Endoscopic Fenestration of the 3rd Ventricular Floor in Aqueductal Stenosis

Kunz, Ulrich; Goldmann, A; Bader, C.; Waldbaur, H.; Oldenkott, P

doi:10.1055/s-2008-1053447

Cited by 74 publications

(34 citation statements)

References 5 publications

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“…The advantages of shunt-free treatment of hydrocephalus are obvious. In the last decade, various articles dealing with the advantages of endoscopic 3rd ventriculostomy have been published [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11]. In addition, some reports of successful 3rd ventriculostomy in communicating or unclear hydrocephalus exist [12, 13, 14, 15].…”

Section: Introductionmentioning

confidence: 99%

Extraventricular Intracisternal Obstructive Hydrocephalus – A Hypothesis to Explain Successful 3rd Ventriculostomy in Communicating Hydrocephalus

Kehler

Gliemroth

2003

Pediatr Neurosurg

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The basis of successful 3rd ventriculostomy in cases of communicating hydrocephalus is not yet understood. We performed 3rd ventriculostomies in 5 patients with free cerebrospinal fluid (CSF) communication from the ventricles to the cisterna magna. Preoperative magnetic resonance images (MRIs) showed dilated ventricles, a downward bulging floor of the 3rd ventricle (interpreted as a sign of pressure gradient between the ventricles and basal cisterns) and a free communication to an enlarged cisterna magna. The other basal cisterns were of normal or smaller size. All patients recovered from their clinical symptoms and none of them needed a shunt. The hypothesis of an intracisternal CSF pathway obstruction (e.g. between the cisterna magna and the prepontine cistern) could explain the MRI findings, although such an obstruction cannot be directly visualized. It would also explain the successful 3rd ventriculostomies in these cases.

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Section: Introductionmentioning

confidence: 99%

Extraventricular Intracisternal Obstructive Hydrocephalus – A Hypothesis to Explain Successful 3rd Ventriculostomy in Communicating Hydrocephalus

Kehler

Gliemroth

2003

Pediatr Neurosurg

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“…Many different neuroendoscopic indications have since been described, and reports on successful endoscopic treatments for various pathological entities such as obstructive hydrocephalus of any origin, 1,[4][5][6]8,10,13,17,[21][22][23]25,[29][30][31][32]38,40,42,48,51 arachnoid cysts, 2,7,9,12,20,24,26,28,35,39,46,47,50 septum pellucidum cysts, 14,19,34 and intra-and paraventricular tumors 16,33 have been frequent. Even in rare cystic lesions 18 or idiopathic normal pressure hydrocephalus, 18 successful CSF circulation restoration has been described with endoscopy.…”

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confidence: 99%

Endoscopic options in children: experience with 134 procedures

Oertel

Baldauf

Schroeder

et al. 2009

PED

106

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Object There are frequent applications for endoscopy in neurosurgery. However, endoscopic surgery in children has peculiar characteristics and is associated with different rates of success. In this study, the authors report on their experience with 134 consecutive endoscopy procedures performed in 126 patients < 18 years of age. Methods Between April 1993 and October 2007, 134 endoscopic procedures were performed in 126 children. Indications for surgery included brain tumors in 48 children, cystic lesions in 24, aqueductal stenosis in 23, various malformations in 20, hemorrhage and infarction in 6, and isolated ventricles in 5 children. In this long-term followup study, data were analyzed with respect to clinical and radiological success rates, as well as shunt dependence both in relation to lesion origin, and to the type of endoscopic procedure performed (endoscopic third ventriculostomy [ETV], septostomy, aqueductoplasty, or cystocisternostomy). Finally, the influence of patient age on the success rate was evaluated. Results In 114 patients, restoration of CSF circulation was the goal of endoscopy, but in 2 patients only ventriculoscopy was performed followed by ventriculoperitoneal shunt placement. In 12 of 114 patients, tumor biopsy sampling or resection was performed simultaneously with shunt placement. In another 12 patients, only endoscopic tumor resection without CSF circulation restoration was done. The follow-up period ranged from 1 to 6 years. Thirteen tumor biopsies, 7 partial tumor resections, and 4 endoscopically complete tumor resections were performed. An intraoperative switch to microsurgery was made in 2 patients because of recurrent hemorrhage and an overly time-consuming endoscopic surgery. Cerebrospinal fluid circulation was successfully restored in 81 (72%) of 112 patients, with the use of endoscopy in the setting of tumor-related hydrocephalus providing the best results (86% success rate). However, of the various endoscopic procedures, cyst openings (cystocisternostomy, cystoventriculostomy, and ventriculocystocisternostomy) provided the best results—superior even to ETV—with a success rate of 77% and no complications. In contrast, endoscopic aqueductoplasty had a high failure and complication rate. Patients < 6 months old who underwent ETV, septostomy, or aqueductoplasty had poor results and became more frequently shunt dependent than older children. Conclusions Overall, endoscopy can be considered safe and effective in children. Based on the authors' data, acute hydrocephalus cases such as those caused by tumors are the best candidates for endoscopic CSF flow restoration. Interestingly, cyst openings to the ventricles or cisterns were the most successful endoscopic techniques with the lowest complication rate. Aqueductoplasty should be reserved for selected cases. Finally, the success rate of endoscopic techniques remains poor in infants < 6 months of age; this was not only true of ETV, but also other techniques such as septostomy and aqueductoplasty.

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“…These range from type (rigid or flexible) and brand of the neuroendoscope used to the various tools used to open and dilate the floor of the third ventricle [3, 4, 5, 6, 14, 15, 16, 17, 18, 19]. In general, there are several ways to perform the procedure, and to a large part surgeon preference dominates the decision tree.…”

Section: Discussionmentioning

confidence: 99%

A Simple and Safe Technique for Endoscopic Third Ventriculocisternostomy

Wellons

Bagley

George³

1999

Pediatr Neurosurg

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A simple and safe technique for performing an endoscopic third ventriculocisternostomy is described using a small-diameter semirigid neuroendoscope in conjunction with a perforated ventricular catheter to bluntly fenestrate the floor of the third ventricle. All previous descriptions involve the initial use of an introducer sheath that in our experience lends to loss of cerebrospinal fluid, consequently distorting the anatomic landmarks of the third ventricle as well as compromising the crucial concave shape of its floor. Our technique limits the loss of cerebrospinal fluid volume, therefore, reducing the chance of basilar artery complex perforation as a consequence of distortion of third ventricular landmarks and loss of third ventricular floor concavity.

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Endoscopic Fenestration of the 3rd Ventricular Floor in Aqueductal Stenosis

Cited by 74 publications

References 5 publications

Extraventricular Intracisternal Obstructive Hydrocephalus – A Hypothesis to Explain Successful 3rd Ventriculostomy in Communicating Hydrocephalus

Extraventricular Intracisternal Obstructive Hydrocephalus – A Hypothesis to Explain Successful 3rd Ventriculostomy in Communicating Hydrocephalus

Endoscopic options in children: experience with 134 procedures

A Simple and Safe Technique for Endoscopic Third Ventriculocisternostomy

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