Neuroendoscopic options in myelomeningocele related hydrocephalus

Introduction: The use of neuroendoscopic for the management of myelomeningocele-associated hydrocephalus is still controversial. Anatomic variations and abnormalities of the ventricular system and the confusing topography of the floor of the third ventricle are of utmost importance in this approach. Case presentation: The present case video displayed a case of a 4-year-old girl with myelomeningocele related hydrocephalus presented with a closure of third ventriculostomy after tethered cord release. Several neuroendoscopic options were depicted such as third ventriculostomy using bipolar diathermia, ventriculocystostomy of a quadrigeminal arachnoid cyst and a choroid plexus cauterization as a strategy to improve the success rate of this procedure and handle the difficulties presented in this form of hydrocephalus. Discussion: This video warned the young neurosurgeons regarding ventricular anatomic challenges presented in this case as well as the need of customization of neuroendoscopic approach. Conclusion: Neuroendoscopic approach is an effective strategy to manage myelomeningocele-associated-hydrocephalus.

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Early Outcome of Endoscopic Third Ventriculostomy With or Without Choroid Plexus Cauterization and Ventriculoperitoneal Shunt as Primary Treatment of Hydrocephalus in Infants With Myelomeningocele

Neurosurgery ◽

10.1093/neuros/nyz310_347 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Bamidele O Adebayo ◽

Okezie Kanu ◽

Olufemi B Bankole ◽

Omotayo Ojo

Keyword(s):

Success Rate ◽

Choroid Plexus ◽

Ventriculoperitoneal Shunt ◽

Endoscopic Third Ventriculostomy ◽

Successful Outcome ◽

Csf Leak ◽

Third Ventriculostomy ◽

Prospective Longitudinal ◽

Choroid Plexus Cauterization

Abstract INTRODUCTION Myelomeningocele is associated with hydrocephalus in 35% to 90% of cases. Hydrocephalus is usually treated with insertion of ventriculoperitoneal shunt. However, endoscopic third ventriculostomy with or without choroid plexus cauterization is a viable alternative. METHODS A prospective longitudinal study from January 2016 to December 2018 on patients with myelomeningocele who presented to Lagos University Teaching Hospital, Nigeria and who had hydrocephalus.Informed consent for research and surgery were obtained. ETV with or without CPC or VPS was done with general anesthesia using standard operative techniques. Patients were followed up monthly for at least 6 mo. The surgery was adjudged failed if there was progressive head enlargement as well as other signs of hydrocephalus necessitating another surgery for hydrocephalus. RESULTS A total of 48 patients completed the study. A total of Six patients were lost to follow-up. Age range of the patients was 1 to 44 wk. A total of Five patients had ETV, 21 had ETV/CPC, and 22 patients had VPS. The mean OFC at the time of surgery were 45.3 cm and 44.9 cm for the endoscopic and VPS arms respectively. There were 2 (7.6%) cases of CSF leak in the endoscopic arm and 3 (13.6%) cases of wound dehiscence, with 1 (4.5%) case of CSF leak in the VPS arm. Mean age at surgery for ETV/CPC arm was 12.3 wand 11.5 wk for the VPS arm. Mean time to failure was 9.9 and 6.3 wk for endoscopic and VPS arms respectively. Four (80%) of the patients who had ETV had a successful outcome, 11 (52.3%) of those who had ETV/CPC had a successful outcome and 13 (59%) of those who had VPS had a successful outcome. At 6 mo follow up, overall success rate for the endoscopic arm was 57.6% and 59% for the VPS. CONCLUSION Endoscopic third ventriculostomy with or without choroid plexus cauterization had similar success rate with VPS at 6 mos.

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Predictors of endoscopic third ventriculostomy ostomy status in patients who experience failure of endoscopic third ventriculostomy with choroid plexus cauterization

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.2.peds18743 ◽

2019 ◽

Vol 24 (1) ◽

pp. 41-46

Author(s):

Andrew T. Hale ◽

Amanda N. Stanton ◽

Shilin Zhao ◽

Faizal Haji ◽

Stephen R. Gannon ◽

...

Keyword(s):

Choroid Plexus ◽

Endoscopic Third Ventriculostomy ◽

Third Ventricle ◽

Aqueductal Stenosis ◽

Third Ventriculostomy ◽

Time To Failure ◽

Chi Square ◽

Significant Difference ◽

Chi Square Test ◽

Choroid Plexus Cauterization

OBJECTIVEAt failure of endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC), the ETV ostomy may be found to be closed or open. Failure with a closed ostomy may indicate a population that could benefit from evolving techniques to keep the ostomy open and may be candidates for repeat ETV, whereas failure with an open ostomy may be due to persistently abnormal CSF dynamics. This study seeks to identify clinical and radiographic predictors of ostomy status at the time of ETV/CPC failure.METHODSThe authors conducted a multicenter, retrospective cohort study on all pediatric patients with hydrocephalus who failed initial ETV/CPC treatment between January 2013 and October 2016. Failure was defined as the need for repeat ETV or ventriculoperitoneal (VP) shunt placement. Clinical and radiographic data were collected, and ETV ostomy status was determined endoscopically at the subsequent hydrocephalus procedure. Statistical analysis included the Mann-Whitney U-test, Wilcoxon rank-sum test, t-test, and Pearson chi-square test where appropriate, as well as multivariate logistic regression.RESULTSOf 72 ETV/CPC failures, 28 patients (39%) had open-ostomy failure and 44 (61%) had closed-ostomy failure. Patients with open-ostomy failure were older (median 5.1 weeks corrected age for gestation [interquartile range (IQR) 0.9–15.9 weeks]) than patients with closed-ostomy failure (median 0.2 weeks [IQR −1.3 to 4.5 weeks]), a significant difference by univariate and multivariate regression. Etiologies of hydrocephalus included intraventricular hemorrhage of prematurity (32%), myelomeningocele (29%), congenital communicating (11%), aqueductal stenosis (11%), cyst/tumor (4%), and other causes (12%). A wider baseline third ventricle was associated with open-ostomy failure (median 15.0 mm [IQR 10.3–18.5 mm]) compared to closed-ostomy failure (median 11.7 mm [IQR 8.9–16.5 mm], p = 0.048). Finally, at the time of failure, patients with closed-ostomy failure had enlargement of their ventricles (frontal and occipital horn ratio [FOHR], failure vs baseline, median 0.06 [IQR 0.00–0.11]), while patients with open-ostomy failure had no change in ventricle size (median 0.01 [IQR −0.04 to 0.05], p = 0.018). Previous CSF temporizing procedures, intraoperative bleeding, and time to failure were not associated with ostomy status at ETV/CPC failure.CONCLUSIONSOlder corrected age for gestation, larger baseline third ventricle width, and no change in FOHR were associated with open-ostomy ETV/CPC failure. Future studies are warranted to further define and confirm features that may be predictive of ostomy status at the time of ETV/CPC failure.

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Quantitative Ventricular Neuroendoscopy Performed on the Third Ventriculostomy: Anatomic Study

Operative Neurosurgery ◽

10.1227/neu.0b013e318211449a ◽

2011 ◽

Vol 68 (suppl_2) ◽

pp. ons347-ons354 ◽

Cited By ~ 1

Author(s):

Alicia Del Carmen Becerra Romero ◽

Paulo Henrique Pires de Aguiar ◽

Tiago Bonini Borchartt ◽

Aura Conci

Keyword(s):

Choroid Plexus ◽

Third Ventricle ◽

Third Ventriculostomy ◽

Anatomic Study ◽

Endoscopic Intervention ◽

Mammillary Bodies ◽

The Third ◽

Infundibular Recess ◽

The University ◽

Third Ventricle Floor

Abstract Background: One of the key elements for a successful endoscopic intervention in the ventricular system is the ability to recognize the anatomic structures and use them as a reference. Objective: To measure the choroid plexus with endoscopy in the interventricular foramen, together with the structures on the third ventricle floor, and to compare these variables. Methods: An observational prospective study was carried out on 37 brains of cadavers for which the cause of death was assessed at the Death Check Unit of the University of São Paulo in April 2008. This study was done on adults of both sexes with a rigid neuroendoscope. Endoscopic images were recorded, submitted for correction of distortion, and then measured. Results: The measurements of the choroid plexus in the interventricular foramen, laterolateral distance of mammillary bodies, distance from the infundibular recess to the mammillary bodies, and area of the triangle in the tuber cinereum were 1.71 ± 0.77 mm, 2.23 ± 0.74 mm, 3.22 ± 0.82 mm, and 3.69 ± 2.09 mm2, respectively. The ventricle floor was opaque in 84% of cases. The internal distance of mammillary bodies was absent in 89%. Associations between the translucent floor of the third ventricle and laterolateral distance of mammillary bodies, internal distance of mammillary bodies, and age were identified. Conclusion: Before this research, there was no record of the measurements of the choroid plexus in the interventricular foramen. The remaining variables of the present study show a greater number in normal brains compared with others.

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Early outcome of combined endoscopic third ventriculostomy and choroid plexus cauterization in childhood hydrocephalus

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.10.peds14228 ◽

2015 ◽

Vol 15 (5) ◽

pp. 524-528 ◽

Cited By ~ 27

Author(s):

Olufemi B. Bankole ◽

Omotayo A. Ojo ◽

Mathias N. Nnadi ◽

Okezie O. Kanu ◽

John O. Olatosi

Keyword(s):

Spina Bifida ◽

Success Rate ◽

Choroid Plexus ◽

Endoscopic Third Ventriculostomy ◽

Subsequent Treatment ◽

Third Ventriculostomy ◽

Shunt Insertion ◽

Endoscopic Techniques ◽

Childhood Hydrocephalus ◽

Choroid Plexus Cauterization

OBJECT Although shunts have been the mainstay in treating hydrocephalus over the past 5 decades, the use of endoscopic techniques in addressing this disorder in children offers both the neurosurgeon and the patient a unique opportunity to avoid shunting and its attendant complications. The combination of endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) remains uncommon in most centers despite its potential promise. The authors sought to investigate the efficacy of combining ETV and CPC (ETV+CPC) in treating childhood hydrocephalus in Nigeria. Infection and spina bifida contribute a high percentage of the cases of hydrocephalus in Nigeria. METHODS Over a 2-year period, all children 0–18 years of age who had endoscopic treatment for hydrocephalus were prospectively evaluated to determine the need for subsequent treatment. Children who had the combination of ETV+CPC were identified as a subcategory and form the basis of this retrospective study. RESULTS Twenty-two of 38 endoscopically treated children had undergone the combination of ETV+CPC for hydrocephalus of varied etiology. There was a male preponderance (2.5:1), and 90% of the patients were infants. The overall success rate was 75%, with the best outcome in children with spina bifida. One child required a repeat ETV. CONCLUSIONS The combination of ETV+CPC is useful in treating children with hydrocephalus of varied etiology. The complication profile is acceptable, and the overall success rate is comparable to that associated with shunt insertion.

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A Successful Treatment of Endoscopic Third Ventriculostomy with Choroid Plexus Cauterization for Hydrocephalus in Walker-Warburg Syndrome

Case Reports in Neurological Medicine ◽

10.1155/2016/7627289 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5

Author(s):

Tomoko Tanaka ◽

Catharine J. Harris ◽

Sarah S. Barnett ◽

N. Scott Litofsky

Keyword(s):

Muscular Dystrophy ◽

Choroid Plexus ◽

Successful Treatment ◽

Endoscopic Third Ventriculostomy ◽

Third Ventricle ◽

Congenital Muscular Dystrophy ◽

Third Ventriculostomy ◽

Csf Flow ◽

Phenotypic Spectrum ◽

Choroid Plexus Cauterization

Walker-Warburg syndrome (WWS) is a rare autosomal recessive congenital muscular dystrophy with brain malformations and ocular abnormalities that falls under the wider phenotypic spectrum of the dystroglycanopathies. Mutations in a number of genes including POMT1, POMT2, POMGNT1, POMGNT2, FKTN, FKRP, LARGE, and ISPD are known to cause alpha dystroglycan-related muscular dystrophy. Mutations in these genes result in a broad phenotypic spectrum ranging from the severe WWS to a mild congenital muscular dystrophy with no brain involvement. WWS is fatal to most patients early in life with mean survival of 9 months. The most common brain finding is cobblestone lissencephaly with the vast majority of patients (97%) also having ventricular dilation with or without hydrocephalus. Surgical treatment has not been frequently detailed. This report describes our successful treatment of a patient with WWS and hydrocephalus with Endoscopic Third Ventriculostomy (ETV) with choroid plexus cauterization (CPC). Fourteen months following treatment, a follow-up MRI CSF flow study demonstrated robust CSF flow through floor of third ventricle from interpeduncular cistern to lateral ventricle.

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Experimental Third Ventriculostomy Performed Using Endovascular Surgical Techniques and Their Adaptation to Percutaneous Intradural Neuronavigation: Proof of Concept Cadaver Study

Neurosurgery ◽

10.1227/01.neu.0000073535.48663.ac ◽

2003 ◽

Vol 53 (2) ◽

pp. 387-392 ◽

Cited By ~ 8

Author(s):

Michael B. Horowitz ◽

Kamal Ramzipoor ◽

Ajit Nair ◽

Susan Miller ◽

George Rappard ◽

...

Keyword(s):

Third Ventricle ◽

Surgical Techniques ◽

Cadaver Study ◽

Brain Parenchyma ◽

Third Ventriculostomy ◽

General Anesthetic ◽

The Third ◽

Noncommunicating Hydrocephalus ◽

Pass Through ◽

The Brain

Abstract OBJECTIVE Endoscopic third ventriculostomy has developed into a therapeutic alternative to shunting for the management of carefully selected patients with primarily noncommunicating hydrocephalus. This procedure, however, requires a general anesthetic and necessitates violation of the brain parenchyma and manipulation near vital neural structures to access the floor of the third ventricle. Using two cadavers and off-the-shelf angiographic catheters, we sought to determine whether it was possible to navigate a catheter, angioplasty balloon, and stent percutaneously through the subarachnoid space from the thecal sac into the third ventricle so as to perform a third ventriculostomy from below. METHODS Using biplane angiography and off-the-shelf angiographic catheters along with angioplasty balloons and stents, we were able to pass a stent coaxially from the thecal sac to and across the floor of the third ventricle so as to achieve a third ventriculostomy from below. RESULTS Coaxial catheter techniques allowed for the percutaneous insertion of a stent across the floor of the third ventricle. Ventriculostomy was confirmed by injecting contrast medium into the lateral ventricle and seeing it pass through the stent and into the chiasmatic cistern. CONCLUSION We describe the performance of third ventriculostomies in two cadavers by use of the new concept of percutaneous intradural neuronavigation. This procedure may obviate the need for general anesthetic and minimize the potential for brain and vascular injury, especially if ultimately combined with magnetic resonance fluoroscopy.

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Choroid plexus papilloma of the third ventricle

Neurosurgery ◽

10.1097/00006123-198302000-00016 ◽

1983 ◽

Vol 12 (2) ◽

pp. 217???20 ◽

Cited By ~ 3

Author(s):

W C Gradin ◽

C Taylon ◽

A H Fruin

Keyword(s):

Choroid Plexus ◽

Third Ventricle ◽

Choroid Plexus Papilloma ◽

The Third ◽

Plexus Papilloma

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Anterior endoscopic transcortical approach to a pineal region cavernous hemangioma

Neurosurgical Focus: Video ◽

10.3171/2021.4.focvid215 ◽

2021 ◽

Vol 5 (1) ◽

pp. V15

Author(s):

Jiuhong Li ◽

Jiaojiang He ◽

Lunxin Liu ◽

Liangxue Zhou

Keyword(s):

Cavernous Hemangioma ◽

Endoscopic Third Ventriculostomy ◽

Third Ventricle ◽

Pineal Region ◽

Postoperative Adhesion ◽

Third Ventriculostomy ◽

Back Side ◽

Coronal Suture ◽

The Third ◽

Transcortical Approach

A 57-year-old female presented with headache and dizziness for 3 months. Preoperative MRI revealed a lesion located at the pineal region and back side of the third ventricle, accompanied by hydrocephalus. The infratentorial supracerebellar approach may cause visuomotor, acousticomotor, and hearing disturbances. With the patient in a supine position, the authors used a frontal linear incision that was 3 cm anterior to the coronal suture and 2 cm away from the midline and an anterior endoscopic transcortical approach, which could achieve endoscopic third ventriculostomy, alleviating and preventing hydrocephalus due to postoperative adhesion and resection of the lesion at the same time. The pathological diagnosis was cavernous hemangioma. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID215.

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