The use of waterjet dissection in endoscopic neurosurgery

2006 ◽  
Vol 105 (6) ◽  
pp. 928-931 ◽  
Author(s):  
Joachim Oertel ◽  
Michail Gen ◽  
Joachim K. Krauss ◽  
Matthias Zumkeller ◽  
Michael R. Gaab
Keyword(s):  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Intraoperative Blood Loss ◽  
Endoscopic Neurosurgery ◽  
Intraoperative Bleeding ◽  
Endoscopic Procedures ◽  
Pressure Setting ◽  
The Third ◽  
Vessel Preservation ◽  
Waterjet Dissection

✓Waterjet dissection enables vessel preservation and a reduction in intraoperative blood loss. Because even minimal bleeding should be avoided during neuroendoscopy, the waterjet device may be a particularly valuable tool in such procedures. The authors used this instrument in experimental endoscopic procedures in 20 cadaveric porcine brains and clinically in four patients with obstructive hydrocephalus. A precise and accurate septostomy was achieved in all of the pig brains. In two patients the hydrocephalus was due to intraventricular hemorrhage, in one a posterior fossa tumor, and in one a cystic craniopharyngioma. In all patients the surgical view was kept clear with waterjet irrigation and suction. Using a pressure setting of 10 bars, the waterjet device successfully perforated the cyst wall of the craniopharyngioma in one patient and the floor of the third ventricle in three patients. The use of the waterjet device in selected endoscopic procedures appears safe, and may help reduce intraoperative bleeding. However, further studies are needed to confirm the utility of the waterjet tool in endoscopy.

scholarly journals Endoscopic treatment of a third ventricle choroid plexus cyst

2013 ◽  
Vol 34 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
Danielle de Lara ◽  
Leo F. S. Ditzel Filho ◽  
Jun Muto ◽  
Daniel M. Prevedello
Keyword(s):  
Choroid Plexus ◽  
Obstructive Hydrocephalus ◽  
Adult Population ◽  
Third Ventricle ◽  
Postoperative Recovery ◽  
Current Treatment ◽  
Posterior Portion ◽  
Cerebrospinal Fluid Flow ◽  
Patient Reports ◽  
The Third

Choroid plexus cysts are frequent benign intraventricular lesions that infrequently cause symptoms, usually in the form of obstructive hydrocephalus. These instances are even less common in the adult population. When warranted, treatment seeks to reestablish cerebrospinal fluid flow and does not necessarily require resection of the cyst itself. Hence, endoscopic exploration of the ventricles with subsequent cyst ablation is the current treatment of choice for these lesions.Herein we present the case of a 25-year-old female patient with a 3-week history of intermittent headaches. Investigation with computerized tomography (CT) of the head detected supratentorial hydrocephalus, with enlargement of the lateral and third ventricles. Magnetic resonance imaging revealed a homogeneous cystic lesion in the third ventricle. A right-sided, pre-coronal burr hole was carried out, followed by endoscopic exploration of the ventricular system. A third-ventriclostomy was performed. With the aid of the 30-degrees endoscope, a cyst arising from the choroid plexus was visualized along the posterior portion of the third ventricle, obstructing the aqueduct opening. The cyst was cauterized until significant reduction of its dimensions was achieved and the aqueduct opening was liberated. Postoperative recovery was without incident and resolution of the hydrocephalus was confirmed by CT imaging. The patient reports complete improvement of her headaches and has been uneventfully followed since surgery.The video can be found here: http://youtu.be/XBtj_SqY07Q.

Neuroepithelial (colloid) cyst of the third ventricle in identical twins

1986 ◽  
Vol 65 (3) ◽  
pp. 401-403 ◽  
Author(s):  
Abdel Wahab M. Ibrahim ◽  
Hisham Farag ◽  
Mohammed Naguib ◽  
Ezzeldin Ibrahim
Keyword(s):  
Cerebrospinal Fluid ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Colloid Cyst ◽  
Content Type ◽  
The Third ◽  
Colloid Cysts ◽  
Fluid Pathway ◽  
Ocular Signs ◽  
Fine Print

✓ Colloid cysts of the third ventricle are described in middle-aged twin brothers. One of them presented with recurrent attacks of headache. In this patient the cyst had reached a size large enough to obstruct the cerebrospinal fluid pathway, resulting in hydrocephalus. The twin brother, although asymptomatic, was suspected of the anomaly and investigated because of the similarity of his ocular signs. The diagnosis was confirmed by computerized tomography in both the patient and his brother. The latter proved to have a smaller colloid cyst situated anteriorly in the third ventricle with no obstructive hydrocephalus. The patient was successfully operated on, while the brother is still under observation. Both brothers have had bilateral cataracts, retinal detachments, and left lateral rectus palsies. The familial occurrence of colloid cysts and their association with these ocular findings have apparently not been described before.

Hematoma from arteriovenous malformation producing hydrocephalus and simulating a thalamic tumor

1971 ◽  
Vol 34 (2) ◽  
pp. 229-235 ◽  
Author(s):  
Larry K. T. Ng ◽  
Gabriel Schwarz ◽  
Mark M. Mishkin
Keyword(s):  
Vascular Malformation ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Intracerebral Hematoma ◽  
Content Type ◽  
The Third ◽  
Brain Substance ◽  
History Of ◽  
The Brain ◽  
Symptoms And Signs

✓ Two patients with a history of progressive unilateral neurological symptoms and signs, and evidence of obstructive hydrocephalus from a mass lesion adjacent to the third ventricle as demonstrated by pneumography, were each found to have an intracerebral hematoma secondary to remote hemorrhage from a small vascular malformation. One patient died shortly after surgical exploration and the other after ventriculography. The pathophysiology of hydrocephalus associated with a vascular malformation is discussed and the need for considering a benign cause for obstructive hydrocephalus from a mass deep in the brain substance is emphasized.

DIZYGOTIC TWINS WITH A COLLOID CYST OF THE THIRD VENTRICLE

Neurosurgery ◽  
2008 ◽  
Vol 63 (5) ◽  
pp. E1003-E1003 ◽  
Author(s):  
Rossana Romani ◽  
Mika Niemelä ◽  
Miikka Korja ◽  
Juha A. Hernesniemi
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Colloid Cyst ◽  
Resonance Imaging ◽  
Transcallosal Approach ◽  
The Third ◽  
Familial Cases ◽  
Colloid Cysts

Abstract OBJECTIVE AND IMPORTANCE Colloid cysts of the third ventricle are rare benign tumors of endodermal origin accounting for 1% of all intracranial tumors. Interestingly, a few familial cases have been reported previously. We present the first case of dizygotic twins with a symptomatic colloid cyst of the third ventricle. CLINICAL PRESENTATION A 10-year-old boy was admitted to a local hospital in 1993 because of severe progressive headache. Computed tomographic and magnetic resonance imaging scans revealed acute obstructive hydrocephalus attributable to a third ventricular colloid cyst, which was removed after emergent ventricular drainage. Fourteen years later, a nonidentical twin brother complained of continuous headache with nausea and vomiting. A magnetic resonance imaging scan showed obstructive hydrocephalus and a third ventricle colloid cyst, which was removed by use of the transcallosal approach. INTERVENTION Both twins underwent complete removal of the cyst by the interhemispheric transcallosal approach without postoperative complications. CONCLUSION On the basis of a literature review, 2 cases of colloid cysts of the third ventricle in monozygotic twins and a few familial cases have been reported. Our case is the first in dizygotic twin brothers. These findings suggest that the prevalence of colloid cyst may be higher in twins than in the general population. We believe that the presence of this lesion in a twin necessitates magnetic resonance imaging of the other twin, and a clinical follow-up would be recommended in all other first-degree relatives.

INTRAOPERATIVE DIRECT THIRD VENTRICULOSTOMY AND AQUEDUCTAL STENTING IN DEEP-SEATED MIDLINE BRAIN TUMOR SURGERY

Neurosurgery ◽  
2009 ◽  
Vol 64 (2) ◽  
pp. 256-267 ◽  
Author(s):  
David I. Pitskhelauri ◽  
Alexander N. Konovalov ◽  
Valeri N. Kornienko ◽  
Natalia K. Serova ◽  
Nikita V. Arutiunov ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Pineal Region ◽  
Third Ventriculostomy ◽  
Success Rates ◽  
Tumor Removal ◽  
The Third ◽  
Total Tumor Removal ◽  
Ventricular Shunting

Abstract OBJECTIVE Surgical resection of deep-seated midline brain tumors does not always resolve obstruction of cerebrospinal fluid pathways, and an additional operation—ventricular shunting—is required. To prevent postoperative obstructive hydrocephalus, we combine tumor removal and internal ventricular shunting in 1 stage. METHODS Between 2000 and 2006, 82 patients with deep-seated midline brain tumors (tumors of the third ventricle, pineal region, thalamus, upper brainstem, and superior half of the fourth ventricle) underwent 84 tumor resections with intraoperative internal ventricular shunting. Two types of intraoperative shunting were performed: direct third ventriculostomy with fenestration of the premammillary membrane of the third ventricle floor and Liliequist's membrane, 53 operations; and aqueductal stenting, 30 operations. In 1 patient, third ventriculostomy and aqueductal stenting were performed simultaneously. RESULTS As most of the tumors had an infiltrative growth pattern, gross total tumor removal was achieved in only 31% of patients in this series. There were no fatal outcomes related to the surgery. Follow-up data were collected in 73 patients (89%) and ranged from 2 to 68 months (median, 16 months). Additional shunting because of inadequate function of stoma or stent was performed in 13 patients at various times after surgery (median, 30 days). The Kaplan-Meier survival analysis demonstrated that at 12 and 24 months the intraoperative direct third ventriculostomy success rates were 67 and 61%, respectively; aqueductal stenting success rates were 93% at both 12 and 24 months. CONCLUSION Intraoperative direct third ventriculostomy and aqueductal stenting under direct visual control were found to be reliable methods of hydrocephalus management in patients with deep-seated midline brain tumors.

Frame-Based and Frameless Endoscopic Procedures in the Third Ventricle

1997 ◽  
Vol 68 (1-4) ◽  
pp. 80-89 ◽  
Author(s):  
P. Grunert ◽  
N. Hopf ◽  
A. Perneczky
Keyword(s):  
Third Ventricle ◽  
Endoscopic Procedures ◽  
The Third

scholarly journals Unusual presentation of xanthogranuloma of the choroid plexus

2010 ◽  
Vol 01 (02) ◽  
pp. 097-098 ◽  
Author(s):  
Jayaprakash Shetty ◽  
KV Devadiga ◽  
Muktha Pai ◽  
Keyword(s):  
Choroid Plexus ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Unusual Presentation ◽  
Benign Tumors ◽  
The Third ◽  
Lateral Ventricles ◽  
Exact Etiology

ABSTRACTIntracranial xanthogranulomas are rare benign tumors and occur most commonly as choroid plexus xanthogranulomas, which rarely become symptomatic. Exact etiology is still a matter of debate. We present a case of xanthogranuloma of the choroid plexus of the third ventricle, causing obstructive hydrocephalus of the lateral ventricles.

Sudden Death of a 22-Year-Old Female Attributed to Complications of a Colloid Cyst in the Third Ventricle

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S76-S76
Author(s):  
Gary Wu ◽  
Jennifer Hammers
Keyword(s):  
Sudden Death ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Memory Loss ◽  
Colloid Cyst ◽  
Intracranial Tumors ◽  
Foramen Of Monro ◽  
Acute Hydrocephalus ◽  
The Third ◽  
Colloid Cysts

Abstract Colloid cysts are rare lesions that account for up to 2% of all intracranial tumors. They are commonly found posterior to the foramen of Monro in the third ventricle and classified as benign lesions due to their slow-growing nature. Diagnosis of colloid cysts are often incidental finds on diagnostic imaging or at autopsy. The strategic location of these cysts primary causes gradual or acute hydrocephalus, as evidenced by flattened gyri and deepened sulci on MRI, nausea, vomiting, and papilledema. Enlargement of the cyst itself can cause a mass effect, which commonly presents with symptoms of ataxia, memory loss, and rapid neurologic deterioration. Microsurgery, endoscopic removal, and stereotactic aspiration are cited to be the most commonly employed treatments in the management of colloid cysts. However, there is no one procedure better than another; the benefits and limitations of several procedures are discussed. Treatment of choice is weighed by clinical judgment and surgical experience that vary between neurosurgeons. Although benign, colloid cysts rarely but can lead to sudden death. Therefore, it is important to consider colloid cysts and other intracranial tumors on the differential diagnosis when presented with acute hydrocephalus and papilledema. We report a case of sudden death in a 22-year-old black female due to obstructive hydrocephalus by a colloid cyst in the third ventricle.

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.

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