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Microsurgical third ventriculocisternostomy as an alternative to ETV: report of two cases.

van Lindert EJ - Childs Nerv Syst (2008)

Bottom Line: Because of slit ventricles, an endoscopic approach was not possible and, therefore, both patients received a microsurgical TVS by a supraorbital approach.In both cases, microsurgical TVS was successful and the patients became shunt free.Microsurgical TVS by a supraorbital craniotomy is a viable alternative to endoscopic TVS in selected cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Radboud University Nijmegen Medical Center, P. B. 9101, 6500 Nijmegen, The Netherlands. e.vanlindert@nch.umcn.nl

ABSTRACT

Objective: To describe a microsurgical alternative to endoscopic third ventriculocisternostomy.

Methods: Two children with shunt-dependent hydrocephalus and multiple shunt revisions were considered candidates for third ventriculocisternostomy (TVS). Because of slit ventricles, an endoscopic approach was not possible and, therefore, both patients received a microsurgical TVS by a supraorbital approach.

Results: In both cases, microsurgical TVS was successful and the patients became shunt free.

Conclusion: Microsurgical TVS by a supraorbital craniotomy is a viable alternative to endoscopic TVS in selected cases.

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Related in: MedlinePlus

Case report 1. a, b Axial T1 MRI depicting very small slit-like lateral and third ventricles, c sagittal T2 MRI showing small third ventricle and lamina terminalis, d, e postoperative axial T1 MRI showing minimal increase in size of the lateral ventricles; f postoperative sagittal T2 MRI shows a minimal increase of the third ventricle, but no flow void phenomenon at the lamina terminalis
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Fig1: Case report 1. a, b Axial T1 MRI depicting very small slit-like lateral and third ventricles, c sagittal T2 MRI showing small third ventricle and lamina terminalis, d, e postoperative axial T1 MRI showing minimal increase in size of the lateral ventricles; f postoperative sagittal T2 MRI shows a minimal increase of the third ventricle, but no flow void phenomenon at the lamina terminalis

Mentions: This eight-year-old boy was born with an occipital meningocele and a thoracolumbar myelomeningocele. Both of these congenital abnormalities were operated upon 1 day after birth. Within several days, the patient developed a hydrocephalus which was treated with a ventriculoperitoneal shunt. One month later, a Chiari type II malformation was treated by a suboccipital craniotomy and a duraplasty. Since then, the patient experienced multiple drain infections and both proximal and distal drain dysfunctions. Ventriculoperitoneal shunting and ventriculoatrial shunting with different types of valves were implanted but none of them led to problem-free shunting, largely due to stiff slit ventricles. In March 2003, the patient experienced another drain dysfunction with an intracranial pressure (ICP) of 50 cm H2O while maintaining slit ventricles followed by infection necessitating external ventricular drainage and antibiotics treatment. In search for a more definitive treatment of his recurrent drain dysfunctions, we considered to perform an ETV. However, the very narrow slit-like lateral ventricles and third ventricle did not allow a safe execution of this procedure (Fig. 1a–c). As an alternative, a microsurgical fenestration of the lamina terminalis and Liliequist’s membrane was performed via a right-sided eyebrow incision and a small supraorbital craniotomy (Fig. 2). The postoperative course was uneventful. The patient did not experience any symptoms suspect for hydrocephalus or raised intracranial pressure during a follow-up of 3 years. MRI control examination did not reveal a significant increase in the size of the ventricular system (Fig. 1d–f).Fig. 1


Microsurgical third ventriculocisternostomy as an alternative to ETV: report of two cases.

van Lindert EJ - Childs Nerv Syst (2008)

Case report 1. a, b Axial T1 MRI depicting very small slit-like lateral and third ventricles, c sagittal T2 MRI showing small third ventricle and lamina terminalis, d, e postoperative axial T1 MRI showing minimal increase in size of the lateral ventricles; f postoperative sagittal T2 MRI shows a minimal increase of the third ventricle, but no flow void phenomenon at the lamina terminalis
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2367395&req=5

Fig1: Case report 1. a, b Axial T1 MRI depicting very small slit-like lateral and third ventricles, c sagittal T2 MRI showing small third ventricle and lamina terminalis, d, e postoperative axial T1 MRI showing minimal increase in size of the lateral ventricles; f postoperative sagittal T2 MRI shows a minimal increase of the third ventricle, but no flow void phenomenon at the lamina terminalis
Mentions: This eight-year-old boy was born with an occipital meningocele and a thoracolumbar myelomeningocele. Both of these congenital abnormalities were operated upon 1 day after birth. Within several days, the patient developed a hydrocephalus which was treated with a ventriculoperitoneal shunt. One month later, a Chiari type II malformation was treated by a suboccipital craniotomy and a duraplasty. Since then, the patient experienced multiple drain infections and both proximal and distal drain dysfunctions. Ventriculoperitoneal shunting and ventriculoatrial shunting with different types of valves were implanted but none of them led to problem-free shunting, largely due to stiff slit ventricles. In March 2003, the patient experienced another drain dysfunction with an intracranial pressure (ICP) of 50 cm H2O while maintaining slit ventricles followed by infection necessitating external ventricular drainage and antibiotics treatment. In search for a more definitive treatment of his recurrent drain dysfunctions, we considered to perform an ETV. However, the very narrow slit-like lateral ventricles and third ventricle did not allow a safe execution of this procedure (Fig. 1a–c). As an alternative, a microsurgical fenestration of the lamina terminalis and Liliequist’s membrane was performed via a right-sided eyebrow incision and a small supraorbital craniotomy (Fig. 2). The postoperative course was uneventful. The patient did not experience any symptoms suspect for hydrocephalus or raised intracranial pressure during a follow-up of 3 years. MRI control examination did not reveal a significant increase in the size of the ventricular system (Fig. 1d–f).Fig. 1

Bottom Line: Because of slit ventricles, an endoscopic approach was not possible and, therefore, both patients received a microsurgical TVS by a supraorbital approach.In both cases, microsurgical TVS was successful and the patients became shunt free.Microsurgical TVS by a supraorbital craniotomy is a viable alternative to endoscopic TVS in selected cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Radboud University Nijmegen Medical Center, P. B. 9101, 6500 Nijmegen, The Netherlands. e.vanlindert@nch.umcn.nl

ABSTRACT

Objective: To describe a microsurgical alternative to endoscopic third ventriculocisternostomy.

Methods: Two children with shunt-dependent hydrocephalus and multiple shunt revisions were considered candidates for third ventriculocisternostomy (TVS). Because of slit ventricles, an endoscopic approach was not possible and, therefore, both patients received a microsurgical TVS by a supraorbital approach.

Results: In both cases, microsurgical TVS was successful and the patients became shunt free.

Conclusion: Microsurgical TVS by a supraorbital craniotomy is a viable alternative to endoscopic TVS in selected cases.

Show MeSH
Related in: MedlinePlus