Trapped Fourth Ventricle Treated with Shunt Placement in the Fourth Ventricle by Direct Visualization with Flexible Neuroendoscope

Abstract

Shunt placement was the most common procedure used for ventricular dilatation, but in many neurosurgical centers it has been substituted by flexible neuroendoscope; however, none of them had solved the problem of the trapped and dilated fourth ventricle. The combination of the ventricle-peritoneal catheter placement in the center of the fourth ventricle by direct visualization with a flexible neuroendoscope using a single coronal burr-hole has solved this problem. Eleven patients with a trapped fourth ventricle, with previous third ventriculostomy and aqueductal plasty, were treated with this procedure; all patients were evaluated clinically and with computed tomography 8 to 24 months (mean, 18 months) later. Here, we describe the technical procedure.

Endoscopic Transaqueductal Placement of a Single-Catheter Cyst-Ventriculoperitoneal Shunt in a Neonate With Dandy-Walker Malformation-Associated Hydrocephalus -Case Report-

“…21) Eleven patients with isolated fourth ventricle were treated with aqueduct plasty and shunts were placed via the cerebral aqueduct in the fourth ventricle with endoscopic assistance. 20) No surgical complications occurred although the endoscope passed through the cerebral aqueduct with shunt catheters in some patients.…”

“…1,5,9,[11][12][13][14]22) Lateral ventriculoperitoneal (VP), cyst-peritoneal (CP), and combined VP and CP shunts have been placed and endoscopic third ventriculostomy (ETV) has been performed in the past decade. 14) Transaqueductal placement of a multiperforated shunt catheter has been used to treat isolated fourth ventricle, 20,21) but not hydrocephalus associated with DWM. We report a pediatric patient with hydrocephalus associated with DWM who was successfully treated with this technique.…”

Descending transtentorial herniation, a rare complication of the treatment of trapped fourth ventricle: case report

“…The main treatment options consist of microsurgical fenestration through a posterior fossa craniotomy/craniectomy with or without placement of a stent to the spinal subarachnoid space, to achieve a diversion of CSF, or a fourth ventricle shunt, either separate or connected via a Y-shaped connector with a supratentorial ventricular catheter. 4,15,21,25,27 The advent and recent evolution of endoscopy has introduced new options in the treatment of this condition. 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.…”

Endoscopic Minimally Invasive Neurosurgery: Emerging Techniques and Expanding Role through an Extensive Review of the Literature and Our Own Experience – Part I: Intraendoscopic Neurosurgery

“…A previously described technique utilized for aqueductal stenting and for catheter placement uses a single-lumen catheter with a cruciate incision at its tip and with multiple lateral perforations at the distal end [31,88,89]. Upchurch et al [90] prefer a dual-port to a single-port technique for fourth ventricular catheter placement.…”