Aqueduct Stent Placement: Indications, Technique, and Clinical Experience

Geng, Jiefeng; Wu, Dongdong; Chen, Xiaolei; Zhang, Meng; Xu, Bainan; Yu, Xin-guang

doi:10.1016/j.wneu.2015.06.031

Cited by 11 publications

(10 citation statements)

References 18 publications

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“…Endoscopic stenting could therefore be a secondline option after ETV and shunt revisions in selected cases of posthemorrhagic hydrocephalus. Prevention of aqueductal stenosis and treatment of mesencephalic syndrome in diencephalic tumors are also good indications for EAS in this series and published studies, 11 because these tumors may not always be amenable to sufficient resection to open the aqueduct or may relapse despite adequate treatment.…”

Section: Discussionmentioning

confidence: 90%

“…As far as the surgical technique is concerned, we used the precoronal endoscopic approach, which is suitable for children with hydrocephalus and enlarged ventricles as previously described, and we emphasize the utility of neuronavigation for both stent preparation and adequate placement of entry points. 4,[9][10][11] This is only a slight varia -FIG. 2.…”

Section: Discussionmentioning

confidence: 96%

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Endoscopic aqueductal stenting in the management of pediatric hydrocephalus

Guida

Benichi

Chivet

et al. 2020

Journal of Neurosurgery: Pediatrics

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OBJECTIVEPediatric patients with long-term shunts may experience specific complications related to the segregation of the supra- and infratentorial spaces along with different pressure regimens, leading to either mesencephalic syndromes during shunt dysfunction or isolated fourth ventricle (IFV). An accepted treatment to reestablish normal CSF pathways and reequilibrate the transtentorial pressures is endoscopic aqueductal stenting (EAS) to avoid restenosis. In the present paper, the authors studied children treated with EAS during the last decade for both IFV and obstructive hydrocephalus, evaluated its impact on the course of the disease, and identified prognostic factors for EAS success.METHODSA noninterventional retrospective study of routinely acquired data was performed, including all hydrocephalic children undergoing EAS between 2011 and 2019 at Hôpital Necker, Paris, France. The following variables were analyzed: etiology of hydrocephalus; number of surgeries before and after stent placement; indication for EAS; type of stent connection (i.e., connected or not to a ventriculoperitoneal shunt); and the stent position. Stent failure was defined as the need to perform further shunt revision. Univariate and multivariate analyses were run to identify factors associated with stent failure.RESULTSSeventeen patients with a mean age at stent placement of 6 years (SD 6.5 years, range 1 month–18 years) and with a mean follow-up after EAS of 47.5 months (SD 33.7 months, range 5–120 months) were included in the analysis. The etiology of hydrocephalus was as follows: obstructive tumoral (41%), posthemorrhagic (35%), postinfectious (12%), and dysraphism related (12%). The indication for EAS was IFV (47%), rostral midbrain dysfunction syndrome (35%), prevention of secondary aqueductal stenosis after debulking surgery (12%), or primary aqueductal stenosis (6%). No transient or permanent neurological deficits related to the procedure were observed. After EAS, 10 patients did not require further surgeries (59%), and for the others the number of hydrocephalus-related surgeries significantly decreased after stenting. In univariate analysis posthemorrhagic etiology and prevention of aqueductal stenosis were identified as predictors of a good outcome, whereas in multivariate analysis posthemorrhagic hydrocephalus was found to predict a favorable outcome.CONCLUSIONSThe results confirm EAS as a first-line treatment for IFV and suggest its efficacy in changing the history of hydrocephalic patients who have undergone multiple operations and who experience rostral midbrain dysfunction syndrome, as well as efficacy in the prevention of aqueductal stenosis in selected cases of obstructive tumoral hydrocephalus.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 96%

Endoscopic aqueductal stenting in the management of pediatric hydrocephalus

Guida

Benichi

Chivet

et al. 2020

Journal of Neurosurgery: Pediatrics

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“…Uniform consensus regarding the best endoscopic approach fails, and the debate concerning the optimal technique paradigm for periaqueductal tumor-related AS-related CSF impairment remains unsolved (Table 1). Geng and colleagues [15] reported on 8 patients (children and adults) who underwent endoscopic TAS. In three of these cases, the aqueductal stent was indicated by intraventricular tumorrelated AS and was successfully placed using a rigid lens Lotta endoscope through a frontal burr hole approach.…”

Section: Discussionmentioning

confidence: 99%

“…Three main endoscopic techniques, namely aqueductoplasty, transaqueductal stenting (TAS), and fenestration into the lateral ventricle have been proposed [8,11,23,40]. Endoscopic TAS has become a valuable treatment option for a selected subset of AS [4][5][6]8,22] and favorable clinical and radiological results have been recently reported [2,8,12,15,22,27,20,34,37 ]. The outcome and prognosis of patients with aqueductal stenosis are highly variable and depending on several factors.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic transaqueductal stent placement for tumors-related aqueductal compression in pediatric patients. Surgical consideration, technique, and results

Prajsnar-Borak,

Schroeder,

Oertel

2023

Preprint

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Purpose: Endoscopic transaqueductal stenting has become a well-accepted treatment option for a selected small subset of aqueductal stenosis-related obstructive hydrocephalus. However, transaqueductal stenting poses unique challenges and risks which requires critical consideration. This report discusses the clinical experiences with tranaqueductal stenting for periaqueductal tumor-related aqueductal stenosis focusing on pediatric patients. Methods: A retrospective analysis of all patients undergoing endoscopic TAS from 01/1993–01/2022 in the author’s departments was performed. Demographic, clinical, radiological, and intraoperative endoscopic data were evaluated. All patients with AS-related occlusive hydrocephalus that was treated with TAS were analyzed and prospectively followed. Special attention has been given to providing insights into indications, surgical technique, and limitations. Results: Out of 28 endoscopic transaqueductal endoscopis stenting procedures, five procedures were performed on periaqueductal tumor-related obstructive hydrocephalus, two children and three adult patients. CSF pathway was obstructed by tumor located in the aqueduct in 2, by tumor in the thalamus/mesencephalon in 1, by a tumor within the third ventricle in 1 and by a tumor of the lamina tecti in 1. Simultaneously with transaqueductal stenting, 2 endoscopic third ventriculostomies (ETV), 3 tumor biopsies, 1 tumor resection were performed. Postoperative complications included; CSF fistula (1 case), and asymptomatic fornix contusion (1 case). A working aqueductal stent was achieved in all cases based on clinical follow up evaluation. Postoperatively, all patients showed improvement or resolution of their symptoms. The mean follow-up period was 25,2 months (range, 1–108 months). One patient died due to tumor progression during early follow up. No stent migration was seen. Conclusion: Endoscopic third ventriculostomy remains the gold standard for treatment of CSF circulation obstrctions with lesions in the posterior third ventricle and aqueduct. Transaqueductal stenting for periaqueductal tumors-related aqueductal compression is technically feasible. However, because of the potential high risks and subtle advantages compared with ETV transaqueductal stenting might be indicated in a small subset of well-selected patients if alternative treatment options are not at hand.

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“…Those patients would better be treated with ETV Patients with IFV have a significant restenosis rate after aqueductoplasty. Therefore, aqueduct stenting is recommended Two transient and one permanent oculomotor nerve palsy One asymptomatic posterior fossa subdural hygroma 24 months Geng et al [ 26 ], 2015 8 Adults and children Intraventricular tumor (3) Intraventricular cysticercosis (2) Membranous AS (3) 6 mm diameter rigid lens (LOTTA, Karl Storz, Tuttlingen, Germany) Frontal bur hole All patients showed improvement, no recurrence of aqueductal obstruction Stent migration (1 case) Transient mutism (2 cases) Transient oculomotor nerve palsy (1 case) 27 months (1–51 months) Our series 5 Children (2) Adults ( 3) Periaqueductal tumor (5) Gaab and Flexible endoscope, (Karl Storz, Tuttlingen, Germany Frontal precoronal Optimal TAS was achieved in all cases. Simultaneously with TAS, 2 ETV, 3 tumor biopsies, 1 tumor resection, and 1 aqueductoplasty have been proceeded.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic transaqueductal stent placement for tumor-related aqueductal compression in pediatric patients: surgical consideration, technique, and results

Prajsnar-Borak,

Schroeder,

Oertel

2023

Childs Nerv Syst

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Purpose Endoscopic transaqueductal stenting has become a well-accepted treatment option for a selected small subset of aqueductal stenosis-related obstructive hydrocephalus. However, transaqueductal stenting poses unique challenges and risks which requires critical consideration. This report discusses the clinical experiences with transaqueductal stenting for periaqueductal tumor-related aqueductal stenosis focusing on pediatric patients. Methods A retrospective analysis of all patients undergoing endoscopic TAS from 01/1993 to 01/2022 in the author’s departments was performed. Demographic, clinical, radiological, and intraoperative endoscopic data were evaluated. All patients with AS-related occlusive hydrocephalus that was treated with TAS were analyzed and prospectively followed. Special attention has been given to providing insights into indications, surgical technique, and limitations. Results Out of 28 endoscopic transaqueductal endoscopis stenting procedures, five procedures were performed on periaqueductal tumor-related obstructive hydrocephalus, two children and three adult patients. CSF pathway was obstructed by tumor located in the aqueduct in 2, by tumor in the thalamus/mesencephalon in 1, by a tumor within the third ventricle in 1, and by a tumor of the lamina tecti in 1. Simultaneously with transaqueductal stenting, 2 endoscopic third ventriculostomies (ETV), 3 tumor biopsies, and 1 tumor resection were performed. Postoperative complications included the following: CSF fistula (1 case), and asymptomatic fornix contusion (1 case). A working aqueductal stent was achieved in all cases based on clinical follow-up evaluation. Postoperatively, all patients showed improvement or resolution of their symptoms. The mean follow-up period was 25.2 months (range, 1–108 months). One patient died due to tumor progression during early follow-up. No stent migration was seen. Conclusion Endoscopic third ventriculostomy remains the gold standard for treatment of CSF circulation obstructions with lesions in the posterior third ventricle and aqueduct. Transaqueductal stenting for periaqueductal tumor-related aqueductal compression is technically feasible. However, because of the potential high risks and subtle advantages compared with ETV transaqueductal stenting, it might be indicated in a small subset of well-selected patients if alternative treatment options are not at hand.

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Aqueduct Stent Placement: Indications, Technique, and Clinical Experience

Cited by 11 publications

References 18 publications

Endoscopic aqueductal stenting in the management of pediatric hydrocephalus

Endoscopic aqueductal stenting in the management of pediatric hydrocephalus

Endoscopic transaqueductal stent placement for tumors-related aqueductal compression in pediatric patients. Surgical consideration, technique, and results

Endoscopic transaqueductal stent placement for tumor-related aqueductal compression in pediatric patients: surgical consideration, technique, and results

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