scholarly journals Endoscopic Third Ventriculostomy for an Idiopathic Disproportionately Large Communicating Fourth Ventricle: A Case Report

2021 ◽  
Vol 7 ◽  
pp. 4
Author(s):  
Hong-Gyu Yoon ◽  
Yong Ko ◽  
Young-Soo Kim ◽  
Koang-Hum Bak ◽  
Hyeong-Joong Yi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Fourth Ventricle ◽  
Facial Pain ◽  
Endoscopic Third Ventriculostomy ◽  
Rare Condition ◽  
Pain Scale ◽  
Third Ventriculostomy ◽  
Brain Computed Tomography ◽  
Prepontine Cistern ◽  
Ventricle Size

A disproportionately large communicating fourth ventricle (DLCFV) is a rare condition. A 34-year-old man experienced severe headaches, nausea, vomiting, and gait disturbance. Initial brain computed tomography (CT) showed markedly dilated ventricles with prepontine cistern shrinkage. Following extraventricular drain (EVD) insertion, approximately 400 mL/d of cerebrospinal fluid (CSF) was removed over 8 days. During this time, no significant changes in ventricle size were observed on CT images or the facial pain scale (FPS). We then performed an endoscopic third ventriculostomy and changed the drainage catheter. Immediately after surgery, the patient’s symptoms were relieved, and the drainage volume gradually decreased. EVD was successfully removed on the eighth postoperative day. Our experiences suggest that neurosurgeons should consider the importance of a third ventriculostomy for the diagnosis and treatment of DLCFV.

Endoscopic opening of the foramen of Magendie using transaqueductal navigation for membrane obstruction of the fourth ventricle outlets

2006 ◽  
Vol 105 (6) ◽  
pp. 924-927 ◽  
Author(s):  
Pierluigi Longatti ◽  
Alessandro Fiorindi ◽  
Alberto Feletti ◽  
Vittorio Baratto
Keyword(s):  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Endoscopic Third Ventriculostomy ◽  
Clinical Symptoms ◽  
Therapeutic Option ◽  
Surgical Approaches ◽  
Third Ventriculostomy ◽  
Prepontine Cistern ◽  
Suboccipital Craniectomy ◽  
Rhomboid Fossa

✓A membrane obstruction of the foramina of Magendie and Luschka is an uncommon origin of hydrocephalus characterized by unusual clinical symptoms of rhomboid fossa hypertension. Various surgical approaches have been proposed to alleviate this obstruction, including opening the obstructed foramen of Magendie using suboccipital craniectomy, shunting procedures, and more recently, endoscopic third ventriculostomy (ETV). In some cases, however, reshaping of the posterior fossa due to the collapse of the prepontine cistern could make ETV difficult for the surgeon and dangerous to the patient. In these cases, endoscopic opening of the foramen of Magendie by transaqueductal navigation of the fourth ventricle is a suitable and feasible therapeutic option.

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.

scholarly journals Endoscopic Third Ventriculostomy in Previously Shunted Children

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Eva Brichtova ◽  
Martin Chlachula ◽  
Tomas Hrbac ◽  
Radim Lipina
Keyword(s):  
Success Rate ◽  
Fourth Ventricle ◽  
Pediatric Patients ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Surgical Revision ◽  
Clinical State ◽  
Third Ventriculostomy ◽  
Safe Procedure ◽  
Shunt Implantation

Endoscopic third ventriculostomy (ETV) is a routine and safe procedure for therapy of obstructive hydrocephalus. The aim of our study is to evaluate ETV success rate in therapy of obstructive hydrocephalus in pediatric patients formerly treated by ventriculoperitoneal (V-P) shunt implantation. From 2001 till 2011, ETV was performed in 42 patients with former V-P drainage implantation. In all patients, the obstruction in aqueduct or outflow parts of the fourth ventricle was proved by MRI. During the surgery, V-P shunt was clipped and ETV was performed. In case of favourable clinical state and MRI functional stoma, the V-P shunt has been removed 3 months after ETV. These patients with V-P shunt possible removing were evaluated as successful. In our group of 42 patients we were successful in 29 patients (69%). There were two serious complications (4.7%)—one patient died 2.5 years and one patient died 1 year after surgery in consequence of delayed ETV failure. ETV is the method of choice in obstructive hydrocephalus even in patients with former V-P shunt implantation. In case of acute or scheduled V-P shunt surgical revision, MRI is feasible, and if ventricular system obstruction is diagnosed, the hydrocephalus may be solved endoscopically.

scholarly journals Neuropsychological Outcome after Endoscopic Third Ventriculostomy

2014 ◽  
Vol 41 (6) ◽  
pp. 729-734 ◽  
Author(s):  
Walter J. Hader ◽  
Brian L. Brooks ◽  
Lisa Partlo ◽  
Mark Hamilton
Keyword(s):  
Executive Function ◽  
Cognitive Dysfunction ◽  
Verbal Memory ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Cognitive Domain ◽  
Third Ventriculostomy ◽  
Neuropsychological Outcome ◽  
Language Functions ◽  
Ventricle Size

AbstractBackground: Cognitive dysfunction is a common complaint associated with obstructive hydrocephalus. The purpose of this study was to determine the effect of endoscopic third ventriculostomy (ETV) on the neuropsychological outcome in patients presenting with cognitive decline and obstructive hydrocephalus. Methods: A retrospective review of patients who underwent ETV at the University of Calgary and had both pre and post operative neuropsychological testing, was completed. Presenting clinical features, etiology of hydrocephalus and ventricle size utilizing frontal occipital horn ratio was obtained. Outcomes and complications of the ETV were recorded. Detailed measures of intelligence, attention and concentration, executive function, visual and verbal memory, language functions and fine motor skills were completed. Post treatment change was determined utilizing Reliable Change Index. Results: A total of 13 patients were identified. Etiology of the hydrocephalus was aqueductal stenosis in 8 and tectal glioma in 4. The majority of patients (11 of 13, 85%) demonstrated cognitive dysfunction at the borderline (≤1 SD) or impairment level (≤1.5 SDs) in at least one domain. Nine patients (69%) showed reliable improvement in at least one cognitive domain. The greatest improvement was seen with visual memory (42%). One quarter to one third of patients demonstrated improvement on tests of intelligence quotient, verbal memory, attention and concentration, and executive function. Two patients declined in executive functioning. Ventricle size improved in eight patients. Conclusions: ETV is a safe effective procedure, capable of producing reliable improvements in cognitive dysfunction with hydrocephalus. Patients with cognitive complaints alone may benefit from ETV.

scholarly journals Dandy–Walker syndrome associated with syringomyelia in an adult: a case report and literature review

2019 ◽  
Vol 47 (4) ◽  
pp. 1771-1777
Author(s):  
Nan Zhang ◽  
Zhenyu Qi ◽  
Xuewen Zhang ◽  
Fangping Zhong ◽  
Hui Yao ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Endoscopic Third Ventriculostomy ◽  
Rare Condition ◽  
Third Ventriculostomy ◽  
Resonance Imaging ◽  
Adult Case ◽  
History Of ◽  
Memory Deterioration

Dandy–Walker syndrome associated with syringomyelia is a rare condition, with few reports of adult cases. We describe an adult case of Dandy–Walker syndrome with concomitant syringomyelia. A 33-year-old man presented with a 3-month history of walking instability, numbness in the hands, memory deterioration, and urinary incontinence. A physical examination showed a positive Romberg sign. Brain computed tomography and magnetic resonance imaging showed hydrocephalus, a cyst in the posterior fossa, absence of the cerebellar vermis, hypoplasia of the corpus callosum and cerebella, and syringomyelia. All of these symptoms were consistent with the diagnosis of Dandy–Walker syndrome. Surgery involving arachnoid adhesiolysis and endoscopic third ventriculostomy was performed. At the 6-month follow-up, the symptoms were completely relieved. Magnetic resonance imaging showed that syringomyelia was greatly reduced and the hydrocephalus remained unchanged. Dandy–Walker syndrome with concomitant syringomyelia in adults is exceedingly rare. Early diagnosis and appropriate surgical treatment of this condition should be highlighted. Combined arachnoid adhesiolysis and endoscopic third ventriculostomy may be an effective approach.

scholarly journals Subdural Hematoma Complicating Ventriculoperitoneal Shunts: An Algerian Centers Experience

2020 ◽  
Vol 9 (03) ◽  
pp. 147-150
Author(s):  
Ibrahim Assoumane ◽  
M. Al-Zekri ◽  
A. Khelifa ◽  
N. Touati ◽  
N. Lagha ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Subdural Hematoma ◽  
Endoscopic Third Ventriculostomy ◽  
Brain Mri ◽  
Third Ventriculostomy ◽  
Ventriculoperitoneal Shunts ◽  
Operative Outcomes ◽  
Brain Ct Scan ◽  
Shunt Dysfunction

Abstract Introduction Subdural hematoma can occur as a complication of a ventriculoperitoneal shunt (VPS), and it should be considered in any patient who present a shunt dysfunction or who does not show the expected recovery after revision of a shunt. Computed tomography (CT) scan is a quick and easy way of detecting subdural hematoma. Materials and Methods We conduct a retrospective study of 17 patients. All of them are admitted for a subdural hematoma on a VPS. The diagnosis in 13 cases is made by CT scan; three cases by brain MRI. Results We operated 16 patients and the evacuation of the hematoma with revision of the shunt was performed; we used an adjustable shunt for three patients and endoscopic third ventriculostomy in one case. The operative outcomes were favorable in 12 patients; there were 4 recurrences, 2 of which required evacuation of the hematoma through a bone flap. Conclusion The subdural hematoma is a complication observed during the surgical treatment of the hydrocephalus and can be a serious issue. We suggest that a brain CT scan should be routinely performed in symptomatic patients with VPS.

Endoscopic third ventriculostomy in hydrocephalus associated with achondroplasia

2012 ◽  
Vol 9 (1) ◽  
pp. 73-81 ◽  
Author(s):  
Dale Swift ◽  
Laszlo Nagy ◽  
Brian Robertson
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Venous Pressure ◽  
Jugular Foramen ◽  
Foramen Magnum ◽  
Variable Pressure ◽  
Dural Sinus ◽  
Third Ventriculostomy ◽  
Suboccipital Decompression ◽  
Ventricle Size

Hydrocephalus in patients with achondroplasia is thought to be due to increased dural sinus venous pressure resulting from narrowing of the jugular foramen. In this setting, where hydrocephalus is presumed to be “vascular” in origin and therefore communicating, endoscopic third ventriculostomy (ETV) would seem contraindicated. The authors describe 3 patients in whom ETV was successfully performed, resulting in MR imaging–documented decreases in ventricle size. The patients were 11 months, 33 months, and 13 years at the time of surgery. All patients had serial preoperative MR images demonstrating progressive hydrocephalus in a “triventricular” pattern with a small fourth ventricle but an open aqueduct. All patients had undergone suboccipital decompression for foramen magnum stenosis prior to the treatment of hydrocephalus. Preoperative retrograde venography revealed variable pressure gradients across the jugular foramen. It is postulated that the increase in intracranial venous pressure resulting from jugular foramen stenosis may lead to disproportionate venous engorgement of the cerebellum and some degree of obstructive hydrocephalus amenable to ETV. The authors discuss the role of suboccipital decompression in the progression of hydrocephalus in patients with achondroplasia.

Late obstruction of an endoscopic third ventriculostomy stoma by metastatic seeding of a recurrent medulloblastoma

2010 ◽  
Vol 5 (6) ◽  
pp. 641-644 ◽  
Author(s):  
Flávio Nigri ◽  
Carlos Telles ◽  
Marcus André Acioly
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Rare Condition ◽  
Third Ventriculostomy ◽  
Unique Case ◽  
Tumor Seeding ◽  
The Third ◽  
Late Failure ◽  
Late Closure ◽  
Delayed Closure

Endoscopic third ventriculostomy (ETV) has been established as an effective method in the treatment of tumoral obstructive hydrocephalus. Delayed closure of the ETV stoma has been attributed to scarring involving the third ventricular floor. Secondary obstruction of the stoma due to intraventricular tumor seeding is an extremely rare condition, with only one case described to date. The authors report on a unique case of late closure of the ETV stoma caused by metastatic seeding of a recurrent medulloblastoma 9 years after the initial treatment. The patient was submitted to a second endoscopic procedure in which a reddish mass located just at the third ventricular floor was resected, leading to reopening of the previous ETV stoma. To the best of the authors' knowledge, this case is the first report of an ETV obstruction due to metastatic CSF seeding of a medulloblastoma. In such cases of late failure of the ETV stoma because of tumor obstruction, a second ETV can be safely performed and lead to adequate function of the stoma, even if limited by the aggressive nature of the disease.

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