Articles: third-ventricle-surgery.
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The main criticism of endoscopic excision of colloid cysts of the third ventricle is the decreased ability to completely resect the cyst wall, therefore increasing the risk of recurrence. The extent of resection varies widely across the endoscopic series and is largely influenced by the surgical technique. We report the results of the rotational technique for endoscopic transforaminal excision of colloid cysts in a series of consecutive patients. Our objective is to contribute to the current literature and to shed more light on an effective and safe yet less commonly used technique. ⋯ Our high total excision rate and low complication profile are in concordance with the recent reports of endoscopic resection of colloid cysts. The rotational technique for the endoscopic transforaminal approach is highly effective and a safe alternative to the bimanual dissection technique.
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Endoscopic third ventriculostomy (ETV) is a well-accepted treatment option instead of ventriculoperitoneal shunt placement in cases of obstructive hydrocephalus. A sufficient flow from the ventricles to the basal cisterns requires perforation of the arachnoid membranes in the retroclival region. This point is critical to achieve an optimal outcome. The complex arachnoid relations were investigated in the retroclival region from the viewpoint of ETV, and anatomic landmarks were defined for subarachnoid dissections. ⋯ Sufficient arachnoid dissection is essential for a successful ETV. The clival line is an important landmark that helps to perform the subarachnoid dissections correctly and achieve an undisrupted cerebral spinal fluid flow between the ventricles and the basal cisterns.
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Endoscopic third ventriculostomy (ETV) remains the mainstay of treatment for noncommunicating hydrocephalus these days. However, there has been no adequate clue for the intraoperative assessment of ETV efficacy until now. This time, we propose a newly defined finding, "folding sign," which is visible and enables us to confirm penetration of both the third ventricle floor and the Liliequist membrane (LM) during operation. In this report, we describe consecutive ETV cases and discuss the mechanism of folding sign and its clinical meanings. ⋯ The folding sign is a newly defined sign to predict the success of ETV during operation. This optimal finding appears only when the LM is sufficiently opened; therefore, it could be a good candidate for an intraoperative assessment tool.
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J Neurosurg Pediatr · Oct 2018
The long-term outcomes of endoscopic third ventriculostomy in pediatric hydrocephalus, with an emphasis on future intellectual development and shunt dependency.
OBJECTIVEThe goal of this study was to clarify the long-term outcome of endoscopic third ventriculostomy (ETV) in pediatric hydrocephalus in light of the ETV Success Score (ETVSS), shunt dependency, and intellectual development. METHODSThe authors retrospectively analyzed pediatric patients with hydrocephalus who underwent ETV between 2002 and 2012 and who were followed for longer than 5 years as a single-center cohort. The data of the patients' pre- and postoperative status were collected. ⋯ CONCLUSIONSThe ETVSS was correlated with the long-term success rate. After 15 months from the initial ETV, no patients required an additional CSF diversion procedure. The ETVSS was not considered to be correlated with long-term intellectual status.
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Ventricular tumors (VTs) represent approximately 10% of intracranial lesions and are associated with hydrocephalus in 73.9%-100% of patients. We present our experience using flexible neuroendoscopy as a diagnostic and hydrocephalus-related treatment strategy for paraventricular and intraventricular tumors. ⋯ Flexible neuroendoscopy is a strategic tool for diagnosis of VTs, especially in patients with associated hydrocephalus and VTs unreachable by other means. Flexible neuroendoscopy has a high rate of definitive diagnosis with low associated complications. More studies evaluating the long-term efficacy of flexible neuroendoscopy for hydrocephalus associated with VTs are needed.