Description of Endoscopic Ventricular Anatomy in Myelomeningocele

Abstract

There are categorical structural alterations in the ventricular system of myelomeningocele patients that are well correlated with previous necropsy and imaging reports. The ventricular system of dysraphic children presents severe anatomic alterations, which alter the reference points of the classical endoscopic third ventricular cisternostomy.

Endoscopic Third Ventriculostomy in Children with Myelomeningocele: A Case Series

“…At the supratentorial level, hydrocephalus can lead to neuropathological changes with neurocognitive consequences that may or may not be reversible with treatment [11]. Structural changes include malformation of the corpus callosum (hypoplasia, dysplasia, focal posterior thinning), enlarged massa intermedia, grey matter heterotopias (medial occipital lobes), absence of the septum pellucidum, stenosis of the foramen of Monro, fusion and thickening of the forniceal columns, thickening of the choroid plexus, interhypothalamic adhesions, thickening or distortion of the floor of the 3rd ventricle (which can complicate visualization of anatomical structures such as the infundibulum or the mammillary bodies) [12,13], large and posteriorly displaced occipital horns, interhemispheric cyst and protrusion of the roof of the 3rd ventricle in a ‘diamond' form up towards the velum interpositum and the quadrigeminal cistern. At the level of the cisterns, one may find anterior displacement of the basilar artery and brainstem, caudal displacement of the basilar apex and a thickened membrane of Lillequist.…”

Surgical technique of retrograde ventricle-sinus shunt is an option for the treatment of hydrocephalus in infants after surgical repair of myelomeningocele

“…Numerous series show that over 70% of shunt patients require long-term review and 54% may need four or more revisions, with all additional risks, costs and negative outcomes 4,5,6,7,8,9,10 . ETV also has known limitations, especially in patients with myelomeningocele and Chiari type II 4,5,6,7,8,9,10,11 . RVSS proposes a safe and more physiological option, using less prosthetic material.…”

“…An important complication is shunt infection, which may occur in up to 5% of the cases. Another drawback is siphoning phenomenon, leading to overdrainage and subdural effusions 8,9,10,11 . Neuroendoscopy, on the other hand, has increased in experience and indications.…”

“…Endoscopic third ventriculostomy (ETV), which consists in fenestrating third ventricle and communicating with interpeduncular and pre-pontine cisterns, is the most applied ventricular endoscopic procedure. However, in patients with myelomeningocele, ventricular anatomy is notoriously variable, with patterns that hinder endoscopy and increase operative risks 8,9,10,11 . Thus, alternatives are needed to treat hydrocephalus in these patients efficiently and safely.…”

Revisiting Retrograde Ventriculosinus Shunt as an Alternative for Treating Hydrocephalus in Children

“…From neuroendoscopy to shunt valve technologies, we could follow significant changes in the paradigms of the treatment of hydrocephalus. 2,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] However, since the 1990s, a few improvements changed the learning curves and the outcome of the hydrocephalus treatment. Currently, ventriculoperitoneal shunt (VPS) is the mainstay for treatment, as well as endoscopic third ventriculostomy (ETV), which is advocated in specific cases.…”