Endoscopic Transventricular Transaqueductal Magendie and Luschka Foraminoplasty for Hydrocephalus

Abstract

Flexible neuroendoscopic transventricular transforaminal Magendie and Luschka foraminoplasty is feasible and safe. These procedures may prove to be viable alternatives to standard ETV and VP shunt in appropriate patients. Adequate intraoperative assessment of ETV success is necessary to identify patients who will benefit.

Idiopathic fourth ventricle outlet obstruction successfully treated by endoscopic third ventriculostomy: a case report

“…Another diagnostic option is direct endoscopic inspection of the fourth ventricle in case where the aqueduct is sufficiently expanded to safely insert a neuro-endoscope through it (Mohanty et al 2008 ). Although this technique needs to be done under general anesthesia and carries a risk of damaging the midbrain around the aqueduct, it has recently been reported to be relatively safe (Longatti et al 2005 , 2006 ; Mohanty et al 2008 ; Torres-Corzo et al 2014 ). When FVOO is highly suspected solely with MRI, this technique could allow simultaneous diagnosis and treatment, thereby reducing the chance of radiation exposure, duration of hospitalization, and risk of drainage infection.…”

“…Endoscopic foraminoplasty by direct fenestration of membranous obstruction at the fourth ventricle outlets is another previously reported treatment option (Longatti et al 2006 , 2009 ; Torres-Corzo et al 2014 ). However, its usefulness is still unclear because it was used in combination with ETV in most cases.…”

Initial Experience with High-Definition Camera-On-a-Chip Flexible Endoscopy for Intraventricular Neurosurgery

“…For example, while flexible neuroendoscopy is used in treating fourth ventricular outlet obstruction through transaqueductal Magendie or Luschka foraminoplastly, and ETV operations, the image quality is not commonly considered comparable with that of rigid endoscopes (20). The steady improvements in flexible endoscopic resolution stand to enhance visual guidance during these procedures.…”

“…Given such technological advancements, the breadth of clinical application of flexible neuroendoscopy has expanded. Reported applications include ETV with choroid plexus cauterization for congenital hydrocephalus(18,21), aqueductal stenting across membranous obstruction in the setting of isolated fourth ventricle obstructions (10), transaqueductal foraminoplasty(20), and aspiration or biopsy of cysts and tumors located in the posterior third ventricle(9).A relatively recent technological advancement for flexible endoscopy is the "camera-on-a-chip" (or "chip-on-a-tip") technology. Classic rigid rod-lens endoscopes utilize a series of glass and air lenses with relative lengths optimized to obtain a wideview, high-resolution image.…”

Avoiding Complications in Endoscopic Third Ventriculostomy

“…These procedures can be used as a viable alternative to standard ETV and ventriculoperitoneal (VP) shunt in appropriate patients. 39 Re-ETV is recommended in the secondary closure of the stoma using the same operative approach and should be taken into consideration before CSF shunt. 40 An Ommaya reservoir should be considered in selected patients (children with acute hydrocephalus and with poor neurologic status, postinfective/posthemorrhagic, or when the surgeon feels that the ETV procedure is suboptimal such as in cisternal scarring) undergoing ETV.…”