Ultrasound-Guided Endoscopic Fenestration of the Third Ventricular Floor for Non-Communicating Hydrocephalus

Abstract

Conventional valve shunting for treatment of hydrocephalus has a high rate of long-term complications. Endoscopic ventriculostomy by fenestration of the third ventricular floor, a minimally-invasive technique, avoids many of the drawbacks of extracranial shunting. Endoscopy was performed in 12 hydrocephalic patients with MRI-diagnosed aqueductal stenosis and neurological signs. Intraoperative ultrasound guidance allowed aiming the tip of the rigid endoscope to the foramen of Monro, and direct entering of the enlarged third ventricle. This technique is as exact as stereotaxy but is faster and easier. No complications were seen due to the surgical procedure. Nine patients were cured from their complaints, in 3 cases there was a subjective improvement of neurology. Long-term patency of the third ventriculostomy was confirmed by movement-sensitive MRI.

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

“…A number of reports [3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14]have described benefit following third ventricular floor fenestration. 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.…”

“…With the advent of endoscopic guidance for third ventricular floor fenestration, ‘success’ rates in recent reports have been described as ranging from 49–100% amongst 3–103 patients evaluated [3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14]. The majority of the studies are descriptive in nature [4, 5, 6, 7, 8, 9, 10, 11, 13]with only three analytic papers [3, 12, 14].…”

“…The majority of the studies are descriptive in nature [4, 5, 6, 7, 8, 9, 10, 11, 13]with only three analytic papers [3, 12, 14]. The outcome measure is vague and described as ‘successful’ [9], ‘improved’ [6, 13, 14], or ‘favorable’ [5]clinical status or lack of requirement of a CS [8].…”

“…With advancement in neuroendoscopic techniques, there has been a renascence of third ventriculostomy (TV) for the treatment of obstructive hydrocephalus. A number of recent studies have described high ‘success’ rates with endoscopic TV ranging from 49–100% [3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14]. …”

A lesson in history: the evolution of endoscopic third ventriculostomy

“…In 1996, Rieger et al 20 used ultrasound guidance for ventricular fenestrations. Ultrasound, they reported, was as accurate as stereotaxy, with a less time-consuming setup.…”