Flexible Endoneurosurgical Therapy for Aqueductal Stenosis

Oka, Kazunari; Yamamoto, Masaaki; Ikeda, Koichi; Tomonaga, Masamichi

doi:10.1227/00006123-199308000-00009

Cited by 126 publications

(30 citation statements)

References 8 publications

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“…ETV has been reported to be effective in the treatment of hydrocephalus with success rates ranging between 49 and 100%, depending on the aetiology of hydrocephalus, the criteria used for patient selection, and the follow-up period [2, 3, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15]. Despite these encouraging reports, most authors have suggested that the outcome following ETV is significantly worse in children less than 1 year old as compared with older children [4, 10, 16, 17, 18, 19].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Endoscopic Third Ventriculostomy on the Management of Newly Diagnosed Hydrocephalus in Infants

et al. 2001

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Objectives: To evaluate the role of endoscopic third ventriculostomy (ETV) as a primary treatment for hydrocephalus in children less than 1 year old and to determine its impact as a whole on the reduction of shunts necessary in a new population of hydrocephalic infants. Methods: Data were collected prospectively on 47 infants with newly diagnosed hydrocephalus of all aetiologies who were referred between 1st April 1998 and 30th September 2000. Twenty-one patients (median age 6 weeks, range 34 weeks of gestation to 10 months) underwent ETV, while the remaining 26 patients had insertion of a ventriculoperitoneal shunt. Anatomical criteria and demonstration of third ventricle outflow obstruction on preoperative magnetic resonance imaging were used to select patients for ETV. Results: There was no mortality or major morbidity following ETV. The median follow-up period was 18 (range 8–36) months. During the follow-up period, the ETV remained patent in 7 (33%) of the 21 patients. Of the 14 patients with failed ETV, 11 had insertion of a ventriculoperitoneal shunt, while 3 have undergone successful redo ETV. Therefore, in total 10 patients (48%) of the ETV group remain shunt independent. The best results were obtained in patients with congenital aqueduct stenosis with 71% (5 of 7 patients) success rate, while patients with posthaemorrhagic hydrocephalus did particularly badly with only 1 of 10 patients having a successful ETV. Overall, 10 of 47 (21%) infants with newly diagnosed hydrocephalus have avoided a shunt. Conclusions: Our results suggest that the selective use of ETV as the primary treatment in infants with hydrocephalus is safe and can lead to a reduction in the shunted population of all newly diagnosed hydrocephalic infants by up to 21%. Success of ETV is aetiology, not age dependent.

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Section: Discussionmentioning

confidence: 99%

The Impact of Endoscopic Third Ventriculostomy on the Management of Newly Diagnosed Hydrocephalus in Infants

et al. 2001

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“…The advantages of shunt-free treatment of hydrocephalus are obvious. In the last decade, various articles dealing with the advantages of endoscopic 3rd ventriculostomy have been published [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11]. In addition, some reports of successful 3rd ventriculostomy in communicating or unclear hydrocephalus exist [12, 13, 14, 15].…”

Section: Introductionmentioning

confidence: 99%

Extraventricular Intracisternal Obstructive Hydrocephalus – A Hypothesis to Explain Successful 3rd Ventriculostomy in Communicating Hydrocephalus

Kehler

Gliemroth

2003

Pediatr Neurosurg

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The basis of successful 3rd ventriculostomy in cases of communicating hydrocephalus is not yet understood. We performed 3rd ventriculostomies in 5 patients with free cerebrospinal fluid (CSF) communication from the ventricles to the cisterna magna. Preoperative magnetic resonance images (MRIs) showed dilated ventricles, a downward bulging floor of the 3rd ventricle (interpreted as a sign of pressure gradient between the ventricles and basal cisterns) and a free communication to an enlarged cisterna magna. The other basal cisterns were of normal or smaller size. All patients recovered from their clinical symptoms and none of them needed a shunt. The hypothesis of an intracisternal CSF pathway obstruction (e.g. between the cisterna magna and the prepontine cistern) could explain the MRI findings, although such an obstruction cannot be directly visualized. It would also explain the successful 3rd ventriculostomies in these cases.

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“…These range from type (rigid or flexible) and brand of the neuroendoscope used to the various tools used to open and dilate the floor of the third ventricle [3, 4, 5, 6, 14, 15, 16, 17, 18, 19]. In general, there are several ways to perform the procedure, and to a large part surgeon preference dominates the decision tree.…”

Section: Discussionmentioning

confidence: 99%

“…Descriptions of the initial opening of the third ventricular floor include the utilization of gentle blunt passage of the neuroendoscope or the use of an electrocautery wire or a laser fiber (Yag/Nd or KTP) [4, 15, 16, 17, 18]. Following this initial perforation, dilatation may be accomplished using a 2-Fr Fogarty balloon catheter (Fogarty arterial embolectomy catheter; Baxter Healthcare, Irvine, Calif., USA) [3, 4, 6, 16]. Another well-known method utilizes the passage of a 1.1- to 1.2-mm neuroendoscope through the peel-away introducer sheath [2, 4].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, patients with obstructive hydrocephalus and patent subarachnoid spaces, typically seen with aqueductal stenosis or posterior fossa tumors, make the best candidates for success of the procedure [2, 3, 4, 5, 6]. In spite of improved technology, basilar artery complex perforation remains a potential devastating complication [4, 7, 8, 9, 10, 11, 12].…”

Section: Introductionmentioning

confidence: 99%

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A Simple and Safe Technique for Endoscopic Third Ventriculocisternostomy

Wellons

Bagley

George³

1999

Pediatr Neurosurg

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A simple and safe technique for performing an endoscopic third ventriculocisternostomy is described using a small-diameter semirigid neuroendoscope in conjunction with a perforated ventricular catheter to bluntly fenestrate the floor of the third ventricle. All previous descriptions involve the initial use of an introducer sheath that in our experience lends to loss of cerebrospinal fluid, consequently distorting the anatomic landmarks of the third ventricle as well as compromising the crucial concave shape of its floor. Our technique limits the loss of cerebrospinal fluid volume, therefore, reducing the chance of basilar artery complex perforation as a consequence of distortion of third ventricular landmarks and loss of third ventricular floor concavity.

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Flexible Endoneurosurgical Therapy for Aqueductal Stenosis

Cited by 126 publications

References 8 publications

The Impact of Endoscopic Third Ventriculostomy on the Management of Newly Diagnosed Hydrocephalus in Infants

The Impact of Endoscopic Third Ventriculostomy on the Management of Newly Diagnosed Hydrocephalus in Infants

Extraventricular Intracisternal Obstructive Hydrocephalus – A Hypothesis to Explain Successful 3rd Ventriculostomy in Communicating Hydrocephalus

A Simple and Safe Technique for Endoscopic Third Ventriculocisternostomy

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