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Mulhem A, Alsulaiman AM, Hammersen S, Kantelhardt S. The endoscopic treatment of fourth ventricle outlet obstruction: Report of two children and systematic review. Clin Case Rep 2023; 11:e8234. [PMID: 38033697 PMCID: PMC10683030 DOI: 10.1002/ccr3.8234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023] Open
Abstract
Fourth ventricle outlet obstruction (FVOO) is a rare cause of hydrocephalus. In the last century, the standard treatment was the suboccipital craniotomy with magendieplasty or ventriculoperitoneal shunt (VP shunt). Since the beginning of the 21st century, the endoscopic third ventriculostomy (ETV) has been considered a less invasive alternative. The medical literature lacks sufficient reports of FVOO cases and strong evidence about ETV's efficacy in treating this condition. We report two cases of FVOO treated with ETV and review published similar cases. Clinical and radiological findings of two FVOO cases with outcomes after ETV were presented. Moreover, we conducted a systematic review after protocol registration in PROSPERO (CRD42021281474). MEDLINE, Embase, Scopus, and Web of Science were searched from inception till December 31, 2022. Studies were included if they reported cases of FVOO treated initially with ETV. Cases with Chiari malformation, Dandy-Walker malformation, tuberous sclerosis, trapped fourth ventricle, or space-occupying lesions were excluded. Two reviewers independently examined title/abstract records in the first stage and full-text publications in the second for eligibility. The primary outcome was the recurrence rate, defined by the need for re-ETV or other invasive treatments (e.g., VP shunt or magendieplasty). Other outcomes included clinical state at follow-up and mortality. Two cases, a 3-year-old male and 3.5-year-old female, with FVOO, were treated with ETV in our department by the same neurosurgeon (SH) in 2013 and 2021. Both cases improved significantly after ETV, and there was no recurrence through the follow-up. Besides the present cases, we found 57 other cases of FVOO treated with ETV reported in 17 studies between 2001 and 2021. The median age was 26 years, with an IQR from 2.4 to 59 years, and 56% of cases were females. The recurrence rate was 32% in the sample (19 out of 59), with a 95% CI from 21% to 46%. The median time to recure was 2 months with IQR from 1.25 to 26. A VP shunt was the treatment for recurrence in 68% and a re-ETV in 32%. At the follow-up (41 ± 29 months), only one case died, and one deteriorated clinically. FVOO is a rare cause of hydrocephalus encountered mainly in the first or sixth decades of life. ETV provides the first reasonable treatment. Despite the moderate recurrence rate, the outcomes are favorable.
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Affiliation(s)
- Ali Mulhem
- Department of NeurosurgeryVivantes Klinikum im FriedrichshainBerlinGermany
- DPhil Program in Evidence‐Based Health Care, Department of Continuing EducationUniversity of OxfordOxfordUK
| | | | - Stefanie Hammersen
- Department of NeurosurgeryVivantes Klinikum im FriedrichshainBerlinGermany
| | - Sven Kantelhardt
- Department of NeurosurgeryVivantes Klinikum im FriedrichshainBerlinGermany
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Habashy K, El Houshiemy MN, Alok K, Kawtharani S, Shehab H, Darwish H. Membranous obstruction of the foramen of magendie: A case report, literature review and recommendations. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Rosa MRF, Cruz TZ, Magalhães Junior EV, Nigri F. Tetraventricular noncommunicating hydrocephalus: Case report and literature review. Surg Neurol Int 2021; 12:519. [PMID: 34754569 PMCID: PMC8571210 DOI: 10.25259/sni_635_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/03/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Tetraventricular hydrocephalus is a common presentation of communicating hydrocephalus. Conversely, cases with noncommunicating etiology impose a diagnostic challenge and are often neglected and underdiagnosed. Herein, we present a review of literature for clinical, diagnostic, and surgical aspects regarding noncommunicating tetrahydrocephalus caused by primary fourth ventricle outlet obstruction (FVOO), illustrating with a case from our service. METHODS We performed a research on PubMed database crossing the terms "FVOO," "tetraventriculomegaly," and "hydrocephalus" in English. Fifteen articles (a total of 34 cases of primary FVOO) matched our criteria and were, therefore, included in this study besides our own case. RESULTS Most cases presented in adulthood (47%), equally divided between male and female. Clinical presentation was unspecific, commonly including headache, nausea, and dizziness as symptoms (35.29%, 21.57%, and 9.80%, respectively), with ataxic gait (65%) and papilledema (40%) being the most frequent signs. MRI and CT were the imaging modalities of choice (11 patients each), often associated with CSF flow studies, such as cine MRI and CT ventriculogram. Endoscopic third ventriculostomy (ETV) was both the most popular and effective surgical approach (50.85% of cases, with 18.91% of recurrence) followed by ventricle-peritoneal shunt (16.95% of patients, 23.0% of recurrence). CONCLUSION FVOO stands for a poorly understood etiology of noncommunicating tetrahydrocephalus. With the use of ETV, these cases, once hopeless, had its morbimortality and recurrence reduced greatly. Therefore, its suspicion and differentiation from other forms of tetrahydrocephalus can improve its natural course, reinforcing the importance of its acknowledgment.
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Affiliation(s)
- Magno Rocha Freitas Rosa
- Department of Surgical Specialties and Neurosurgery, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil
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Li D, Ravindra VM, Lam SK. Rigid versus flexible neuroendoscopy: a systematic review and meta-analysis of endoscopic third ventriculostomy for the management of pediatric hydrocephalus. J Neurosurg Pediatr 2021; 28:439-449. [PMID: 34298514 DOI: 10.3171/2021.2.peds2121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/12/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Endoscopic third ventriculostomy (ETV), with or without choroid plexus cauterization (±CPC), is a technique used for the treatment of pediatric hydrocephalus. Rigid or flexible neuroendoscopy can be used, but few studies directly compare the two techniques. Here, the authors sought to compare these methods in treating pediatric hydrocephalus. METHODS A systematic MEDLINE search was conducted using combinations of keywords: "flexible," "rigid," "endoscope/endoscopic," "ETV," and "hydrocephalus." Inclusion criteria were as follows: English-language studies with patients 2 years of age and younger who had undergone ETV±CPC using rigid or flexible endoscopy for hydrocephalus. The primary outcome was ETV success (i.e., without the need for further CSF diversion procedures). Secondary outcomes included ETV-related and other complications. Statistical significance was determined via independent t-tests and Mood's median tests. RESULTS Forty-eight articles met the study inclusion criteria: 37 involving rigid endoscopy, 10 involving flexible endoscopy, and 1 propensity scored-matched comparison. A cumulative 560 patients had undergone 578 rigid ETV±CPC, and 661 patients had undergone 672 flexible ETV±CPC. The flexible endoscopy cohort had a significantly lower average age at the time of the procedure (0.33 vs 0.53 years, p = 0.001) and a lower preoperatively predicted ETV success score (median 40, IQR 32.5-57.5 vs 62.5, IQR 50-70; p = 0.033). Average ETV success rates in the rigid versus flexible groups were 54.98% and 59.65% (p = 0.63), respectively. ETV-related complication rates did not differ significantly at 0.63% for flexible endoscopy and 3.46% for rigid endoscopy (p = 0.30). There was no significant difference in ETV success or complication rate in comparing ETV, ETV+CPC, and ETV with other concurrent procedures. CONCLUSIONS Despite the lower expected ETV success scores for patients treated with flexible endoscopy, the authors found similar ETV success and complication rates for ETV±CPC with flexible versus rigid endoscopy, as reported in the literature. Further direct comparison between the techniques is necessary.
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Affiliation(s)
- Daphne Li
- 1Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Vijay M Ravindra
- 2Department of Neurological Surgery, Naval Medical Center San Diego, California
| | - Sandi K Lam
- 3Department of Surgery, Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago; and.,4Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Salem-Memou S, Amal T, Salihy SM, Soumare O, Najat B. Endoscopic Third Ventriculostomy in the Fourth Ventricle Outlet Obstruction Associated with Chiari Malformation Type I and Syringomyelia: Case Report. Asian J Neurosurg 2021; 16:170-173. [PMID: 34211888 PMCID: PMC8202361 DOI: 10.4103/ajns.ajns_67_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/05/2020] [Accepted: 08/04/2020] [Indexed: 11/06/2022] Open
Abstract
Hydrocephalus by the fourth ventricle outlet obstruction (FVOO) associated with a Chiari malformation type I and syringomyelia is a well-known entity but a rare situation in clinical practice. Although suboccipital craniectomy with the opening of the obstruction membrane appears to be the most physiological approach, by restoring the original pathway of cerebrospinal fluid flow, the endoscopic third ventriculostomy (ETV) represents an important minimally invasive alternative. We report the case of an adult patient with tetra ventricular hydrocephalus by FVOO associated with Chiari malformation and syringomyelia. The ETV alone completely resolved all symptoms, as well as neuroimaging abnormalities on the control magnetic resonance imaging. The ETV is a minimally invasive option for the treatment of hydrocephalus in patients with obstruction at the exit of the fourth ventricle, even in cases associated with Chiari malformation and syringomyelia.
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Affiliation(s)
- Sidi Salem-Memou
- Department of Neurosurgery, National Hospital Center, Nouakchott, Mauritania
| | - Tolba Amal
- Department of Neurosurgery, National Hospital Center, Nouakchott, Mauritania
| | - Sidi-Mohamed Salihy
- Department of Neurosurgery, National Hospital Center, Nouakchott, Mauritania
| | - Outouma Soumare
- Department of Neurosurgery, National Hospital Center, Nouakchott, Mauritania
| | - Boukhrissi Najat
- Department of Neurosurgery, National Hospital Center, Nouakchott, Mauritania
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Chowdhury FH, Haque MR, Rumi JUM, Arifin MS. Fourth Ventricular Outflow Obstruction in an Infant with Ileal Atresia and Laryngomalacia: Endoscopic Management. INDIAN JOURNAL OF NEUROSURGERY 2020. [DOI: 10.1055/s-0040-1710104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
AbstractFourth ventricle outflow obstruction (FVOO) is a rare cause of obstructive hydrocephalus. In this study, we described a case of idiopathic FVOO with ileal atresia and laryngomalacia which was managed with endoscopic third ventriculostomy (ETV) and re-endoscopy. We also described the techniques of fenestration of Liliequist membrane and partial removal of arachnoid membrane over dorsum sella (DS) to prevent closure of fenestration and recurrence of hydrocephalus. The patient was a 4-month-old infant presented with progressively increasing head size, feeding difficulty, respiratory distress, and tense fontanel. The infant had a history of laparotomy for ileal atresia. CT scan showed panventriculomegaly due to FVOO. ETV with fenestration of Liliequist membrane was done on emergency basis. After operation, the patient improved clinically and radiologically. Four weeks later, the patient returned with recurrent hydrocephalus. Endoscopic reoperation showed closure of fenestration in arachnoid membrane (Lilieqiest membrane). Endoscopic refenestration with partial excision of arachnoid on DS was done. The patient again recovered radiologically and clinically till last follow-up. In idiopathic FVOO, ETV with wide fenestration of Liliequist membrane, preferably with partial removal of arachnoid on DS, may be very useful in treating hydrocephalus (HCP) and preventing recurrent HCP even in infants.
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Affiliation(s)
- Forhad H. Chowdhury
- Department of Neurosurgery, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
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Gürbüz MS, Dağçınar A, Bayri Y, Şeker A, Güçlü H. Anterior third ventricular height and infundibulochiasmatic angle: two novel measurements to predict clinical success of endoscopic third ventriculostomy in the early postoperative period. J Neurosurg 2020; 132:1764-1772. [DOI: 10.3171/2019.1.jns181330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 01/29/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVEThe authors sought to develop a set of parameters that reliably predict the clinical success of endoscopic third ventriculostomy (ETV) when assessed before and after the operation, and to establish a plan for MRI follow-up after this procedure.METHODSThis retrospective study involved 77 patients who had undergone 78 ETV procedures for obstructive hydrocephalus between 2010 and 2015. Constructive interference in steady-state (CISS) MRI evaluations before and after ETV were reviewed, and 4 parameters were measured. Two well-known standard parameters, fronto-occipital horn ratio (FOHR) and third ventricular index (TVI), and 2 newly defined parameters, infundibulochiasmatic (IC) angle and anterior third ventricular height (TVH), were measured in this study. Associations between preoperative measurements of and postoperative changes in the 4 variables and the clinical success of ETV were analyzed.RESULTSOf the 78 ETV procedures, 70 (89.7%) were successful and 8 (10.3%) failed. On the preoperative MR images, the mean IC angle and anterior TVH were significantly larger in the successful procedures. On the 24-hour postoperative MR images of the successful procedures, the mean IC angle declined significantly from 114.2° to 94.6° (p < 0.05) and the mean anterior TVH declined significantly from 15 to 11.2 mm (p < 0.05). The mean percentage reduction of the IC angle was 17.1%, and that of the anterior TVH was 25.5% (both p < 0.05). On the 1-month MR images of the successful procedures, the mean IC angle declined significantly from 94.6° to 84.2° (p < 0.05) and the mean anterior TVH declined significantly from 11.2 to 9.3 mm (p < 0.05). The mean percentage reductions in IC angle (11%) and anterior TVH (16.9%) remained significant at this time point but were smaller than those observed at 24 hours. The 6-month and 1-year postoperative MR images of the successful group showed no significant changes in mean IC angle or mean anterior TVH. Regarding the unsuccessful procedures, there were no significant changes observed in IC angle or anterior TVH at any of the time points studied. Reduction of IC angle and reduction of anterior TVH on 24-hour postoperative MR images were significantly associated with successful ETV. However, no clinically significant association was found between FOHR, TVI, and ETV success.CONCLUSIONSAssessing the IC angle and anterior TVH on preoperative and 24-hour postoperative MR images is useful for predicting the clinical success of ETV. These 2 measurements could also be valuable as radiological follow-up parameters.
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Affiliation(s)
- Mehmet Sabri Gürbüz
- Department of Neurosurgery, School of Medicine, İstanbul Medeniyet University
| | - Adnan Dağçınar
- Department of Neurosurgery, School of Medicine, Marmara University; and
| | - Yaşar Bayri
- Department of Neurosurgery, School of Medicine, Marmara University; and
| | - Aşkın Şeker
- Department of Neurosurgery, School of Medicine, Marmara University; and
| | - Hasan Güçlü
- Department of Biostatistics and Medical Informatics, School of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
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Novegno F, Pagano A, Fava F, Umana G, Lunardi P, Fraioli MF. Abrupt foramen magnum syndrome due to shunt malfunction in a previously asymptomatic chiari I malformation: the hidden predictable risk in long-lasting shunted patients. Br J Neurosurg 2019:1-5. [DOI: 10.1080/02688697.2019.1691977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Federica Novegno
- Department of Neurosurgery, Tor Vergata University Medical School, Rome, Italy
| | - Andrea Pagano
- Department of Neurosurgery, Tor Vergata University Medical School, Rome, Italy
| | - Filippo Fava
- Department of Neurosurgery, Tor Vergata University Medical School, Rome, Italy
| | - Giuseppe Umana
- Department of Neurosurgery, Tor Vergata University Medical School, Rome, Italy
| | - Pierpaolo Lunardi
- Department of Neurosurgery, Tor Vergata University Medical School, Rome, Italy
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Bartoli A, Soleman J, Berger A, Wisoff JH, Hidalgo ET, Mangano FT, Keating RF, Thomale UW, Boop F, Roth J, Constantini S. Treatment Options for Hydrocephalus Following Foramen Magnum Decompression for Chiari I Malformation: A Multicenter Study. Neurosurgery 2019; 86:500-508. [DOI: 10.1093/neuros/nyz211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 02/24/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Andrea Bartoli
- Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Neurosurgery, Dana Children's Hospital Tel Aviv, Tel Aviv University, Tel Aviv, Israel
| | - Jehuda Soleman
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Neurosurgery, Dana Children's Hospital Tel Aviv, Tel Aviv University, Tel Aviv, Israel
- Department of Neurosurgery and Division of Pediatric Neurosurgery, University Hospital of Basel, Basel, Switzerland
| | - Assaf Berger
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Neurosurgery, Dana Children's Hospital Tel Aviv, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey H Wisoff
- Division of Pediatric Neurosurgery, NYU Langone Health, New York, New York
| | | | - Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Robert F Keating
- Department of Neurosurgery, Children's National Medical Center, Washington, DC
| | - Ulrich W Thomale
- Pediatric Neurosurgery, Charité Universitätsmedizin, Berlin, Germany
| | - Frederick Boop
- Department of Pediatrics, Neuroscience Institute, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Jonathan Roth
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Neurosurgery, Dana Children's Hospital Tel Aviv, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Constantini
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Neurosurgery, Dana Children's Hospital Tel Aviv, Tel Aviv University, Tel Aviv, Israel
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10
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Sufianov AA, Kasper EM, Sufianov RA. An optimized technique of endoscopic third ventriculocisternostomy (ETV) for children with occlusive hydrocephalus. Neurosurg Rev 2017; 41:851-859. [PMID: 29230595 DOI: 10.1007/s10143-017-0934-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 09/27/2017] [Accepted: 11/22/2017] [Indexed: 11/28/2022]
Abstract
In this article, we present an optimized minimally invasive technique of ETV for children with occlusive hydrocephalus. The study comprises of 64 consecutive pediatric cases (34 boys and 30 girls aged from 1 month to 5 years) of occlusive hydrocephalus from various etiologies, which were treated with a modified technique of ETV. Mean clinical follow-up period after ETV was 24.2 ± 3.8 months. Application of the new technique made it possible to significantly reduce the length of the soft tissue incision for access, and the use of upgraded instruments allowed to perform a twist drill hole in the skull to less than half a usual size. Access to the brain and lateral ventricle was performed by blunt trephination of the dura without the need for significant corticectomy or coagulation, and yielded minimal damage to the brain, which is very important in patients of young age. Continued endoscopic control during the approach down to the lateral ventricle increases safety and decreases risk of injury, and can be performed in cases of pathologies affecting the anatomical relationships of the lateral and third ventricle. Mortality in our cohort was 0%, and there were no postoperative neurological, endocrinological, or infectious complications. Patency rates of the first ETV performed was 78%, with the remaining patients requiring additional surgical procedures for complicated settings. This new technique of minimally invasive ETV placement in pediatric patients is an effective and safe method to treat occlusive hydrocephalus and can be recommended for extensive clinical use.
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Affiliation(s)
- Albert Akramovich Sufianov
- Federal State-Financed Institution "Federal Centre of Neurosurgery" of Ministry of Health of the Russian Federation (city of Tyumen), Ul. 4 km. Chervishevskogo trakta, 5, Tyumen, 625032, Russia. .,I.M. Sechenov First Moscow State Medical University, 8-2 Trubetskaya st, Moscow, 119991, Russia.
| | - Ekkehard M Kasper
- Department of Neurosurgery, Harvard Medical School, A-111, 25 Shattuck Street, Boston, 02115, MA, USA.,Division of Neurosurgery, Beth Israel Deaconess Medical Center, 110, Francis Street - Suite 3B, Boston, MA, 02215, USA
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11
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Oertel JM, Burkhardt BW. Vitom-3D for Exoscopic Neurosurgery: Initial Experience in Cranial and Spinal Procedures. World Neurosurg 2017; 105:153-162. [PMID: 28559068 DOI: 10.1016/j.wneu.2017.05.109] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/17/2017] [Accepted: 05/18/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The authors describe the application of a new exoscope that offers 3-dimensional (3D) visualization in cranial and spinal neurosurgery in detail. METHODS Five cranial and 11 spinal procedures were performed with a 3D exoscope. Instrument handling, repositioning of the exoscope, handling of the image control unit, the adjustment of magnification and focal length, the depth perception, the image quality, the illumination, and the comfort level of the posture during the procedure were assessed via a questionnaire. RESULTS The following procedures were performed: Microvascular decompression (n = 1), craniotomy and tumor resection (n = 4), anterior cervical discectomy and fusion with cervical plating (n = 2), cervical laminectomy and lateral mass fixation (n = 1), shear cervical lateral mass osteosynthesis (n = 1), lumbar canal decompression (n = 1), transforaminal lumbar interbody fusion (n = 2), thoracic intraspinal extradural tumor resection (n = 1), and lumbar discectomy (n = 3). Instrument handling, the intraoperative repositioning and handling of the VITOM-3D, and the comfort level of the intraoperative posture was rated excellent in 100% of procedures. The image quality was rated equal to the operating microscope in 68.75% of procedures. None of the procedures had to be stopped because of technical problems. No surgical complications were noted that could be related to the use of the exoscope. CONCLUSIONS The 3D-exoscopic system is safe and effective tool to perform spinal procedures and less demanding cranial procedures. The image quality and 3D visualization were comparable with the operating microscope. The technique harbors the unique advantage of excellent comfort for the involved surgical team during the procedure.
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Affiliation(s)
- Joachim M Oertel
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany.
| | - Benedikt W Burkhardt
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany
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12
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Shimoda Y, Murakami K, Narita N, Tominaga T. Fourth Ventricle Outlet Obstruction with Expanding Space on the Surface of Cerebellum. World Neurosurg 2017; 100:711.e1-711.e5. [PMID: 28153613 DOI: 10.1016/j.wneu.2017.01.088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hydrocephalus is classified as noncommunicating and communicating based on whether all ventricular and subarachnoid spaces are communicating. Although the diagnosis between the two different states is crucial, it is difficult in certain conditions. In particular, communicating hydrocephalus and noncommunicating hydrocephalus owing to fourth ventricle outlet obstruction are highly misdiagnosed. We describe a case of fourth ventricle outlet obstruction of unknown origin that was initially misdiagnosed as communicating hydrocephalus. CASE DESCRIPTION A 66-year-old woman with gait disturbance and incontinence caused by hydrocephalus underwent ventriculoperitoneal shunt surgery. After 9 months, her fourth ventricle became enlarged and could not be controlled by lowering the shunt pressure. Magnetic resonance imaging (MRI) demonstrated obstruction at the foramen of Magendie, foramina of Luschka, and the cerebral aqueduct. Endoscopic surgery for aqueduct plasty with third ventriculostomy was planned. Because the aqueduct was observed to open spontaneously, only the standard third ventriculostomy was performed. When MRI findings were reviewed retrospectively, an unnatural space was observed between the lower cranial nerves and cerebellar hemisphere that grew along with the fourth ventricular enlargement. This space was determined by MRI cisternography to be the cystic membrane ballooning out from the foramen of Luschka. The primary hydrocephalus likely resulted from fourth ventricle outlet obstruction. CONCLUSIONS Enlargement of the whole ventricular system with an expanded space between the lower cranial nerves and cerebellar hemisphere can be caused by fourth ventricle outlet obstruction. In such cases, preoperative evaluation of anatomic architecture and cerebrospinal fluid obstruction using MRI cisternography is essential and leads to a successful endoscopic strategy.
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Affiliation(s)
- Yoshiteru Shimoda
- Department of Neurosurgery, Kesen-numa City Hospital, Miyagi, Japan; Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Kensuke Murakami
- Department of Neurosurgery, Sendai Medical Center, Sendai, Japan
| | - Norio Narita
- Department of Neurosurgery, Kesen-numa City Hospital, Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Ishi Y, Asaoka K, Kobayashi H, Motegi H, Sugiyama T, Yokoyama Y, Echizenya S, Itamoto K. Idiopathic fourth ventricle outlet obstruction successfully treated by endoscopic third ventriculostomy: a case report. SPRINGERPLUS 2015; 4:565. [PMID: 26543700 PMCID: PMC4627988 DOI: 10.1186/s40064-015-1368-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 09/22/2015] [Indexed: 11/30/2022]
Abstract
Introduction Fourth ventricle outlet obstruction (FVOO) is a rare cause of obstructive hydrocephalus. We describe a case of idiopathic FVOO that was successfully treated with endoscopic third ventriculostomy (ETV). Case report A 3-year old boy without any remarkable medical history presented with a headache and vomiting. Computed tomography (CT) images, which had incidentally been taken 2 years previously due to a minor head injury, showed no abnormality. Magnetic resonance imaging on admission showed tetra-ventricular hydrocephalus associated with the dilatation of the fourth ventricle outlets, without any obstructive lesions. However, CT ventriculography, involving contrast medium injection through a ventricular catheter, suggested mechanical obstruction of the cerebrospinal fluid (CSF) at the fourth ventricle outlets. Thus, the patient was diagnosed with FVOO and ETV was performed; the hydrocephalus was subsequently resolved. Although hydrocephalus recurred 1 year postoperatively, re-ETV for the highly stenosed fenestration successfully resolved this condition. Conclusions ETV should be considered for FVOO treatment, particularly in idiopathic cases without CSF malabsorption.
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Affiliation(s)
- Yukitomo Ishi
- Department of Neurosurgery, Teine Keijinkai Hospital, 1-40, Maeda 1-12, Teine-ku, Sapporo, 006-8555 Japan ; Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638 Japan
| | - Katsuyuki Asaoka
- Department of Neurosurgery, Teine Keijinkai Hospital, 1-40, Maeda 1-12, Teine-ku, Sapporo, 006-8555 Japan
| | - Hiroyuki Kobayashi
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638 Japan
| | - Hiroaki Motegi
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638 Japan
| | - Taku Sugiyama
- Department of Neurosurgery, Teine Keijinkai Hospital, 1-40, Maeda 1-12, Teine-ku, Sapporo, 006-8555 Japan
| | - Yuka Yokoyama
- Department of Neurosurgery, Teine Keijinkai Hospital, 1-40, Maeda 1-12, Teine-ku, Sapporo, 006-8555 Japan
| | - Sumire Echizenya
- Department of Neurosurgery, Teine Keijinkai Hospital, 1-40, Maeda 1-12, Teine-ku, Sapporo, 006-8555 Japan
| | - Koji Itamoto
- Department of Neurosurgery, Teine Keijinkai Hospital, 1-40, Maeda 1-12, Teine-ku, Sapporo, 006-8555 Japan
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Wen L, Ma C, Wang H, Hu Z. The role of hydrocephalus in the development of Chiari I malformation and syringomyelia. J Neurol Sci 2014; 344:240-2. [PMID: 25015845 DOI: 10.1016/j.jns.2014.06.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 06/20/2014] [Accepted: 06/23/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Lili Wen
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China
| | - Chiyuan Ma
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China
| | - Handong Wang
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China.
| | - Zhigang Hu
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China
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15
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Antes S, Tschan CA, Oertel JM. An operative technique combining endoscopic third ventriculostomy and long-term ICP monitoring. Childs Nerv Syst 2014; 30:331-5. [PMID: 23989429 DOI: 10.1007/s00381-013-2269-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 08/13/2013] [Indexed: 01/11/2023]
Abstract
Neuroendoscopy has been well established in the treatment of many neurological and neurosurgical diseases. Especially its application in occlusive hydrocephalus to restore a physiological cerebrospinal fluid circulation has been extensively examined in the past. Although such procedures are believed to be safe and effective, complication as well as failure rates up to 20% have been described pointing to the importance of long-term postoperative care. Therefore, different and partly invasive procedures as ventricular drain insertions or complex cranial imaging methods have been proposed; however, associated pitfalls and restrictions often limited their prognostic value and long-term benefit. An operative technique combining endoscopic third ventriculostomy and telemetric increased intracranial pressure monitoring has now been developed to optimize the postoperative care management. The main intention is to provide sufficient brain pressure data for long-term observation and early recognition of endoscopy failures and complications. The new operative technique was applied in a series with 24 patients suffering from occlusive hydrocephalus. Surgical technique and future perspectives are presented.
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Affiliation(s)
- Sebastian Antes
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Kirrberger Straße, Gebäude 90.5, 66421, Homburg, Germany,
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Torres-Corzo J, Sánchez-Rodríguez J, Cervantes D, Rodríguez-Della Vecchia R, Muruato-Araiza F, Hwang SW, Rangel-Castilla L. Endoscopic Transventricular Transaqueductal Magendie and Luschka Foraminoplasty for Hydrocephalus. Neurosurgery 2013; 74:426-35; discussion 436. [DOI: 10.1227/neu.0000000000000283] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
ABSTRACT
BACKGROUND:
Routinely, hydrocephalus related to fourth ventricular outlet obstruction (FVOO) has been managed with ventriculoperitoneal (VP) shunting or endoscopic third ventriculostomy (ETV). Few reports on Magendie foraminoplasty exist, and Luschka foraminoplasty has not been described.
OBJECTIVE:
To present an alternative technique in the management of FVOO via an endoscopic transventricular transaqueductal Magendie and Luschka foraminoplasty and to discuss the indications, technique, findings, and outcomes.
METHODS:
Between 1994 and 2011, all patients who underwent endoscopic Magendie and Luschka foraminoplasty were analyzed.
RESULTS:
A total of 33 Magendie (28) and/or Luschka (5) foraminoplasties were performed in 30 patients. Twenty-three were adult and 7 were pediatric patients. The etiology of the FVOO was divided into primary etiologies (congenital membrane in 5 and atresia in 2) and secondary causes (neurocysticercosis in 14 patients, bacterial meningitis in 9). Fifteen (50%) had previously failed procedures. Intraoperative findings that led to Magendie/Luschka foraminoplasty were ETV not feasible to perform, nonpatent basal subarachnoid space, or primary FVOO. Minor postoperative complications were seen in 3 patients. Only 26 patients had long-term follow-up; 17 (65.3%) of these had clinical improvement and did not require further procedures. Nine (34.7%) did not improve. Eight required another procedure (7 shunts, and 1 endoscopic procedure). One patient died.
CONCLUSION:
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.
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Affiliation(s)
- Jaime Torres-Corzo
- Department of Neurosurgery, Hospital Central, University of San Luis Potosi and School of Medicine, San Luis Potosi, Mexico
| | - Juan Sánchez-Rodríguez
- Department of Neurosurgery, Hospital Central, University of San Luis Potosi and School of Medicine, San Luis Potosi, Mexico
| | - Dominic Cervantes
- Department of Neurosurgery, Hospital Central, University of San Luis Potosi and School of Medicine, San Luis Potosi, Mexico
| | | | - Fernando Muruato-Araiza
- Department of Neurosurgery, Hospital Central, University of San Luis Potosi and School of Medicine, San Luis Potosi, Mexico
| | - Steven W. Hwang
- Department of Neurosurgery, Tufts Medical Center and Floating Hospital for Children, Boston, Massachusetts
| | - Leonardo Rangel-Castilla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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17
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Neuroendoscopy in the Youngest Age Group. World Neurosurg 2013; 79:S23.e1-11. [DOI: 10.1016/j.wneu.2012.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Accepted: 02/02/2012] [Indexed: 12/13/2022]
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18
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Rangel-Castilla L, Barber S, Zhang YJ. The Role of Endoscopic Third Ventriculostomy in the Treatment of Communicating Hydrocephalus. World Neurosurg 2012; 77:555-60. [DOI: 10.1016/j.wneu.2011.06.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 05/09/2011] [Accepted: 06/23/2011] [Indexed: 10/15/2022]
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Roth J, Ben-Sira L, Udayakumaran S, Constantini S. Contrast ventriculo-cisternography: an auxiliary test for suspected fourth ventricular outlet obstruction. Childs Nerv Syst 2012; 28:453-9. [PMID: 22124573 DOI: 10.1007/s00381-011-1639-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 11/17/2011] [Indexed: 12/14/2022]
Abstract
PURPOSE Fourth ventricular outlet obstruction (FVOO) causes obstructive hydrocephalus. Often, despite high-quality MRI sequences, differentiation between FVOO and communicating (absorptive) hydrocephalus is not easy. We describe our initial experience with five children with suspected FVOO that underwent CT ventriculography (CTV) or cisternography (CTC), to assist with this difficult diagnosis. METHODS Over 2.5 years, five children with suspected FVOO (5 months-7.5 years old) underwent CTV or CTC. Technical and clinical data were retrospectively collected. RESULTS Four children had progressive macrocephaly, and one child had progressive ventriculomegaly. On CTV/CTC, four of five children showed communication between the ventricular system and spinal subarachnoid space or prepontine cistern, as evidenced by passage of contrast material. One child had a FVOO and therefore underwent an endoscopic third ventriculostomy, and is since, symptom and shunt free for 2.5 years. CONCLUSION CT ventriculography in infants, and CT cisternography in elder children, may assist to differentiate between FVOO and communicating hydrocephalus. The importance of these tests is for children with MRI suggestive of FVOO related hydrocephalus, but with no clear demonstration of the obstruction site. The implication of this differentiation may be for deciding between treatment of hydrocephalus with a ventriculoperitoneal shunt or with an endoscopic third ventriculostomy.
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Affiliation(s)
- Jonathan Roth
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.
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Unal OF, Aras Y, Aydoseli A, Akcakaya MO. Ascending transaqueductal cystoventriculoperitoneal shunting in Dandy-Walker malformation: technical note. Pediatr Neurosurg 2012; 48:389-93. [PMID: 23941970 DOI: 10.1159/000353610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 06/03/2013] [Indexed: 11/19/2022]
Abstract
The optimal treatment for Dandy-Walker malformation is still controversial. Ventriculoperitoneal shunting, cystoperitoneal shunting or combinations are the most common surgical options in the management of this clinical entity. Endoscopic procedures like ventriculocystostomy, 3rd ventriculostomy or endoscopy-assisted shunt surgeries have become the focus of recent publications. We describe a new transcystic endoscopic technique, with the usage of a single ascending transaqueductal shunt catheter with additional holes, whereby both the posterior fossa cyst and supratentorial ventricular compartments are drained effectively. By using this new technique complications associated with combined shunting can be avoided. In addition, by equalizing the pressure within the supra- and infratentorial compartments, the upward or downward herniations associated with single-catheter shunting can be prevented.
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Affiliation(s)
- Omer Faruk Unal
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
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Warf BC, Dewan M, Mugamba J. Management of Dandy-Walker complex-associated infant hydrocephalus by combined endoscopic third ventriculostomy and choroid plexus cauterization. J Neurosurg Pediatr 2011; 8:377-83. [PMID: 21961544 DOI: 10.3171/2011.7.peds1198] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECT Dandy-Walker complex (DWC) is a continuum of congenital anomalies comprising Dandy-Walker malformation (DWM), Dandy-Walker variant (DWV), Blake pouch cyst, and mega cisterna magna (MCM). Hydrocephalus is variably associated with each of these, and DWC-associated hydrocephalus has mostly been treated by shunting, often with 2-compartment shunting. There are few reports of management by endoscopic third ventriculostomy (ETV). This study is the largest series of DWC or DWM-associated hydrocephalus treated by ETV, and the first report of treatment by combined ETV and choroid plexus cauterization (ETV/CPC) in young infants with this association. METHODS A retrospective review of the CURE Children's Hospital of Uganda clinical database between 2004 and 2010 identified 45 patients with DWC confirmed by CT scanning (25 with DWM, 17 with DWV, and 3 with MCM) who were treated for hydrocephalus by ETV/CPC. Three were excluded because of other potential causes of hydrocephalus (2 postinfectious and 1 posthemorrhagic). RESULTS The median age at treatment was 5 months (88% of patients were younger than 12 months). There was a 2.4:1 male predominance among patients with DWV. An ETV/CPC (ETV only in one) was successful with no further operations in 74% (mean and median follow-up 24.2 and 20 months, respectively [range 6-65 months]). The rate of success was 74% for DWM, 73% for DWV, and 100% for MCM; 95% had an open aqueduct, and none required posterior fossa shunting. CONCLUSIONS Endoscopic treatment of DWC-associated hydrocephalus should be strongly considered as the primary management in place of the historical standard of creating shunt dependence.
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Affiliation(s)
- Benjamin C Warf
- Department of Neurosurgery, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts 02115, USA.
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22
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Dinçer A, Özek MM. Radiologic evaluation of pediatric hydrocephalus. Childs Nerv Syst 2011; 27:1543-62. [PMID: 21928020 DOI: 10.1007/s00381-011-1559-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 08/09/2011] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The aim of this review is to present the contemporary role of radiology in evaluating pediatric hydrocephalus. Although conventional brain imaging with ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) reveal the degree of ventricular enlargement and often the etiology of the hydrocephalus, the diagnosis and management of hydrocephalus present common problems in pediatric populations. DISCUSSION US, usually sufficient to assess and monitor ventricular size, is used most commonly in preterm infants who have germinal matrix hemorrhages and not able to tolerate transport to the radiology department. Although CT can demonstrate gross dilatation of ventricles, in most cases, it will be necessary to more closely define the nature of the obstruction, either functionally or anatomically. MRI is the best imaging modality to provide such functional and anatomic information. However, since identification of obstructive pathologic processes at any level through the cerebrospinal fluid (CSF) pathway in patients with hydrocephalus is of significant importance because it can change the treatment options, avoiding shunt insertion, a more sophisticated MRI approach is needed instead of obtaining a routine cranial MRI. Furthermore, the outcome after neuroendoscopic procedures is clearly related to patient selection under guidance of neuroimaging. CONCLUSION Therefore, the article focuses mainly on the effective usage of various MRI sequences in both diagnosis and follow-up of pediatric hydrocephalus, such as 3D CISS, cine PC, TSE, and GRE T2* sequences, to be able to investigate all possible obstructive pathology through the CSF pathway and to assess the efficiency of treatment in a standardized way.
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Affiliation(s)
- Alp Dinçer
- Department of Radiology, School of Medicine, Acibadem University, Inonu Cad. Okur Sok. No:21, Kozyatagı, Istanbul 34742, Turkey.
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Foroughi M, Wong A, Steinbok P, Singhal A, Sargent MA, Cochrane DD. Third ventricular shape: a predictor of endoscopic third ventriculostomy success in pediatric patients. J Neurosurg Pediatr 2011; 7:389-96. [PMID: 21456911 DOI: 10.3171/2011.1.peds10461] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The criteria for identifying patients in whom endoscopic third ventriculostomy (ETV) provides control of hydrocephalus remain in evolution. In particular, it is not clear when ETV would be effective if intraventricular obstruction is not found preoperatively. The authors postulated that 1) displacement of the third ventricle floor inferiorly into the interpeduncular cistern and displacement of the lamina terminalis anteriorly into the lamina terminalis cistern could predict clinical success of ETV, and 2) improvement in these displacements would correlate with the success of ETV. METHODS Magnetic resonance imaging in 38 consecutive patients treated between 2004 and 2010 was reviewed to assess displacement of the lamina terminalis and third ventricular floor prior to and following ETV. Displacements of the floor and lamina terminalis were judged qualitatively and quantitatively, using a newly created index, the Third Ventricular Morphology Index (TVMI). The association between the aforementioned morphological features and clinical success of ETV was analyzed. RESULTS Ninety-six percent of patients in whom the authors preoperatively observed displacement of the lamina terminalis and the third ventricular floor were successfully treated with ETV. Displacements of the third ventricular floor and lamina terminalis, as judged qualitatively, correlated with the clinical success of ETV. The TVMI correlated with the qualitative assessments of displacement. Postoperative decrease in the TVMI occurred in the majority of successfully treated patients. Changes in third ventricular morphology preceded changes in other measures of third and lateral ventricular volume following ETV. CONCLUSIONS Assessment of third ventricular floor and lamina terminalis morphology is useful in predicting clinical success of ETV and in the follow-up in treated patients. The TVMI provided a quantitative assessment of the third ventricular morphology, which may be useful in equivocal cases and in research studies.
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Affiliation(s)
- Mansoor Foroughi
- Division of Neurosurgery, Department of Surgery, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
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Gallo P, Szathmari A, De Biasi S, Mottolese C. Endoscopic third ventriculostomy in obstructive infantile hydrocephalus: remarks about the so-called 'unsuccessful cases'. Pediatr Neurosurg 2010; 46:435-41. [PMID: 21540620 DOI: 10.1159/000324913] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 02/02/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND The failure rate following endoscopic third ventriculostomy (ETV) in infants younger than 2 years of age has been reported to be higher compared with that of older children, and it is unclear whether ETV might be superior to shunt placement in this age group. METHODS Between 2003 and 2009, 23 patients younger than 6 months and without a previous history of shunting underwent ETV in our institution. A review of the literature was performed on the basis of publications presenting detailed data on age and etiology in every single patient. RESULTS In our own patients, total success rate was 39.1%. In the successful cases, median age was 140 days, whereas in the unsuccessful cases it was 47 days. The difference between the two groups was statistically significant (p = 0.01). The median ages of both successful and unsuccessful groups corresponded to data gained from an analysis of the literature (p = 0.04). At a median follow-up of 47 months, 2 out of 14 patients shunted after a failed ETV were revised for ventriculoperitoneal shunt malfunction. CONCLUSION The impact of age on ETV failure in infants is clear and becomes crucial during the first 2 months of life, even when excluding etiological factors. Nevertheless, age cannot be considered the only parameter of the decision-making process, especially in these very young patients. Probably, the definition of 'unsuccessful ETV' should be reevaluated in light of decreased risk of shunt malfunction observed after a failed ETV.
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Affiliation(s)
- Pasquale Gallo
- Pediatric Neurosurgery Unit, Hôpital Neurologique et Neurochirurgical, Pierre Wertheimer, Bron, France.
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