Neuronavigated endoscopic aqueductoplasty with panventricular stent plus septostomy for isolated fourth ventricle in complex hydrocephalus and syringomyelia associated with myelomeningocele: how I do it

Guil-Ibáñez, José Javier; Carreño, Tesifón Parrón; Gomar-Alba, Mario; Narro-Donate, José María; Masegosa-González, José

doi:10.1007/s00701-023-05649-9

Cited by 4 publications

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“…The implementation of ETV for the treatment of noncommunicating obstructive hydrocephalus revolutionized the management of these patients. 1-3 Over the years, the possible complications associated with the technique and their frequency have been described. 4,5 Despite being a complex procedure, the percentage of complications is low.…”

Section: Discussionmentioning

confidence: 99%

“…Noncommunicating obstructive hydrocephalus is one of the main pathologies treated using endoscopic third ventriculostomy (ETV). 1-3 Since its introduction to the present day, both the technique for its implementation and the associated complications have been thoroughly described. 4,5 Unlike classical ventricular shunt techniques, which are associated with a high number of complications, the morbidity and mortality associated with endoscopic techniques are low.…”

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confidence: 99%

“…4,5 Unlike classical ventricular shunt techniques, which are associated with a high number of complications, the morbidity and mortality associated with endoscopic techniques are low. 2 Among the possible complications of the technique, the most complex and challenging to treat are injuries to the vascular structures located beneath the tuber cinereum, primarily the basilar artery and its branches. 6 According to the classical technique, to avoid damaging these structures, the perforation of the floor of the third ventricle should be performed in the midline halfway between mammillary bodies and the infundibular recess.…”

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Dorsum Sellae as Key Landmark in ETV With Disminished Prepontine Cistern: Technical Note and Case Series

Guil-Ibáñez,

Parrón-Carreño,

Gomar-Alba

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: One of the key aspects in the surgical technique of endoscopic third ventriculostomy (ETV) is the perforation of the floor of the third ventricle because of the high risk of injuring vital structures located in that region. According to the standard technique, this perforation should be performed in the midline halfway between mammillary bodies and the infundibular recess to avoid damage to the structures. This can be performed without excessive complications when the diameter of the prepontine cistern is wide. However, in situations where the diameter is reduced (defined in the literature as having a prepontine interval [PPI] ≤1 mm), the probability of complications increases exponentially. In this article, we propose using dorsum sellae as a key point to safely perform ETV in patients with a decreased PPI, guiding the trajectory and its marking using neuronavigation. METHODS: A review was conducted on the latest 100 ETV procedures performed by our team in the past 5 years. The measurement of the PPI was conducted using archived preoperative MRI imaging studies, specifically between the dorsum sellae and the basilar artery. In cases where the PPI was ≤1 mm and, therefore, the use of the dorsum sellae was applied as a reference point, the technical results and procedural functions were documented. RESULTS: In the cohort, 7 patients with a PPI ≤1 mm were identified. In all 7 cases, fenestration of the tuber cinereum was successfully performed without causing vascular damage or associated complications. ETV was successful in 6 patients, with only one experiencing ETV failure necessitating the placement of a ventriculoperitoneal shunt. CONCLUSION: The utilization of the dorsum sellae as a reference point to perform ETV in reduced PPI constitutes a safe alternative to the classical technique.

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