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

Abstract

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.

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

“…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.…”

“…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.…”