Endoscopic Aqueductoplasty and Interventriculostomy for the Treatment of Isolated Fourth Ventricle in Children

Fritsch, Michael; Kienke, Sven; Manwaring, Kim H.; Mehdorn, H. Maximilian

doi:10.1227/01.neu.0000130444.71677.bc

Cited by 83 publications

(48 citation statements)

References 13 publications

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“…Recent series of endoscopic treatment for TFV suggest a success rate of 25% to 33% over 9.8 to 29.7 months with aqueductoplasty alone, but as high as 71% to 100% when aqueductoplasty or interventriculostomy was followed by fourth ventricular stenting. 4,11,30 Ogiwara and Morota studied 8 pediatric patients who underwent endoscopic stent placement for TFV (n = 5) or pre-TFV (aqueduct still patent) (n = 3). They found that all patients experienced improvement in symptoms and reduction in fourth ventricular size with reoperation in 33% of patients over a mean follow-up of 49.6 months.…”

Section: Discussionmentioning

confidence: 99%

Frequency and long-term follow-up of trapped fourth ventricle following neonatal posthemorrhagic hydrocephalus

Pomeraniec

Ksendzovsky

Ellis

et al. 2016

PED

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OBJECTIVE Intraventricular hemorrhage (IVH) is a common complication of premature neonates with small birth weight, which often leads to hydrocephalus and treatment with ventriculoperitoneal (VP) shunting procedures. Trapped fourth ventricle (TFV) can be a devastating consequence of the subsequent occlusion of the cerebral aqueduct and foramina of Luschka and Magendie. METHODS The authors retrospectively reviewed 8 consecutive cases involving pediatric patients with TFV following VP shunting for IVH due to prematurity between 2003 and 2012. The patients ranged in gestational age from 23.0 to 32.0 weeks, with an average age at first shunting procedure of 6.1 weeks (range 3.1–12.7 weeks). Three patients were managed with surgery. Patients received long-term radiographic (mean 7.1 years; range 3.4–12.2 years) and clinical (mean 7.8 years; range 4.6–12.2 years) follow-up. RESULTS The frequency of TFV following VP shunting for neonatal posthemorrhagic hydrocephalus was found to be 15.4%. Three (37.5%) patients presented with symptoms of posterior fossa compression and were treated surgically. All of these patients showed signs of radiographic improvement with stable or improved clinical examinations during postoperative follow-up. Of the 5 patients treated conservatively, 80% experienced stable ventricular size and 1 patient experienced a slight increase (3 mm) on imaging. All of the nonsurgical patients showed stable to improved clinical examinations over the follow-up period. CONCLUSIONS The frequency of TFV among premature IVH patients is relatively high. Most patients with TFV are asymptomatic at presentation and can be managed without surgery. Symptomatic patients may be treated surgically for decompression of the fourth ventricle.

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Section: Discussionmentioning

confidence: 99%

Frequency and long-term follow-up of trapped fourth ventricle following neonatal posthemorrhagic hydrocephalus

Pomeraniec

Ksendzovsky

Ellis

et al. 2016

PED

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“…In fact, an internal CSF diversion channel for trapped fourth ventricle may be achieved with aqueductoplasty, with or without aqueductal stent placement, or by fenestration of the superior medullary velum. 3,6,7,20,22,24 This procedure is not devoid of complications; it carries a risk of midbrain injury, with neurological defects such as dysconjugate eye movement and Parinaud syndrome. It may be performed by approaching the aqueduct from above, when the supratentorial ventricles are dilated, or from below with a suboccipital approach, usually when a working CSF shunting device is present.…”

Section: Discussionmentioning

confidence: 99%

Descending transtentorial herniation, a rare complication of the treatment of trapped fourth ventricle: case report

Frassanito

Markogiannakis

Bonaventura

et al. 2015

PED

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Descending transtentorial herniation (DTH) is a complication of raised pressure in the supratentorial compartment, usually resulting from mass lesion of several etiologies. The authors report an exceptional case of DTH complicating the implant of a CSF shunting device in the trapped fourth ventricle of a 17-year-old boy in whom a second CSF shunting device had been implanted for neonatal posthemorrhagic and postinfectious hydrocephalus. The insidious clinical and radiological presentation of DTH, mimicking a malfunction of the supratentorial shunt, is documented. Ultimately, the treatment consisted of removal of the infratentorial shunt and endoscopic acqueductoplasty with stenting. The absence of supratentorial mass lesion and other described etiologies of DTH prompted the authors to speculate on the hydrodynamic pathogenesis of DTH in the present case.

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“…Shunting of the fourth ventricle has long been advocated as the procedure of choice; 4,7,8 however, this procedure has a high rate of associated shunt malfunction, requiring revision in up to 40% of patients within the first year, 9 and significant complications have been described. 1,10-13 Endoscopic approaches have been utilised: aqueductoplasty, aqueductal stent placement, lateral ventricle fenestration, [14][15][16][17][18] and third ventriculostomy. 19 There are, however, high rates of failure and significant complications 17 21 The dura was closed with a dural graft.…”

Section: Discussionmentioning

confidence: 99%

Cranio-cervical decompression and expansile duroplasty for isolated fourth ventricle in a patient with Chiari II malformation

Banh¹,

Brophy²

2013

Journal of Clinical Neuroscience

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Endoscopic Aqueductoplasty and Interventriculostomy for the Treatment of Isolated Fourth Ventricle in Children

Cited by 83 publications

References 13 publications

Frequency and long-term follow-up of trapped fourth ventricle following neonatal posthemorrhagic hydrocephalus

Frequency and long-term follow-up of trapped fourth ventricle following neonatal posthemorrhagic hydrocephalus

Descending transtentorial herniation, a rare complication of the treatment of trapped fourth ventricle: case report

Cranio-cervical decompression and expansile duroplasty for isolated fourth ventricle in a patient with Chiari II malformation

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