Endoscopic aqueductoplasty and placement of a stent in the cerebral aqueduct in the management of isolated fourth ventricle in children

Cinalli, Giuseppe; Spennato, Pietro; Savarese, Luciano; Ruggiero, Claudio; Aliberti, Ferdinando; Cuomo, Lorenzo; Cianciulli, Emilio; Maggi, G

doi:10.3171/ped.2006.104.1.21

Cited by 56 publications

(63 citation statements)

References 24 publications

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“…It is caused by the excessive drainage of CSF via a shunt system changing the CSF pathways, which results in the isolation of the fourth ventricle. One course of treatment for this could be the endoscopic placement of a stent in the aqueduct, as suggested by Cinalli et al (Cinalli et al 2006).…”

Section: Complicationsmentioning

confidence: 99%

Vision in children with hydrocephalus

Andersson¹,

Persson²,

Aring³

et al. 2006

Dev Med Child Neurol

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Aims: To analyse trends in the live-birth prevalence of infantile hydrocephalus and hydrocephalus associated with myelomeningocele (MMC) during the period [1989][1990][1991][1992][1993][1994][1995][1996][1997][1998][1999][2000][2001][2002] and to study the outcome in terms of learning disability, cerebral palsy, epilepsy and visual deficits. Another objective was to explore motor function and disability profiles in various aetiological and gestational-age subgroups and to see whether treatment complications and neuroradiological findings correlate with outcome. Material and methods: A population-based study of all 262 live-born children with infantile hydrocephalus and hydrocephalus associated with MMC born in 1989-2002 in western Sweden. Aetiological and clinical information was collected from medical records, neuroimaging and ophthalmological examinations. A subgroup of 114 children were clinically examined and interviewed. Results: The live-birth prevalence of hydrocephalus was 0.77 per 1,000 live births, 0.48 for infantile hydrocephalus and 0.29 for hydrocephalus associated with MMC. The prevalence of infantile hydrocephalus decreased from 0.55 in 1989 to 0.48 per 1,000 in 2002, while that of MMC decreased from 0.35 to 0.16 per 1,000 during the same period. The prevalence in children born extremely preterm increased dramatically, with a gestational-age-specific prevalence of 13 per 1,000 in 1989 compared with 45 per 1,000 live births in 2002. During the same period, the perinatal mortality in these children decreased from 40 to 15 per 1,000 live births. A ventriculoperitoneal shunt was the first surgical intervention in 230 children (88%), while an endoscopic ventriculostomy was performed in 31 (12%). At least one surgical revision was required in 64% of the children. Of children with infantile hydrocephalus, 63% had at least one associated impairment, compared with 33% in the MMC group, apart from the consequences of the spinal lesion. Visual and other ophthalmological impairments were identified in the majority of the children. Very preterm birth was associated with a high risk of visual impairment. No child with normal neuroimaging had any associated neurological or visual impairment, compared with eleven of twelve with impairments in children with generalised parenchymal lesions. Conclusions: A decrease in the prevalence of infantile hydrocephalus was noted during the period 1989-1998, but it did not continue in 1999-2002. The stagnation was mainly explained by the increased survival of children born extremely preterm with post-haemorrhagic hydrocephalus. The aetiology of the hydrocephalus and gestational age at birth were important for outcome. The majority of the children had some associated neuroimpairment, such as learning disability, cerebral palsy or epilepsy, and more than three-quarters had ophthalmological abnormalities. Neuroimaging was found to be useful for aetiological, treatment and outcome considerations.

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Section: Complicationsmentioning

confidence: 99%

Vision in children with hydrocephalus

Andersson¹,

Persson²,

Aring³

et al. 2006

Dev Med Child Neurol

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“…8 The most commonly described treatments are the placement of a shunt in the fourth ventricle through the aqueduct or foramen of Magendie, aqueductoplasty, fenestration of the outlets, or readjustment of overdrainage (where the cause is overdrainage of the supratentorial shunt). 1,5,15,21,22 Transcerebellar, transtentorial, and transtentorial hiatus routes are equally well described.…”

Section: Discussionmentioning

confidence: 99%

The marionette technique for treatment of isolated fourth ventricle

Longatti

Marton²,

Magrini³

2013

PED

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Isolated fourth ventricle is not uncommon in complex posthemorrhagic or postinfectious hydrocephalus. When the condition is symptomatic, the current surgical treatment is endoscopic aqueductoplasty, followed by endoscope-assisted placement of a catheter in the fourth ventricle. The authors suggest a very simple method of steering the tip of standard ventricular catheters by using materials commonly available in all operating rooms. The main advantage of this method is that it permits less invasive transaqueductal drainage of trapped fourth ventricles, especially in cases of narrow third ventricle, because the scope and catheter are introduced in sequence and not in a double-barreled fashion. Two illustrative cases are reported.

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“…3,10 It may present with symptoms and signs of brainstem and cerebellar compression, thus requiring treatment to relieve pressure on these vital structures. However, the indications for the treatment of trapped fourth ventricle are not always so clear, because neurological symptoms may present more subtly.…”

Section: Discussionmentioning

confidence: 99%

“…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. 3,6,7,20,22,24 This procedure is not devoid of complications; it carries a risk of midbrain injury, with neurological defects such as dysconjugate eye movement and Parinaud syndrome. It may be performed by approaching the aqueduct from above, when the supratentorial ventricles are dilated, or from below with a suboccipital approach, usually when a working CSF shunting device is present.…”

Section: Discussionmentioning

confidence: 99%

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

Frassanito

Markogiannakis

Bonaventura

et al. 2015

PED

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Descending transtentorial herniation (DTH) is a complication of raised pressure in the supratentorial compartment, usually resulting from mass lesion of several etiologies. The authors report an exceptional case of DTH complicating the implant of a CSF shunting device in the trapped fourth ventricle of a 17-year-old boy in whom a second CSF shunting device had been implanted for neonatal posthemorrhagic and postinfectious hydrocephalus. The insidious clinical and radiological presentation of DTH, mimicking a malfunction of the supratentorial shunt, is documented. Ultimately, the treatment consisted of removal of the infratentorial shunt and endoscopic acqueductoplasty with stenting. The absence of supratentorial mass lesion and other described etiologies of DTH prompted the authors to speculate on the hydrodynamic pathogenesis of DTH in the present case.

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Endoscopic aqueductoplasty and placement of a stent in the cerebral aqueduct in the management of isolated fourth ventricle in children

Abstract: Endoscopic placement of a stent in the aqueduct is more effective in preventing the repeated occlusion of the aqueduct than aqueductoplasty alone and should be indicated as the initial treatment in each case of compatible anatomy.

Cited by 56 publications

References 24 publications

Vision in children with hydrocephalus

Vision in children with hydrocephalus

The marionette technique for treatment of isolated fourth ventricle

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

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