Endoscopic Treatment of Isolated Fourth Ventricle

Schulz, Matthias; Goelz, Leonie; Spors, Birgit; Haberl, Hannes; Thomale, Ulrich‐Wilhelm

doi:10.1227/neu.0b013e318236717f

Cited by 41 publications

(22 citation statements)

References 31 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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“…17,18 Rapid change in ventricle size has been reported as a possible association with an increased chance of stent dislodgement. 22 To avoid stent migration, we advise fixation of the stent to a bur hole reservoir (Fig. 6) that also allows the clinician to tap CSF from the reservoir, if necessary, without the patient who has experienced acute neurological decompensation having to undergo another operation.…”

Section: Stent Placement Is a Safe Procedures During Neuroendoscopymentioning

confidence: 99%

“…The best-studied stenting procedure is aqueductal stenting in the setting of triventricular hydrocephalus and in cases of isolated fourth ventricles in children, which is known to be technically feasible and has shown good results in long-term follow-up. 2,9,13,18,22 Limited reports exist, however, about the value and outcome of endoscopic stent placement in adults.We present the first series of neuroendoscopic stent placement in adults from a single center over 20 years. The aim of the present study was to identify favorable indications for neuroendoscopic stent placement in adults, including operative results, complications, and clinical outcomes data.…”

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Neuroendoscopic stent placement for cerebrospinal fluid pathway obstructions in adults

Marx

Fleck

Refaee

et al. 2016

JNS

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Since its revival in the early 1990s, neuroendoscopy has become an integral component of modern neurosurgery. 7,16,19 Various endoscopic techniques have been described and are frequently used for the treatment of CSF circulation disorders including third ventriculostomy, septostomy, lamina terminalis fenestration, temporal ventriculostomy, foraminoplasty of the foramen of Monro, and aqueductoplasty. 21 Endoscopic placement of indwelling stents, however, is a rarely performed, but nonetheless valuable, procedure. The best-studied stenting procedure is aqueductal stenting in the setting of triventricular hydrocephalus and in cases of isolated fourth ventricles in children, which is known to be technically feasible and has shown good results in long-term follow-up. 2,9,13,18,22 Limited reports exist, however, about the value and outcome of endoscopic stent placement in adults.We present the first series of neuroendoscopic stent placement in adults from a single center over 20 years. The aim of the present study was to identify favorable indications for neuroendoscopic stent placement in adults, including operative results, complications, and clinical outcomes data.abbreviatioNs AC = arachnoid cyst; ETV = endoscopic third ventriculostomy. results Of 526 endoscopic intraventricular procedures, stents were placed for treatment of CSF disorders in 25 cases (4.8%). The technique was used in the management of arachnoid cysts (ACs; n = 8), tumor-related CSF disorders (n = 13), and hydrocephalus due to stenosis of the foramen of Monro (n = 2) or aqueduct (n = 2). The mean follow-up was 87.1 months. No deaths or infections occurred that were related to endoscopic placement of intracranial stents. Late stent dislocation or migration was observed in 3 patients (12%). coNclusioNs Endoscopic intracranial stent placement in adults is rarely required but is a safe and helpful technique in select cases. It is indicated when reliable and long-lasting restoration of CSF pathway obstructions cannot be achieved with standard endoscopic techniques. In the treatment of tumor-related hydrocephalus, it is a good option to avoid reclosure of the restored CSF pathway by tumor growth. Currently, routine stent placement after endoscopic fenestration of ACs is not recommended. Stent placement for treatment of CSF disorders due to tumor is a good option for avoiding CSF shunting. To avoid stent migration and dislocation, and to allow for easy removal if needed, the device should be fixed to a bur hole reservoir.

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Endoscopic Treatment of Isolated Fourth Ventricle

Abstract: The clinical and radiological outcomes after endoscopic aqueductoplasty and interventriculostomy in children with an isolated fourth ventricle indicate that this procedure is feasible, effective, and safe.

Cited by 41 publications

References 31 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

Neuroendoscopic stent placement for cerebrospinal fluid pathway obstructions in adults

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