Third Ventriculostomy in Late-onset Idiopathic Aqueductal Stenosis Treatment: A Focus on Clinical Presentation and Radiological Diagnosis

Abstract

Endoscopic third ventriculostomy (ETV) is considered the gold standard treatment for obstructive hydrocephalus due to partial or complete obstruction of cerebrospinal fluid (CSF) ventricular pathways caused by mass lesions. However long-term efficacy of this procedure remains controversial as treatment of chronic adult hydrocephalus due to stenosis of Sylvian acqueduct [late-onset idiopathic aqueductal stenosis (LIAS)]. The authors describe clinical presentation, diagnostic investigations in patients affected by LIAS, and define their clinical and radiological outcome after ETV. From January 2003 to December 2008, 13 consecutive LIAS patients treated by ETV were retrospectively reviewed. Pre- and post-operative clinical and radiological findings, including conventional and phase-contrast (PC) cine magnetic resonance imaging (MRI) were investigated. ETV was successfully performed in all patients. Patient's neurological condition improved. No one required a second ETV procedure or shunt implantation. Clinical and radiological results reveal a satisfactory outcome of LIAS patients treated by ETV. At follow-up a clinical improvement could be demonstrated in all cases. Selection criteria of LIAS patients seem to be crucial to obtain satisfactory and long-lasting results. Even in elderly patients with chronic hydrocephalus, ETV can be considered the treatment of choice.

Hydrocephalus presenting as idiopathic aqueductal stenosis with subsequent development of obstructive tumor: report of 2 cases demonstrating the importance of serial imaging

“…Unfortunately, their only patient with an acute presentation was lost to followup at 3 months after ETV. 12 In our first case, the timeline of presentation was the main finding not consistent with LIAS. Additionally, newonset obstructive hydrocephalus in adolescence is more commonly related to neoplasia than to aqueductal stenosis.…”

“…Several case series suggest chronicity of onset to be more common in LIAS. 6,11,12 Although, acute onset of neurological symptoms attributable to LIAS has previously been reported. 15 Therefore, to distinguish cases of LIAS from those of congenital or tumor-related etiology, Fukuhara and Luciano proposed the following criteria: 1) no intracerebral lesions except hydrocephalus; 2) enlarged lateral and third ventricles with a comparatively small fourth ventricle; 3) no apparent history of intracerebral bleeding or meningitis; 4) no prior surgical treatment for hydrocephalus; and 5) undiagnosed in infancy.…”

The predictor role of the aqueduct cerebrospinal fluid flow on endoscopic third ventriculostomy: explication on assumption physical model

“…ETV is a minimally invasive and a safe method for CSF diversion. It is considered to be the gold standard treatment for aqueduct stenosis causing tri-ventricular obstructive hydrocephalus (1,9,15). Endoscopic fenestration of the floor of the third ventricle performed via ETV creates an alternative route for the CSF to flow to the subarachnoid space.…”

Non-Tumor Obstructive Hydrocephalus Treated with Endoscopic Third Ventriculostomy in Cameroon

“…In the study from Wisniewska et al [29], intellectual disability occurred significantly more frequently in patients treated with shunt than in those who had ETV, incidence of gait disturbances was also significantly higher in shunted patients than in those who had ETV (P = 0.006). In adult patients suffering from late onset idiopathic aqueduct stenosis, ETV achieved neurocognitive improvement in most patients and was recommended as the treatment of choice [13] [17].…”