Endoscopic aqueductoplasty and stenting in the treatment of isolated fourth ventricle in children: 20-year institutional experience

Imperato, Alessia; Ascencio, Luz Monserrat Almaguer; Ruggiero, Claudio; Spennato, Pietro; Martino, Giuliana Di; Aliberti, Ferdinando; Mirone, Giuseppe; Cinalli, Giuseppe

doi:10.1007/s00381-020-05024-4

Cited by 13 publications

(18 citation statements)

References 20 publications

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“…Conventionally, patients with IFV have been managed by fourth ventricle shunt placement or fenestration of the occluded outlet foramen via posterior fossa craniotomy ( 3 ). With the development of neuroendoscopic surgery, patients with IFV have also been treated with endoscopic procedures, including aqueductoplasty and aqueductal stenting ( 4 , 5 ).…”

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confidence: 99%

Hemangioblastoma of the medulla oblongata that caused isolated fourth ventricle after stereotactic radiosurgery: A case report

et al. 2023

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Isolated fourth ventricle is a rare complication following shunt insertion of the lateral ventricles for hydrocephalus. The present report describes a rare case of a hemangioblastoma of the medulla oblongata that caused isolated fourth ventricle due to intraventricular deposition of fibrin. A 34-year-old man presented with headache a month before admission. Magnetic resonance imaging indicated multiple tumors in the medulla oblongata and the bilateral cerebellar hemisphere with surrounding edema, and the patient was diagnosed with hemangioblastoma. The patient began to develop progressive headache and nausea after stereotactic radiosurgery, and computed tomography showed obstructive hydrocephalus. Endoscopic third ventriculostomy was performed, and the intraoperative view of this showed that the walls of the lateral and third ventricles were covered with a white membrane-like substance. Endoscopic third ventriculostomy and then ventriculoperitoneal shunt did not improve the hydrocephalus. The patient's consciousness deteriorated due to isolated fourth ventricle and upward herniation. The patient underwent posterior fossa craniotomy and the tumor in the medulla oblongata was removed via a telovelar approach. Intraoperatively, the fourth ventricle was filled with a white membrane-like substance, which was surgically removed and pathologically diagnosed as fibrin. The patient's consciousness and obstructive hydrocephalus improved after surgery. The present case suggests that isolated fourth ventricle may occur after VP shunt placement for the hydrocephalus with hyperproteinorachia.

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Section: Discussionmentioning

confidence: 99%

Hemangioblastoma of the medulla oblongata that caused isolated fourth ventricle after stereotactic radiosurgery: A case report

et al. 2023

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“…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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“…1-10 This condition is more frequently observed in shunted patients after postmeningitic or posthemorrhagic hydrocephalus of preterm infants. 2 When neuroimaging show progression or when symptoms of brainstem compression are present, surgery is highly recommended. 2-8 Considering this etiology, it is not uncommon that some patients present symptomatically to the hospital during an episode of shunt malfunction.…”

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confidence: 99%

“…2 When neuroimaging show progression or when symptoms of brainstem compression are present, surgery is highly recommended. [2][3][4][5][6][7][8] Considering this etiology, it is not uncommon that some patients present symptomatically to the hospital during an episode of shunt malfunction. In those patients with ventricular size enlargement, the shunt malfunction can provide a suitable scenario for the cotreatment of IFV by performing an endoscopic aqueductoplasty with a single panventricular catheter using a precoronal approach.…”

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Role of Endoscopic Aqueductoplasty With Panventricular Stent in the Treatment of Isolated Fourth Ventricle During Shunt Malfunction: 2-Dimensional Operative Video

Gomar-Alba

Carreño

Guil-Ibáñez

et al. 2023

Operative Neurosurgery

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Endoscopic aqueductoplasty with stent is an effective surgical technique for isolated fourth ventricle (IFV) treatment. [1][2][3][4][5][6][7][8][9][10] This condition is more frequently observed in shunted patients after postmeningitic or posthemorrhagic hydrocephalus of preterm infants. 2 When neuroimaging show progression or when symptoms of brainstem compression are present, surgery is highly recommended. [2][3][4][5][6][7][8] Considering this etiology, it is not uncommon that some patients present symptomatically to the hospital during an episode of shunt malfunction. In those patients with ventricular size enlargement, the shunt malfunction can provide a suitable scenario for the cotreatment of IFV by performing an endoscopic aqueductoplasty with a single panventricular catheter using a precoronal approach. In this operative video, we present a 10-month-old infant, previously treated by ventriculoperitoneal shunt after suffering posthemorrhagic and postmeningitic hydrocephalus, who presented at our institution with symptoms of shunt malfunction and progressive radiologic worsening of the IFV. Through a right precoronal approach, an endoscopic aqueductplasty with a refashioned panventricular stent was performed. The patient's guardians consented to the procedure and publication of the patient's image. During the surgical video, the tricks and technical issues that made the procedure more efficient and easier to perform are highlighted and discussed. Postoperative neuroimaging showed radiologic improvement after restoration of the cerebrospinal fluid circulation. In the early postoperative period, the patient presented transient dysconjugate ocular movements, which was completely restored during the first postoperative week. The patient had an excellent recovery and was discharged on postoperative day 4 after completing the magnetic resonance imaging study with no new neurological deficits.

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Endoscopic aqueductoplasty and stenting in the treatment of isolated fourth ventricle in children: 20-year institutional experience

Cited by 13 publications

References 20 publications

Hemangioblastoma of the medulla oblongata that caused isolated fourth ventricle after stereotactic radiosurgery: A case report

Hemangioblastoma of the medulla oblongata that caused isolated fourth ventricle after stereotactic radiosurgery: A case report

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

Role of Endoscopic Aqueductoplasty With Panventricular Stent in the Treatment of Isolated Fourth Ventricle During Shunt Malfunction: 2-Dimensional Operative Video

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