Endoscopic Third Ventriculostomy in Idiopathic Normal Pressure Hydrocephalus

Gangemi, M; Maiuri, Francesco; Buonamassa, Simona; Colella, Giuseppe; Divitiis, Enrico de

doi:10.1093/neurosurgery/56.5.1166e

Cited by 21 publications

(34 citation statements)

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“…The condition was called``asymptomatic ventriculomegaly with features of iNPH on MRI'' (AVIM). 17) During a follow-up period of 4-8 years, 25% of the subjects with AVIM developed dementia and/or gait disturbance, suggesting that AVIM may represent a preclinical stage of iNPH. 17) It remains unknown, however, whether AVIM really develops into shuntresponsive, definite iNPH.…”

Section: Asymptomatic Ventriculomegaly With Features Of Inph On Mrimentioning

confidence: 96%

“…As described in the present Guidelines, the term``possible iNPH with MRI support'' is defined by the MRI features of iNPH (i.e., enlargement of the ventricles and disproportionate narrowing of the subarachnoid space and cortical sulci at the high convexity of the cerebrum) and the presence of one or more symptoms of iNPH. Using these criteria, the prevalence of possible iNPH with MRI support was estimated to be 2.9% 16) and 1.4% 30) in residents aged 65 years or older and 0.5% 17) in those aged 61 years or older. The weighted mean of these 3 studies was 1.1% in the elderly living in a Japanese community.…”

Section: -A Population-based Studies On the Prevalence Of Inphmentioning

confidence: 99%

“…27,124) Their strides become shorter, and instability becomes more pronounced during turning than during walking in a straight line. 17,89) The foot rotation angles are increased and the strides are variable during walking. 124,125) Freezing of gait sometimes becomes apparent when the patients start walking, walk in a narrow place, and turn around.…”

Section: Clinical Symptoms Of Inph 1-a Characteristics Of Gait Distumentioning

confidence: 99%

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Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus: Second Edition

Mori

Ishikawa

Kato

et al. 2012

Neurol. Med. Chir.(Tokyo)

552

723

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Among the various disorders manifesting dementia, gait disturbance, and urinary incontinence in the elderly population, idiopathic normal pressure hydrocephalus (iNPH) is becoming of great importance. After the publication of the first edition of the Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus in 2004 (the English version was published in 2008), clinical awareness of iNPH has risen dramatically, and the number of shunt surgeries has increased rapidly across Japan. Clinical and basic research on iNPH has increased significantly, and more high-level evidence has since been generated. The second edition of the Japanese Guidelines was thus published in July 2011, to provide a series of timely evidence-based recommendations related to iNPH. The revision of the Guidelines has been undertaken by a multidisciplinary expert working group of the Japanese Society of Normal Pressure Hydrocephalus in conjunction with the Japanese Ministry of Health, Labour and Welfare research project on``Studies on the epidemiology, pathophysiology, and treatment of normal pressure hydrocephalus.'' This English version of the second edition of the Guidelines was made to share these ideas with the international community and to promote international research on iNPH.

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Section: Asymptomatic Ventriculomegaly With Features Of Inph On Mrimentioning

confidence: 96%

Section: -A Population-based Studies On the Prevalence Of Inphmentioning

confidence: 99%

Section: Clinical Symptoms Of Inph 1-a Characteristics Of Gait Distumentioning

confidence: 99%

See 1 more Smart Citation

Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus: Second Edition

Mori

Ishikawa

Kato

et al. 2012

Neurol. Med. Chir.(Tokyo)

552

723

View full text Add to dashboard Cite

show abstract

“…There is also the element of associated financial cost and the time required to set up these systems in the emergency setting. Furthermore, in several case series, the authors quote a single entry point for ETVs [1][2][3][4][5][6] suggesting a generally accepted surgical practice not to use neuronavigation routinely. In search of an operative planning aid, we have created a mathematical formula that incorporates the target ventricle size using the FHR and computes the location of the optimal ETV entry point.…”

Section: Etv Planning Aid With the Incorporation Of Ventricle Sizementioning

confidence: 99%

“…Endoscopic third ventriculostomy (ETV) is a minimally invasive procedure of cerebrospinal fluid (CSF) diversion widely used for treating hydrocephalus of various etiologies [1][2][3] with a success rate of 68.5-83% [1,[4][5][6]. This technique involves passing a rigid endoscope through the CSF spaces of the ventricular system to access and fenestrate the floor of the third ventricle.…”

Section: Introductionmentioning

confidence: 99%

Operative planning aid for optimal endoscopic third ventriculostomy entry points in pediatric cases

et al. 2017

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Object Endoscopic third ventriculostomy (ETV) uses anatomical spaces of the ventricular system to reach the third ventricle floor and create an alternative pathway for cerebrospinal fluid flow. Optimal ETV trajectories have been previously proposed in the literature, designed to grant access to the third ventricle floor without a displacement of eloquent periventricular structures. However, in hydrocephalus, there is a significant variability to the configuration of the ventricular system, implying that the optimal ETV trajectory and cranial entry point needs to be planned on a case-by-case basis. In the current study, we created a mathematical model, which tailors the optimal ETV entry point to the individual case by incorporating the ventricle dimensions. Methods We retrospectively reviewed the imaging of 30 consecutive pediatric patients with varying degrees of ventriculomegaly. Three dimensional radioanatomical models were created using preoperative MRI scans to simulate the optimal ETV trajectory and entry point for each case. The surface location of cranial entry points for individual ETV trajectories was recorded as Cartesian coordinates centered at Bregma. The distance from the Bregma in the coronal plane represented as Bx^, and the distance from the coronal suture in the sagittal plane represented as By^. The correlation between the ventricle dimensions and the x, y coordinates were tested using linear regression models. Results The distance of the optimal ETV entry point from the Bregma in the coronal plane (Bx^) and from the coronal suture in the sagittal plane (By^) correlated well with the frontal horn ratio (FHR). The coordinates for x and y were fitted along the following linear equations: x = 85.8 FHR−13.3 (r 2 = 0.84, p < 0.001) and y = −69.6 FHR + 16.7 (r 2 = 0.83, p < 0.001). Conclusion The surface location of the optimal cranial ETV entry point correlates well with the ventricle size. We provide the first model that can be used as a surgical planning aid for a case specific ETV entry site with the incorporation of the ventricle size.

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Anatomy of the floor of the third ventricle in relation to endoscopic ventriculostomy

et al. 2009

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Neuroanatomical structures that form the floor of the third ventricle (FTV) and neighboring tissues are important in the context of third ventriculostomy (TV) procedures. Thorough knowledge of the anatomical and histological organization of the region would be useful in understanding and preventing surgical complications. Taking the third ventricle region as a model, we aimed to simulate TV and make measurements of 23 cadaver brains, as well as perform histological examinations of the third ventricular floor on five cadaver brains. During the endoscopic TV, we examined the degree to which the structures surrounding the FTV were affected by surgical simulation. To make a clinical comparison, the distance between the center of the FTV and the basilar apex was measured on cranial magnetic resonance images (MRIs) of 15 subjects with normal ventricular systems and 15 subjects with moderately enlarged ventricles. Histological examination revealed that the ependymal cells and arachnoid membrane formed the inner and outer surfaces of the third ventricle floor, respectively, whereas the stroma was made up of glial cells exclusively. This region was gliotic and avascular. When cadaver brains with normal and hydrocephalic ventricles were compared, there were significant differences in the distance between the center of the floor and the basilar apex (P < 0.001). On the basis of our study, the optimal site for TV fenestration and balloon inflation is just anterior to the mamillary bodies to avoid injury to neighboring structures.

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Endoscopic Third Ventriculostomy in Idiopathic Normal Pressure Hydrocephalus

Cited by 21 publications

References 0 publications

Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus: Second Edition

Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus: Second Edition

Operative planning aid for optimal endoscopic third ventriculostomy entry points in pediatric cases

Anatomy of the floor of the third ventricle in relation to endoscopic ventriculostomy

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