Aqueductal stenting with an intra-catheter endoscope—a technical note

Antes, Sebastian; Salah, Mohamed; Linsler, Stefan; Tschan, Christoph A.; Breuskin, David; Oertel, Joachim

doi:10.1007/s00381-015-2902-4

Cited by 22 publications

(18 citation statements)

References 21 publications

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“…Therefore, for some patients with DLCFV, lowering the supratentorial pressure cannot fully treat DLCFV. The CSF produces 70% of the choroid (VP), lowering of the opening pressure of the adjustable valve, ETV, aqueductoplasty with or without stent placement, interventriculostomy, septostomy, foraminoplasty, and decompressive craniectomy of the posterior fossa [5][6][7].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Third Ventriculostomy for an Idiopathic Disproportionately Large Communicating Fourth Ventricle: A Case Report

Yoon

Kim

et al. 2021

Asian J Pain

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A disproportionately large communicating fourth ventricle (DLCFV) is a rare condition. A 34-year-old man experienced severe headaches, nausea, vomiting, and gait disturbance. Initial brain computed tomography (CT) showed markedly dilated ventricles with prepontine cistern shrinkage. Following extraventricular drain (EVD) insertion, approximately 400 mL/d of cerebrospinal fluid (CSF) was removed over 8 days. During this time, no significant changes in ventricle size were observed on CT images or the facial pain scale (FPS). We then performed an endoscopic third ventriculostomy and changed the drainage catheter. Immediately after surgery, the patient’s symptoms were relieved, and the drainage volume gradually decreased. EVD was successfully removed on the eighth postoperative day. Our experiences suggest that neurosurgeons should consider the importance of a third ventriculostomy for the diagnosis and treatment of DLCFV.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Third Ventriculostomy for an Idiopathic Disproportionately Large Communicating Fourth Ventricle: A Case Report

Yoon

Kim

et al. 2021

Asian J Pain

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“…This technique is therefore easier with an enlarged foramen of Monro, and this limit could be overcome by the use of flexible endoscopes or with an intracatheter endoscope (such as the Shunt Scope) that allows EAS to be performed through a single trajectory. 12,13 The indication for EAS in the present study has been broadened and is not limited solely to the treatment of IFVs. Inflammatory processes in the CSF may lead to both obstruction of the outflow through membranous blockage of the aqueduct and/or Magendie foramen, and CSF resorption decrease.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic aqueductal stenting in the management of pediatric hydrocephalus

Guida

Benichi

Chivet

et al. 2020

Journal of Neurosurgery: Pediatrics

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OBJECTIVEPediatric patients with long-term shunts may experience specific complications related to the segregation of the supra- and infratentorial spaces along with different pressure regimens, leading to either mesencephalic syndromes during shunt dysfunction or isolated fourth ventricle (IFV). An accepted treatment to reestablish normal CSF pathways and reequilibrate the transtentorial pressures is endoscopic aqueductal stenting (EAS) to avoid restenosis. In the present paper, the authors studied children treated with EAS during the last decade for both IFV and obstructive hydrocephalus, evaluated its impact on the course of the disease, and identified prognostic factors for EAS success.METHODSA noninterventional retrospective study of routinely acquired data was performed, including all hydrocephalic children undergoing EAS between 2011 and 2019 at Hôpital Necker, Paris, France. The following variables were analyzed: etiology of hydrocephalus; number of surgeries before and after stent placement; indication for EAS; type of stent connection (i.e., connected or not to a ventriculoperitoneal shunt); and the stent position. Stent failure was defined as the need to perform further shunt revision. Univariate and multivariate analyses were run to identify factors associated with stent failure.RESULTSSeventeen patients with a mean age at stent placement of 6 years (SD 6.5 years, range 1 month–18 years) and with a mean follow-up after EAS of 47.5 months (SD 33.7 months, range 5–120 months) were included in the analysis. The etiology of hydrocephalus was as follows: obstructive tumoral (41%), posthemorrhagic (35%), postinfectious (12%), and dysraphism related (12%). The indication for EAS was IFV (47%), rostral midbrain dysfunction syndrome (35%), prevention of secondary aqueductal stenosis after debulking surgery (12%), or primary aqueductal stenosis (6%). No transient or permanent neurological deficits related to the procedure were observed. After EAS, 10 patients did not require further surgeries (59%), and for the others the number of hydrocephalus-related surgeries significantly decreased after stenting. In univariate analysis posthemorrhagic etiology and prevention of aqueductal stenosis were identified as predictors of a good outcome, whereas in multivariate analysis posthemorrhagic hydrocephalus was found to predict a favorable outcome.CONCLUSIONSThe results confirm EAS as a first-line treatment for IFV and suggest its efficacy in changing the history of hydrocephalic patients who have undergone multiple operations and who experience rostral midbrain dysfunction syndrome, as well as efficacy in the prevention of aqueductal stenosis in selected cases of obstructive tumoral hydrocephalus.

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“…Implementing the intraluminal fibreoptic Shunt-Scope has revolutionized catheter implantations in complex hydrocephalus cases. Several case series have reported favorable surgical outcomes by ensuring correct catheter placement with the ShuntScope [10][11][12][13]. However, data on intraluminal endoscopy is still limited to relatively small cohorts, often mixed with adults and children (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Image quality and related outcomes of the ShuntScope for catheter implantation in pediatric hydrocephalus—experience of 65 procedures

2022

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Purpose Ventricular catheter implantation in pediatric hydrocephalus can become a highly challenging task due to abnormal anatomical configuration or the need for trans-aqueductal stent placement. Transluminal endoscopy with the ShuntScope has been invented to increase the rate of successful catheter placements. This study aims to evaluate ShuntScope’s image qualities and related surgical outcomes in the pediatric population. Methods A retrospective analysis of all pediatric patients undergoing ventricular catheter placement using the ShuntScope from 01/2012 to 01/2022 in the author’s department was performed. Demographic, clinical, and radiological data were evaluated. The visualization quality of the intraoperative endoscopy was stratified into the categories of excellent, medium, and poor and compared to the postoperative catheter tip placement. Follow-up evaluation included the surgical revision rate due to proximal catheter occlusion. Results A total of 65 ShuntScope-assisted surgeries have been performed on 51 children. The mean age was 5.1 years. The most common underlying pathology was a tumor- or cyst-related hydrocephalus in 51%. Achieved image quality was excellent in 41.5%, medium in 43%, and poor in 15.5%. Ideal catheter placement was achieved in 77%. There were no intraoperative complications and no technique-related morbidity associated with the ShuntScope. The revision rate due to proximal occlusion was 4.61% during a mean follow-up period of 39.7 years. No statistical correlation between image grade and accuracy of catheter position was observed (p-value was 0.290). Conclusion The ShuntScope can be considered a valuable addition to standard surgical tools in treating pediatric hydrocephalus. Even suboptimal visualization contributes to high rates of correct catheter placement and, thereby, to a favorable clinical outcome.

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Aqueductal stenting with an intra-catheter endoscope—a technical note

Cited by 22 publications

References 21 publications

Endoscopic Third Ventriculostomy for an Idiopathic Disproportionately Large Communicating Fourth Ventricle: A Case Report

Endoscopic Third Ventriculostomy for an Idiopathic Disproportionately Large Communicating Fourth Ventricle: A Case Report

Endoscopic aqueductal stenting in the management of pediatric hydrocephalus

Image quality and related outcomes of the ShuntScope for catheter implantation in pediatric hydrocephalus—experience of 65 procedures

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