Traumatic Basilar Aneurysm after Endoscopic Third Ventriculostomy: Case Report

Mr, McLaughlin; Jb, Wahlig; Kaufmann, Andreas M.; Al, Albright

doi:10.1097/00006123-199712000-00034

Cited by 200 publications

(97 citation statements)

References 18 publications

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“…Others have raised concern regarding the high mortality (as reviewed by Hoffman et al [17]at 0–20% for percutaneous TV) and morbidity (e.g. cardiac arrest, vascular perforation, diabetes insipidus, syndrome of inappropriate antidiuretic hormone secretion, subdural hematoma or meningitis) [8, 18, 19, 20, 21]associated with the procedure – sequela which are essentially nonexistent secondary to a CS procedure. Reports of unsuccessful completion of the procedure due to technical difficulties are as high as 26% [3].…”

Section: Discussionmentioning

confidence: 99%

Third Ventriculostomy versus Cerebrospinal Fluid Shunt as a First Procedure in Pediatric Hydrocephalus

1999

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Background: Third ventriculostomy (TV) has been reported to be efficacious for diverse causes of obstructive hydrocephalus in pediatric patients, and preferable to a first CSF shunt (CS) in those eligible. We reviewed the respective failure rates in a prospective cohort of patients at our institution. Method: All patients having either TV or CS (i.e ventriculoperitoneal shunt) over the period 1987 to 1997 were prospectively entered into a database. To compare homogeneous patients, only diagnoses of either aqueductal stenosis or tumor were considered. Failure was defined as any subsequent surgical procedure for CSF diversion. Kaplan-Meier curves were constructed to determine survivorship. A multivariable Cox model using time-dependent covariates was constructed. Results: There were 32 TV and 210 CS patients: 14 (44%) and 95 (45%) failed, respectively. TV patients were older (median age = 8.1 vs. 3.6 years) and had a higher incidence of aqueductal stenosis (53 vs. 25%). There was no statistically significant difference between the two procedures based on bivariate analysis (p = 0.87) and on multivariable analysis using the Cox model after adjusting for the potential confounders (p = 0.66, hazard ratio = 1.19, 95% confidence interval = 0.55-2.56). Conclusion: Failure from TV is not unlike that of CS when analyzed by survival methods. Larger prospective series are needed to look at specific subgroups who may benefit from TV. Quality of life and clinical outcome measures are also required to analyze the difference between these two procedures.

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Section: Discussionmentioning

confidence: 99%

Third Ventriculostomy versus Cerebrospinal Fluid Shunt as a First Procedure in Pediatric Hydrocephalus

1999

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“…With the distortion of the third ventricular floor, the risk of injury to the vulnerable basilar artery complex increases. Basilar artery complex perforation is a devastating complication which may result in subarachnoid hemorrhage, intraventricular hemorrhage, traumatic aneurysm formation, or death [4, 7, 8, 9, 10, 11, 12]. Management of a basilar artery complex perforation consists of copious intraventricular irrigation, carefully ensuring to not overinflate the ventricular system.…”

Section: Discussionmentioning

confidence: 99%

“…Diagnostic angiography should then be performed in order to identify damage to the basilar artery complex. McLaughlin et al [11]reported the delayed formation of a traumatic basilar apex aneurysm after an intial negative angiogram; therefore, four-vessel angiography should be postponed several days to allow formation of the potential pseudoaneurysm. Traumatic aneurysm formation requires direct repair via an appropriate craniotomy [4, 7, 11].…”

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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“…These results confirm that ETV is a successful and safe procedure for the treatment of occlusive hydrocephalus. Other authors observed that serious morbidity and mortality associated with ETV during perforation of the third ventricular floor due to damage of the basilar artery or another vessel of the distal basilar artery complex (BA complex) may occur [17, 18, 19, 20]. …”

Section: Introductionmentioning

confidence: 99%

Virtual Endoscopy for Planning Endoscopic Third Ventriculostomy Procedures

Burtscher¹,

Dessl²,

Bale³

et al. 2000

Pediatr Neurosurg

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Virtual endoscopy was used to plan 10 endoscopic third ventriculostomy procedures in 9 patients suffering from occlusive hydrocephalus due to idiopathic aqueductal stenosis and tumors. The patients were 4 children (4–14 years, mean age: 9 years) and 5 adults (21–38 years, mean age: 29 years). The aim of the study was to preoperatively evaluate the individual intraventricular and vascular endoscopic anatomy at the floor of the third ventricle based on virtual endoscopic images. The virtual views were correlated with the real endoscopic images, intraoperatively obtained by a standard ventriculoscope (Wolf, Knittlingen, Germany) during endoscopic third ventriculostomy procedures. Contrast-medium-enhanced MR images (3D-MPRAGE; Siemens, Germany) were semiautomatically segmented with a surface-rendering technique (‘Navigator’ software; General Electric Medical, Buc, France) to produce the virtual endoluminal views. The virtual endoscopic images were comparable with the real intraoperative endoscopic view in 8 of 9 patients. Virtual endoscopy can display the position of the basilar artery, the posterior cerebral arteries and the posterior communicating arteries in their relationship to the mammillary bodies and the clivus. Preoperative virtual endoscopy planning can intraoperatively assist the neurosurgeon to find a safe location for third ventriculostomy.

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Traumatic Basilar Aneurysm after Endoscopic Third Ventriculostomy: Case Report

Abstract: Hemorrhagic complications after endoscopic third ventriculostomy are rare. The formation of a traumatic basilar tip aneurysm after this procedure has not been reported in the literature. Laser fenestration of the third ventricular floor may increase the risk of this event.

Cited by 200 publications

References 18 publications

Third Ventriculostomy versus Cerebrospinal Fluid Shunt as a First Procedure in Pediatric Hydrocephalus

Third Ventriculostomy versus Cerebrospinal Fluid Shunt as a First Procedure in Pediatric Hydrocephalus

A Simple and Safe Technique for Endoscopic Third Ventriculocisternostomy

Virtual Endoscopy for Planning Endoscopic Third Ventriculostomy Procedures

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