Neuroendoscopic septostomy: Indications and surgical technique

Giammattei, Lorenzo; Aureli, Viviana; Daniel, Roy Thomas; Messerer, Mahmoud

doi:10.1016/j.neuchi.2018.02.004

Cited by 7 publications

(10 citation statements)

References 9 publications

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“…Giammattei et al provide a modern and detailed account of the relevant anatomy and indications for endoscopic septostomy. 8 Others have previously described the relevant anatomy of the lateral ventricles and septum pellucidum. 9,10 The cur- rent literature reports a wide range of complication rates, from 3.5% to 30%.…”

Section: Discussionmentioning

confidence: 99%

Complications of neuroendoscopic septostomy

Atchley

Sowers

Arynchyna

et al. 2022

Journal of Neurosurgery: Pediatrics

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OBJECTIVE The advent of neuroendoscopy revolutionized the management of complex hydrocephalus. Fenestration of the septum pellucidum (septostomy) is often a therapeutic and/or necessary intervention in neuroendoscopy. However, these procedures are not without risk. The authors sought to record the incidence and types of complications. They attempted to discern if there was decreased likelihood of septostomy complications in patients who underwent endoscopic third ventriculostomy (ETV)/choroid plexus cauterization (CPC) as compared with those who underwent other procedures and those with larger ventricles preoperatively. The authors investigated different operative techniques and their possible relationships to septostomy complications. METHODS The authors retrospectively reviewed all neuroendoscopic procedures with Current Procedural Terminology code 62161 performed from January 2003 until June 2019 at their institution. Septostomy, either alone or in conjunction with other procedures, was performed in 118 cases. Basic demographic characteristics, clinical histories, operative details/findings, and adverse events (intraoperative and postoperative) were collected. Pearson chi-square and univariate logistic regression analyses were performed. Patients with incomplete records were excluded. RESULTS Of 118 procedures, 29 (24.5%) septostomies had either intraoperative or postoperative complications. The most common intraoperative complication was bleeding, as noted in 12 (10.2%) septostomies. Neuroendocrine dysfunction, including apnea, bradycardia, neurological deficit, seizure, etc., was the most common postoperative complication and seen after 15 (12.7%) procedures. No significant differences in complications were noted between ventricular size or morphology or between different operative techniques or ventricular approaches. There was no significant difference between the complication rate of patients who underwent ETV/CPC and that of patients who underwent septostomy as a part of other procedures. Greater length of surgery (OR 1.013) was associated with septostomy complications. CONCLUSIONS Neuroendoscopy for hydrocephalus due to varying etiologies provides significant utility but is not without risk. The authors did not find associations between larger ventricular size or posterior endoscope approach and lower complication rates, as hypothesized. No significant difference in complication rates was noted between septostomy performed during ETV/CPC and other endoscopic procedures requiring septostomy.

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Section: Discussionmentioning

confidence: 99%

Complications of neuroendoscopic septostomy

Atchley

Sowers

Arynchyna

et al. 2022

Journal of Neurosurgery: Pediatrics

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“…CPTs most commonly present with signs of raised ICP and hydrocephalus [77][78][79]. Hydrocephalus can result due to overproduction of CSF, IVH, obstruction of CSF flow or impaired absorption.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…Endoscopic septostomy allows to bypass a unilateral foramen of Monro obstruction creating a CSF circulation between the obstructed ventricle and the opposite lateral ventricle that communicates with the third ventricle by the normal foramen of Monro [77]. This communication between both the lateral ventricles converts them into a single compartment thus allowing both the ventricles to be drained by one shunt in cases of bilateral foramen of Monro obstruction.…”

Section: Septostomymentioning

confidence: 99%

Lesions at the Foramen of Monro Causing Obstructive Hydrocephalus

Chugh¹,

Gotecha²,

Punia³

et al. 2022

Cerebrospinal Fluid

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The foramen of Monro has also been referred to by the name of interventricular foramen. The structures comprising this foramen are the anterior part of the thalamus, the fornix and the choroid plexus. Vital structures surround the foramen, the damage to which can be catastrophic leading to disability either temporary or permanent. In the literature it has been shown that tumors occurring in the area of interventricular foramen are rare and usually cause hydrocephalus. The operative approach depends upon the location of the tumor which can be either in the lateral or the third ventricle. Various pathologies which can lead to foramen of Monro obstruction and obstructive hydrocephalus include colloid cyst, craniopharyngioma, subependymal giant cell astrocytoma [SEGA], Neurocysticercosis, tuberculous meningitis, pituitary macroadenoma, neurocytoma, ventriculitis, multiseptate hydrocephalus, intraventricular hemorrhage, functionally isolated ventricles, choroid plexus tumors, subependymomas and idiopathic foramen of monro stenosis. In this chapter, we will discuss the various lesions at the level of foramen of Monro causing obstructive hydrocephalus and the management and associated complications of these lesions based on their type, clinical picture and their appearance on imaging.

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“…It is part of the limbic system and is connected with the amygdala, habenula, and brainstem reticular formation [12]. The SP is composed of two parts: The upper SP contains only ber tracts and the lower part called septum Verum (anterior to the foramen of Monro (FOM) and above the rostrum of the corpus callosum(CC)) which contains various nuclei including the septal nuclei, the diagonal band of Broca, the bed nucleus of the anterior commissure and the bed nucleus of the stria terminalis [13] The SP contains no arteries but one to three veins draining in the thalamostriate vein, with an asymmetric distribution in greater than 50% cases. In most cases, the large septal veins are located anterior to the foramen of Monro (3,4,5)…”

Section: Review Of Current Surgical Disclosures About Technical Surgerymentioning

confidence: 99%

“…The rst sticking point is the position of the patient's burr hole to access the lateral ventricle. Most authors advocate performing a single 1 cm precoronal drill, 2 or 3 cm from the midline, to get a trajectory more perpendicular to the septum pellucidum [10], [13] However, Tamburrini et al consider a standard precoronal burr hole to be disadvantageous, arguing that it does not allow a su cient view of the septal anatomy, making it di cult to perforate the septum. Therefore, they propose to make a more lateral frontal horn approach to a standard Kocher burr hole (1 cm precoronal, 3-5 cm from midline) [8].…”

Section: Review Of Current Surgical Disclosures About Technical Surgerymentioning

confidence: 99%

Neuroendoscopic septostomy in unilateral and bilateral ventricular hydrocephalus

et al. 2022

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Purpose: This study describes the results of septostomy (SPT) in terms of success and analysis of follow-up in a series of pediatric patients diagnosed with unilateral ventricular hydrocephalus (UHV) and biventricular hydrocephalus (BVH) Methods: A total of 29 pediatric patients diagnosed with UVH or BVH were included in this study. In UVH, a neuroendoscopic SPT was performed (sometimes accompanied by NEFPFMO). In those diagnosed with BVH, an SPT combined with VPS was carried out. Demographic, etiological, clinical, and diagnostic variables and percentage of treatment success were collected.Results: During follow-up, SPT was considered successful when no VPS was required in UVH and when only unilateral VPS was implanted in BVH. At the time of surgery, 16 patients needed a ventriculoperitoneal shunt. The rst SPT was successful in 22 patients, requiring a second surgery in 7 patients, from the oncological group diagnosed with BHV.Conclusions: The surgical management of UVH and BVH still has some disclosure points to be reviewed. However, SPT seems to be a secure, nontraumatic, and e cient procedure.

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Neuroendoscopic septostomy: Indications and surgical technique

Cited by 7 publications

References 9 publications

Complications of neuroendoscopic septostomy

Complications of neuroendoscopic septostomy

Lesions at the Foramen of Monro Causing Obstructive Hydrocephalus

Neuroendoscopic septostomy in unilateral and bilateral ventricular hydrocephalus

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