Chiari I malformation: a rare cause of noncommunicating hydrocephalus treated by third ventriculostomy

2001 ◽  
Vol 95 (5) ◽  
pp. 783-790 ◽  
Author(s):  
Philippe Decq ◽  
Caroline Le Guérinel ◽  
Jean-Christophe Sol ◽  
Pierre Brugières ◽  
Michel Djindjian ◽  
...  
Keyword(s):  
Third Ventricle ◽  
Chiari I Malformation ◽  
Third Ventriculostomy ◽  
Transverse Diameter ◽  
Content Type ◽  
The Third ◽  
Chiari I ◽  
Noncommunicating Hydrocephalus ◽  
Fine Print

Object. Hydrocephalus associated with Chiari I malformation is a rare entity related to an obstruction in the flow of cerebrospinal fluid (CSF) in the foramen of Magendie. Like all forms of noncommunicating hydrocephalus, it can be treated by endoscopic third ventriculostomy (ETV). The object of this study is to report a series of five cases of hydrocephalus associated with Chiari I malformation and to evaluate the use of ETV in the treatment of this anomaly. Methods. Five patients (four women and one man with a mean age of 29.6 years) underwent ETV for hydrocephalus associated with Chiari I malformation between April 1991 and February 1997. All patients had presented with paroxysmal headaches, which in two cases were associated with visual disorders. All patients had also presented with hydrocephalus (mean transverse diameter of the third ventricle 12.79 mm; mean sagittal diameter of the fourth ventricle 18.27 mm) with a mean herniation of the cerebellar tonsils at 13.75 mm below the basion—opisthion line. Surgery was performed in all patients by using a rigid endoscope. No complications occurred either during or after the procedure, except in one patient who experienced a wound infection that was treated by antibiotic medications. The mean duration of follow up in this study was 50.39 months. Four patients became completely asymptomatic and remained stable throughout the follow-up period. One patient required an additional third ventriculostomy after 1 year, due to secondary closure, and has remained stable since that time. Postoperative magnetic resonance images demonstrated a significant reduction in the extent of hydrocephalus in all patients (mean transverse diameter of the third ventricle 6.9 mm [p = 0.0035]; mean sagittal diameter of the fourth ventricle 10.32 mm [p = 0.007]), with a mean ascent of the cerebellar tonsils from 13.75 mm below the basion—opisthion line to 7.76 mm below it (p = 0.01). In addition, CSF flow was identified on either side of the orifice of the third ventriculostomy in all patients postoperatively. Conclusions. Results in this series confirm the efficacy of ETV in the treatment of hydrocephalus associated with Chiari I malformation. It is a reliable, minimally invasive technique that also provides a better understanding of the pathophysiology of this malformation.

A new device for endoscopic third ventriculostomy

2000 ◽  
Vol 93 (3) ◽  
pp. 509-512 ◽  
Author(s):  
Philippe Decq ◽  
Caroline Le Guerinel ◽  
Stéphane Palfi ◽  
Michel Djindjian ◽  
Yves Kéravel ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Third Ventriculostomy ◽  
Content Type ◽  
New Device ◽  
The Third ◽  
Endoscopic Control ◽  
Gentle Pressure ◽  
Single Use ◽  
Fine Print

✓ Since its description by Dandy in 1922, several techniques have been used to perform third ventriculostomy under endoscopic control. Except for the blunt technique, in which the endoscope is used by itself to create the opening in the floor of the third ventricle, the other techniques require more than one instrument to perforate the floor of the ventricle and enlarge the ventriculostomy. The new device described is a sterilizable modified forceps that allows both the opening of the floor and the enlargement of the ventriculostomy in a simple and effective way.The new device has the following characteristics: 1) the tip of the forceps is thin enough to allow the easy perforation of the floor of the ventricle; 2) the inner surface of the jaws is smooth to avoid catching vessels of the basal cistern; and 3) the outer surface of the jaws has indentations that catch the edges of the opening to prevent them from slipping along the instrument's jaws. The ventricle floor is opened by gentle pressure of the forceps, which is slowly opened so that the edges of the aperture are caught by the distal outer indentation of the jaws, leading to an approximately 4-mm opening of the floor. This device has been used successfully in 10 consecutive patients.This new device allows surgeons to perform third ventriculostomy under endoscopic control in a very simple, quick, and effective way, avoiding the need for additional single-use instruments.

Treatment of colloid cysts of the third ventricle by stereotaxic microsurgical laser craniotomy

1989 ◽  
Vol 70 (4) ◽  
pp. 525-529 ◽  
Author(s):  
Chad D. Abernathey ◽  
Dudley H. Davis ◽  
Patrick J. Kelly
Keyword(s):  
Third Ventricle ◽  
Total Removal ◽  
Total Resection ◽  
Content Type ◽  
The Third ◽  
Cyst Aspiration ◽  
Colloid Cysts ◽  
Mass Lesions ◽  
Fine Print

✓ The therapeutic strategies employed in the management of anterior third-ventricular mass lesions remain controversial. Resection by conventional craniotomy, whether via a transcallosal or transcortical approach, carries well-known risks and limitations. Alternatively, in this region traditional stereotaxy has been relegated to use with biopsy only or cyst aspiration procedures. Combining aspects of both conventional and stereotaxic techniques has allowed total removal of 12 colloid cysts in six women and six men ranging in age from 25 to 71 years. No mortality and minimal morbidity have been associated with the procedures. There has been no evidence of recurrence in an average follow-up period of 19 months. By coupling the benefits of stereotaxic precision and localization to the microsurgical management of colloid cysts, several rewards have been realized: 1) only a limited cortical dissection is needed; 2) the hazards of callosal or forniceal injury can be avoided; 3) the lesion is easily localized regardless of ventricular size; 4) hemostasis can be readily achieved with bipolar cautery or defocused laser power; and 5) most importantly, a total resection is possible with little risk to the patient. Stereotaxic microsurgical laser craniotomy provides a new option for the management of colloid cysts and other anterior third-ventricular lesions.

Use of a simple intraoperative hydrostatic pressure test to assess the relationship between mobility of the ventricular stoma and success of third ventriculostomy

2005 ◽  
Vol 103 (5) ◽  
pp. 848-852 ◽  
Author(s):  
Mahmoud Hamdy Kamel ◽  
Michael Kelleher ◽  
Kristian Aquilina ◽  
Chris Lim ◽  
John Caird ◽  
...  
Keyword(s):  
Predictive Value ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Fluid Pressure ◽  
Third Ventriculostomy ◽  
Content Type ◽  
The Third ◽  
The Relationship ◽  
Ventricular Reservoir ◽  
Fine Print

Object. Neuroendoscopists often note pulsatility or flabbiness of the floor of the third ventricle during endoscopic third ventriculostomy (ETV) and believe that either is a good indication of the procedure's success. Note, however, that this belief has never been objectively measured or proven in a prospective study. The authors report on a simple test—the hydrostatic test—to assess the mobility of the floor of the third ventricle and confirm adequate ventricular flow. They also analyzed the relationship between a mobile floor (a positive hydrostatic test) and prospective success of ETV. Methods. During a period of 3 years between July 2001 and July 2004, 30 ETVs for obstructive hydrocephalus were performed in 22 male and eight female patients. Once the stoma had been created, the irrigating Ringer lactate solution was set at a 30-cm height from the external auditory meatus, and the irrigation valve was opened while the other ports on the endoscope were closed. The ventricular floor ballooned downward and stabilized. The irrigation valve was then closed and ports of the endoscope were opened. The magnitude of the upward displacement of the floor was then assessed. Funneling of the stoma was deemed to be a good indicator of floor mobility, adequate flow, and a positive hydrostatic test. All endoscopic procedures were recorded using digital video and recordings were subsequently assessed separately by two blinded experienced neuroendoscopists. Patients underwent prospective clinical follow up during a mean period of 11.2 months (range 1 month–3 years), computerized tomography and/or magnetic resonance imaging studies of the brain, and measurements of cerebrospinal fluid pressure through a ventricular reservoir when present. Failure of ETV was defined as the subsequent need for shunt implantation. The overall success rate of the ETV was 70% and varied from 86.9% in patients with a mobile stoma and a positive hydrostatic test to only 14.2% in patients with a poorly mobile floor and a negative test (p < 0.05). The positive predictive value of the hydrostatic test was 86.9%, negative predictive value 85.7%, sensitivity 95.2%, and specificity 66.6%. Conclusions. The authors concluded that the hydrostatic test is an easy, brief test. A positive test result confirms a mobile ventricular floor and adequate flow through the created ventriculostomy. Mobility of the stoma is an important predictor of ETV success provided that there is no obstruction at the level of the arachnoid granulations or venous outflow. A thin, redundant, mobile third ventricle floor indicates a longstanding pressure differential between the third ventricle and the basal cisterns, which is a crucial factor for ETV success. A positive hydrostatic test may avert the need to insert a ventricular reservoir, thus avoiding associated risks of infection.

Posterior atlantooccipital membrane for duraplasty

2002 ◽  
Vol 97 (2) ◽  
pp. 266-268 ◽  
Author(s):  
R. Shane Tubbs ◽  
John C. Wellons ◽  
Jeffrey P. Blount ◽  
W. Jerry Oakes
Keyword(s):  
Foreign Body ◽  
Postoperative Complications ◽  
Pediatric Patients ◽  
Chiari I Malformation ◽  
Posterior Cranial Fossa ◽  
Content Type ◽  
Chiari I ◽  
Cranial Fossa ◽  
Fine Print

✓ The authors describe the use of autogenetic posterior atlantooccipital (PAO) membrane for duraplasty following after posterior cranial fossa surgery. The PAO membrane is routinely exposed for procedures of the posterior cranial fossa and merely needs to be dissected free of the underlying dura mater. Recently this membrane was obtained in several pediatric patients following procedures of the posterior cranial fossa such as duraplasty in case of Chiari I malformation. No postoperative complications were found at 6-month follow-up examination. The advantages of this intervention include less manipulation of muscle and fascia than that involved in other procedures and, therefore, seemingly less postoperative pain and the negation of issues inherent with foreign-body graft sources. The authors believe this structure to be of use as a dural substitute in small dural openings of the posterior cranial fossa.

Experience with a shunt system using the third ventricle

1975 ◽  
Vol 42 (1) ◽  
pp. 104-107 ◽  
Author(s):  
Fernando Gutierrez-Lara ◽  
Salomon Hakim D.
Keyword(s):  
Third Ventricle ◽  
Shunt System ◽  
Content Type ◽  
The Third ◽  
Fine Print

✓ The authors present a technique involving placement of a catheter in the third ventricle in shunt systems for hydrocephalus, in order to avoid obstruction of the proximal catheter by particles of chorioid plexus. They emphasize the simplicity of the technique, lack of morbidity, and the good results they have obtained in 30 cases with a follow-up from six to 40 months.

Percutaneous thecoperitoneal shunt for syringomyelia

1991 ◽  
Vol 74 (5) ◽  
pp. 827-831 ◽  
Author(s):  
Umesh S. Vengsarkar ◽  
Venilal G. Panchal ◽  
Parimal D. Tripathi ◽  
Sushil V. Patkar ◽  
Alok Agarwal ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Clinical Improvement ◽  
Clinical Presentation ◽  
Simple Procedure ◽  
Chiari I Malformation ◽  
Magnetic Resonance Images ◽  
Content Type ◽  
The Third ◽  
Chiari I ◽  
Fine Print

✓ Between January and April, 1990, three consecutive cases of syringomyelia were treated by percutaneous placement of thecoperitoneal shunts. Two of these patients had undergone craniovertebral decompression earlier at other centers and the third was treated primarily by a thecoperitoneal shunt. In each case, the syrinx was associated with Chiari I malformation, although the clinical presentation was due to a myelopathy. All three patients obtained unequivocal benefit from this simple procedure. Postoperative magnetic resonance images showed considerable shrinkage of the cysts corresponding with clinical improvement.

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.

Endoscopic treatment of thalamic neuroepithelial cysts

2005 ◽  
Vol 103 (2) ◽  
pp. 342-346 ◽  
Author(s):  
Kelly Schmidt ◽  
Caetano Coimbra
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Third Ventriculostomy ◽  
Content Type ◽  
The Third ◽  
The Central Nervous System ◽  
Fine Print ◽  
Neuroepithelial Cysts

✓ Thalamic neuroepithelial cysts are rare lesions of the central nervous system. Surgical management of these lesions has varied and yielded mixed results. The authors identified 10 reported cases in the literature, five of which involved symptomatic lesions. The authors present three unique cases of symptomatic thalamic neuroepithelial cysts associated with hydrocephalus, which were all successfully treated using endoscopic third ventriculostomy and fenestration of the cyst into the third ventricle.

Endoscopic management of cysticercal cysts within the lateral and third ventricles

2000 ◽  
Vol 92 (1) ◽  
pp. 14-23 ◽  
Author(s):  
Marvin Bergsneider ◽  
Langston T. Holly ◽  
Jae Hong Lee ◽  
Wesley A. King ◽  
John G. Frazee
Keyword(s):  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Endoscopic Approach ◽  
Endoscopic Management ◽  
Third Ventriculostomy ◽  
General Description ◽  
Content Type ◽  
The Third ◽  
Lateral Ventricles ◽  
Fine Print

Object. In this report the authors review their 3-year experience with the endoscopic management of patients with hydrocephalus who harbored cysticercal cysts within the third and lateral ventricles. The management plan was to utilize an endoscopic approach to remove the cysts and to incorporate techniques useful in treating obstructive hydrocephalus. The ultimate goals were to avoid having to place a complication-prone cerebrospinal fluid shunt and to eliminate the risk of complications related to cyst degeneration.Methods. A retrospective analysis of 10 patients with hydrocephalus and cysticercal cysts within the third or lateral ventricles who were endoscopically managed was performed. A general description of the instrumentation and technique used for removal of the intraventricular cysts is given. At presentation, neuroimaging revealed findings suggestive of obstructive hydrocephalus in eight patients.Seven of the 10 patients treated endoscopically were spared the necessity of shunt placement. Three successful third ventriculostomies and one therapeutic septum pellucidotomy were performed. Despite frequent rupture of the cyst walls during removal of the cysts, there were no cases of ventriculitis. The endoscopic approach allowed successful removal of a cyst situated in the roof of the anterior third ventricle. One patient suffered from recurrent shunt obstructions secondary to a shunt-induced migration of cysts from the posterior fossa to the lateral ventricles.Conclusions. The endoscopic removal of third and lateral ventricle cysticercal cysts, combined with a third ventriculostomy or septum pellucidotomy in selected cases, is an effective treatment in patients with hydrocephalus and should be considered the primary treatment for this condition.

Natural history of asymptomatic colloid cysts of the third ventricle

1999 ◽  
Vol 91 (3) ◽  
pp. 364-369 ◽  
Author(s):  
Bruce E. Pollock ◽  
John Huston
Keyword(s):  
Natural History ◽  
Third Ventricle ◽  
Benign Tumors ◽  
Content Type ◽  
The Third ◽  
History Of ◽  
Colloid Cysts ◽  
The Mean ◽  
Fine Print

Object. To determine the natural history of colloid cysts of the third ventricle in patients in whom the cysts were incidentally discovered, the authors retrospectively reviewed cases observed during the modern neuroimaging era (1974–1998).Methods. During this 25-year interval, 162 patients with colloid cysts were examined and cared for at our center. Sixty-eight patients (42%) were thought to be asymptomatic with regard to their colloid cyst and observation with serial neuroimaging was recommended. The mean patient age was 57 years at the time of diagnosis (range 7–88 years) and the mean cyst size was 8 mm (range 4–18 mm). Computerized tomography scanning revealed a hyperdense cyst in 49 (84%) of 58 patients. Three patients were excluded from the study because they died of unrelated causes within 6 months of scanning and seven patients were lost to follow-up review. Clinical follow-up evaluation was available at a mean of 79 months (range 7–268 months) in the remaining 58 patients. The numbers of patients who participated in follow-up review at 2, 5, and 10 years after diagnosis were 40, 28, and 14, respectively. The incidences of symptomatic progression related to the cyst were 0%, 0%, and 8% at 2, 5, and 10 years, respectively. No patient died suddenly during the follow-up interval. Two (6%) of 34 patients in whom follow-up imaging was performed either exhibited cyst growth (one patient) or experienced hydrocephalus (one patient) at a mean of 41 months after diagnosis (range 4–160 months).Conclusions. Patients in whom asymptomatic colloid cysts are diagnosed can be cared for safely with observation and serial neuroimaging. If a patient becomes symptomatic, the cyst enlarges, or hydrocephalus develops, prompt neurosurgical intervention is necessary to prevent the occurrence of neurological decline from these benign tumors.

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