeningocele Repair

A female newborn patient presents with meningitis and hydrocephalus after lumbosacral myelomeningocele repair and skin closure. An external ventricular drain was used during the meningitis treatment. Patient had a late onset multiloculated hydrocephalus and isolated fourth ventricle on CT scan follow-up. We performed combined approach with a craniotomy, dissection of intraparietal sulcus entering in the atrium of left lateral ventricle and used endoscopic assistance to fenestrate intraventricular septations and to put a ventricular catheter through tentorium to drain both supra and infratentorial ventricles. The patient improved clinically and radiologically.

Efficacy of the Ghajar Guide revisited: a prospective study

2000 ◽  
Vol 92 (5) ◽  
pp. 801-803 ◽  
Author(s):  
Shaun T. O'Leary ◽  
Max K. Kole ◽  
Devon A. Hoover ◽  
Steven E. Hysell ◽  
Ajith Thomas ◽  
...  
Keyword(s):  
Catheter Placement ◽  
Target Point ◽  
Ventricular Catheter ◽  
Foramen Of Monro ◽  
Content Type ◽  
Successful Cannulation ◽  
Tunnel Technique ◽  
Catheter Tip ◽  
A Prospective Study ◽  
Fine Print

Object. The goal of this study was to compare the freehand technique of catheter placement using external landmarks with the technique of using the Ghajar Guide for this procedure. The placement of a ventricular catheter can be a lifesaving procedure, and it is commonly performed by all neurosurgeons. Various methods have been described to cannulate the ventricular system, including the modified Friedman tunnel technique in which a soft polymeric tube is inserted through a burr hole. Paramore, et al., have noted that two thirds of noninfectious complications have been related to incorrect positioning of the catheter.Methods. Forty-nine consecutive patients were randomized between either freehand or Ghajar Guide—assisted catheter placement. The target was the foramen of Monro, and the course was through the anterior horn of the lateral ventricle approximately 10 cm above the nasion, 3 cm from the midline, to a depth of 5.5 cm from the inner table of the skull. In all cases, the number of passes was recorded for successful cannulation, and pre- and postplacement computerized tomography scans were obtained. Calculations were performed to determine the bicaudate index and the distance from the catheter tip to the target point.Conclusions. Successful cannulation was achieved using either technique; however, the catheters placed using the Ghajar Guide were closer to the target.

Accurate placement of coronal ventricular catheter using stereotactic coordinate-guided free-hand passage

1994 ◽  
Vol 80 (4) ◽  
pp. 750-755 ◽  
Author(s):  
Dachling Pang ◽  
Paul A. Grabb
Keyword(s):  
Choroid Plexus ◽  
Catheter Placement ◽  
Ventricular Catheter ◽  
Catheter Position ◽  
Foramen Of Monro ◽  
Shunt Insertion ◽  
Content Type ◽  
Surface Anatomy ◽  
Skull Radiographs ◽  
Fine Print

✓ Long-term patency of the ventricular catheter of a cerebrospinal fluid shunt depends on the positioning of the hole-bearing segment of the catheter. Placement of this segment near the choroid plexus or injured ependyma increases the probability of obstruction. Proper positioning for a coronal shunt in turn depends on the ventricular catheter length and target coordinates. The authors describe a method of calculating the catheter length based on bone landmarks on skull radiographs, and a technique for accurate ventricular catheter placement using free-hand passage guided by simple stereotactic coordinates based on visible and palpable surface anatomy. The insertion trajectory is aligned with the coronal obliquity of the lateral ventricle so that, even with slit ventricles, the entire hole-bearing segment of the catheter can be reliably situated within the anterior horn. The predetermined catheter length also fixes the tip at the foramen of Monro, away from the choroid plexus and injured ependyma. Of 160 children undergoing ventriculoperitoneal shunt insertion using this technique, only three required catheter revision during a mean follow-up period of 39 months. Radiographic grading of the ventricular catheter position in 112 children showed a satisfactory placement rate of 93.2%; all three children with occlusion showed poor catheter positioning. Thus, this method results in accurate ventricular catheter placement with a 1.9% obstruction rate, which compares favorably to the 16% to 18% incidence of proximal obstruction reported in the literature. This technique is applicable to patients of all ages but is particularly suitable for children because of the greater variability in head size.

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.

Stereotactic transtentorial hiatus ventriculoperitoneal shunting for the sequestered fourth ventricle

1994 ◽  
Vol 80 (4) ◽  
pp. 759-761 ◽  
Author(s):  
José L. Montes ◽  
David B. Clarke ◽  
Jean-Pierre Farmer
Keyword(s):  
Effective Treatment ◽  
Fourth Ventricle ◽  
Content Type ◽  
Ventriculoperitoneal Shunting ◽  
Isolated Fourth Ventricle ◽  
Fine Print

✓ The authors describe a technique of stereotactic transtentorial hiatus ventriculoperitoneal shunting for the treatment of the sequestered fourth ventricle, used successfully in the care of four patients. They recommend it as a safe, effective treatment of patients suffering from an isolated fourth ventricle.

scholarly journals Trapped fourth ventricle: a rare complication in children after supratentorial CSF shunting

2020 ◽  
Vol 36 (12) ◽  
pp. 2961-2969
Author(s):  
Ahmed El Damaty ◽  
Ahmed Eltanahy ◽  
Andreas Unterberg ◽  
Heidi Baechli
Keyword(s):  
Fourth Ventricle ◽  
Rare Complication ◽  
Pediatric Neurosurgery ◽  
Clinical Findings ◽  
Ventricular Catheter ◽  
Mri Imaging ◽  
Presenting Symptoms ◽  
Trapped Fourth Ventricle ◽  
Early Diagnose ◽  
Endoscopic Aqueductoplasty

Abstract Purpose Trapped fourth ventricle (TFV) is a well-identified problem in hydrocephalic children. Patients with post-hemorrhagic hydrocephalus (PHH) are mostly affected. We tried to find out predisposing factors and describe clinical findings to early diagnose TFV and manage it. Methods We reviewed our database from 1991 to 2018 and included all patients with TFV who required surgery. We analyzed prematurity, cause of hydrocephalus, type of valve implanted, revision surgeries, modality of treatment of TFV, and their clinical examination and MRI imaging. Results We found 21 patients. Most of patients suffered from PHH (16/21), tumor (2/21), post-meningitis hydrocephalus (2/21), and congenital hydrocephalus (1/21). Seventeen patients were preterm. Seven patients suffered from a chronic overdrainage with slit ventricles in MRI. Thirteen patients showed symptoms denoting brain stem dysfunction; in 3 patients, TFV was asymptomatic and in 5 patients, we did not have available information regarding presenting symptoms due to missing documentation. An extra fourth ventricular catheter was the treatment of choice in 18/21 patients. One patient was treated by cranio-cervical decompression. Endoscopic aqueductoplasty with stenting was done in last 2 cases. Conclusion Diagnosis of clinically symptomatic TFV and its treatment is a challenge in our practice of pediatric neurosurgery. PHH and prematurity are risk factors for the development of such complication. Both fourth ventricular shunting and endoscopic aqueductoplasty with stenting are effective in managing TFV. Microsurgical fourth ventriculostomy is not recommended due to its high failure rate. Early detection and intervention may help in avoiding fatal complication and improving the neurological function.

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