Efficacy of Endoscopic Third Ventriculostomy in Fourth Ventricular Outlet Obstruction

Mohanty, Aaron; Biswas, Anup; S, Satish; Vollmer, Dennis G.

doi:10.1227/01.neu.0000333262.38548.e1

Cited by 64 publications

(69 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6,9) A late symptomatic presentation is supposedly explained by a late decompensation of the semipermeable property of these congenital or acquired membranes. 4,5,8) In accordance with this theory, the age range of our patients was between 21 years and 44 years.…”

Section: Discussionsupporting

confidence: 80%

“…7) Hydrocephalus resulting from FVOO is commonly observed to have a postinfectious or posthemorrhagic etiology in infants and young children although the secondary causes of obstruction are more common. 4) In adults, the occlusion is rather acquired than congenital, linked to infection, head trauma, intraventricular hemorrhage, tumors, or Chiari malformation.…”

Section: Discussionmentioning

confidence: 99%

“…Congenital occlusive lesions occur primarily in children and are seen mainly in association with Chiari malformations, Dandy-Walker cysts, tuberous sclerosis, spina bifida, platybasia, acondroplasia, basilar impression, and atlantooccipital fusion. [1][2][3][4][5][6] Idiopathic stenosis or closure of the foramina of Magendie and Luschka indicated upper extremity paresis and hyperactive reflexes, bilaterally Hoffmann's sign. The proximal muscle group was 4/5, and distal group was 2/5.…”

Section: Introductionmentioning

confidence: 99%

“…Histopathological evaluation of the membrane has revealed neural tissue and gliosis without any active inflammation. 4) The treatment for these malformations is still controversial. Hydrocephalus can be treated with cerebro-spinal fluid (CSF) shunting, opening the membranes with suboccipital craniotomy, placement of a catheter, and endoscopic third ventriculostomy (ETV) or endoscopic fourth ventriculostomy.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Fourth Ventriculostomy in Occlusion of the Foramen of Magendie Associated with Chiari Malformation and Syringomyelia

Orakdogen¹,

Emon²,

Erdoğan³

et al. 2015

NMC Case Report Journal

View full text Add to dashboard Cite

is a rare cause of obstructive hydrocephalus.7) However, a distinct subgroup of patients present with radiological evidence of FVOO, in their adulthood, without any significant underlying etiology.3) It is most often seen associated with an underlying pathology that is responsible for the inflammation and scarring of the outlet foramina; however, there have been a few reports in which no predisposing causes have been identified. Histopathological evaluation of the membrane has revealed neural tissue and gliosis without any active inflammation. 4)The treatment for these malformations is still controversial. Hydrocephalus can be treated with cerebro-spinal fluid (CSF) shunting, opening the membranes with suboccipital craniotomy, placement of a catheter, and endoscopic third ventriculostomy (ETV) or endoscopic fourth ventriculostomy. Materials and MethodsInformed patient consent was obtained for this procedure. All patients' data are summarized in Table 1. A 40-year-old man approached us with complaints of headache and neck pain. The patient's neurological examination was normal. Magnetic resonance imaging (MRI) revealed tetraventricular hydrocephalus, dilatation level of aquaductus Sylvii, tonsillar ectopia, and compression to the brain stem and cerebellum, and a membrane causing an obstruction at the level of foramen Magendie. Cervical MRI showed syringomyelia between C1 and C7. Cine-MR revealed no CSF f low through the foramen Magendie and foramen magnum. At the level of aquaductus Sylvii, turbulence, and tertiary flow were observed.Second patient; a 44-year-old woman presented with weakness in bilateral upper extremity. She complained of numbness in the arms, defect in discriminating between hot and cold, and difficulty in swallowing. MRI showed tetraventricular hydrocephalus, tonsillar ectopia, and syringomyelia between C1 and L1. Neurological examination showed left 11th and 12th cranial nerve deficiency, reduced GAG reflex, quadriparesis, hyperactive reflexes, and bilaterally ankle clonus.Third patient; a 33-year-old woman complained of headache. MRI revealed tetraventricular hydrocephalus and Chiari Type I malformation with syringomyelia between C1 and C5. Neurological examination was normal.Fourth patient; a 21-year-old man presented with weakness in the hands and urinary incontinence. MRI demonstrated tetraventricular hydrocephalus, tonsillar ectopia, and syringomyelia between C1 and L1. Neurological examinationWe present four cases of hydrocephalus caused by occlusion of foramen of Magendie associated with Chiari Type I malformation and syringomyelia. The aim of this study is to evaluate the results of surgical treatment via fourth ventriculostomy with catheter from the fourth ventricle to the upper cervical subarachnoid space. Obstructive tetraventricular hydrocephalus due to occlusion of the foramina of Luschka and Magendie can be treated with cerebro-spinal fluid shunting, opening the membranes with suboccipital craniotomy, placement of a catheter, endoscopic third ventriculostomy, and endoscopic four...

show abstract

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Fourth Ventriculostomy in Occlusion of the Foramen of Magendie Associated with Chiari Malformation and Syringomyelia

Orakdogen¹,

Emon²,

Erdoğan³

et al. 2015

NMC Case Report Journal

View full text Add to dashboard Cite

show abstract

“…34,42 However, cases of loculated hydrocephalus are more complex and challeng- ing. 11 Enlarging loculated components of the ventricular system along with trapped ventricles require fenestration to establish communication between these areas and other compartments within the ventricular system that are able to absorb CSF, or to use a single ventriculoperitoneal shunt catheter.…”

Section: Hydrocephalusmentioning

confidence: 99%

Emerging technology in intracranial neuroendoscopy: application of the NICO Myriad

Dlouhy¹,

Dahdaleh²,

Greenlee³

2011

FOC

View full text Add to dashboard Cite

Improvement in fiber optics and imaging paved the way for tremendous advancements in neuroendoscopy. These advancements have led to increasingly widespread use of the endoscope in neurosurgical procedures, which in turn incited a technological revolution leading to new approaches, instruments, techniques, and a diverse armamentarium for the treatment of a variety of neurosurgical disorders. Soft-tissue removal is often a rate-limiting aspect to endoscopic procedures, especially when the soft tissue is dense or fibrous. The authors review a series of cases involving patients treated between August 2009 and October 2010 with a new device (the NICO Myriad), a non–heat-generating, oscillating, cutting, and tissue removal instrument that can be used through the working channel of the endoscope as well as in open neurosurgical procedures. They used this device in 14 purely endoscopic intracranial procedures and 1 endoscope-assisted keyhole craniotomy. They report that the device was easy to use and found that tissue resection was more efficient than with other available endoscopic instruments, especially in the resection of fibrotic tissue. There were no observed device-related complications. The authors discuss the technical aspects of using this device in endoscopic resection of pituitary tumors, craniopharyngiomas, and colloid cysts. They also demonstrate its use in hydrocephalus and intraventricular clot removal and discuss its potential use in other neurosurgical disorders.

show abstract

The endoscopic treatment of fourth ventricle outlet obstruction: Report of two children and systematic review

Mulhem,

Alsulaiman,

Hammersen

et al. 2023

Clinical Case Reports

View full text Add to dashboard Cite

Key Clinical MessageFourth ventricle outlet obstruction (FVOO) is a rare cause of hydrocephalus. In the last century, the standard treatment was the suboccipital craniotomy with magendieplasty or ventriculoperitoneal shunt (VP shunt). Since the beginning of the 21st century, the endoscopic third ventriculostomy (ETV) has been considered a less invasive alternative. The medical literature lacks sufficient reports of FVOO cases and strong evidence about ETV's efficacy in treating this condition. We report two cases of FVOO treated with ETV and review published similar cases. Clinical and radiological findings of two FVOO cases with outcomes after ETV were presented. Moreover, we conducted a systematic review after protocol registration in PROSPERO (CRD42021281474). MEDLINE, Embase, Scopus, and Web of Science were searched from inception till December 31, 2022. Studies were included if they reported cases of FVOO treated initially with ETV. Cases with Chiari malformation, Dandy‐Walker malformation, tuberous sclerosis, trapped fourth ventricle, or space‐occupying lesions were excluded. Two reviewers independently examined title/abstract records in the first stage and full‐text publications in the second for eligibility. The primary outcome was the recurrence rate, defined by the need for re‐ETV or other invasive treatments (e.g., VP shunt or magendieplasty). Other outcomes included clinical state at follow‐up and mortality. Two cases, a 3‐year‐old male and 3.5‐year‐old female, with FVOO, were treated with ETV in our department by the same neurosurgeon (SH) in 2013 and 2021. Both cases improved significantly after ETV, and there was no recurrence through the follow‐up. Besides the present cases, we found 57 other cases of FVOO treated with ETV reported in 17 studies between 2001 and 2021. The median age was 26 years, with an IQR from 2.4 to 59 years, and 56% of cases were females. The recurrence rate was 32% in the sample (19 out of 59), with a 95% CI from 21% to 46%. The median time to recure was 2 months with IQR from 1.25 to 26. A VP shunt was the treatment for recurrence in 68% and a re‐ETV in 32%. At the follow‐up (41 ± 29 months), only one case died, and one deteriorated clinically. FVOO is a rare cause of hydrocephalus encountered mainly in the first or sixth decades of life. ETV provides the first reasonable treatment. Despite the moderate recurrence rate, the outcomes are favorable.

show abstract

Efficacy of Endoscopic Third Ventriculostomy in Fourth Ventricular Outlet Obstruction

Cited by 64 publications

References 21 publications

Fourth Ventriculostomy in Occlusion of the Foramen of Magendie Associated with Chiari Malformation and Syringomyelia

Fourth Ventriculostomy in Occlusion of the Foramen of Magendie Associated with Chiari Malformation and Syringomyelia

Emerging technology in intracranial neuroendoscopy: application of the NICO Myriad

The endoscopic treatment of fourth ventricle outlet obstruction: Report of two children and systematic review

Contact Info

Product

Resources

About