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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 2. a, b Preoperative CT scan depicting slit-like ventricles; c, d postoperative CT scan with minimal increase of ventricle size and a residual ventricular catheter that could not be removed
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Fig3: Case report 2. a, b Preoperative CT scan depicting slit-like ventricles; c, d postoperative CT scan with minimal increase of ventricle size and a residual ventricular catheter that could not be removed

Mentions: At this time, he was referred to our department. As a first measure, a PaediGav 9/29 gravitational valve was applied because we had gained good experience with this type of valve but without any positive effect on the headaches. Although the patient did not improve after many shunt upgrading, it was felt that his headaches most likely were to be attributed to chronic overdrainage. Therefore, we sought for a means to have the patient shunt independent (after proven shunt dependency at the time). Because an ETV was considered to be impossible, a right supraorbital craniotomy with a lamina terminalis fenestration and fenestration of Liliequist’s membrane was executed and the shunt was completely removed, except for the ventricular catheter that was fixated and therefore left behind. Again, no significant change of the headache could be observed. A 24-h continuous ICP monitoring, performed after 6 weeks because of unchanged symptoms, revealed a normal ICP in supine and upright positions with a maximum nightly increase to 13 mm Hg. Two years after surgery, the patient is still shunt independent with chronic headaches, no papilledema (contrary to the first shunt explantation before MTV), and in a rehabilitation program. A computed tomography (CT) scan 1.5 years after surgery shows a minimal increase in the size of the ventricles (Fig. 3).Fig. 3


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

van Lindert EJ - Childs Nerv Syst (2008)

Case report 2. a, b Preoperative CT scan depicting slit-like ventricles; c, d postoperative CT scan with minimal increase of ventricle size and a residual ventricular catheter that could not be removed
© Copyright Policy
Related In: Results  -  Collection

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

Fig3: Case report 2. a, b Preoperative CT scan depicting slit-like ventricles; c, d postoperative CT scan with minimal increase of ventricle size and a residual ventricular catheter that could not be removed
Mentions: At this time, he was referred to our department. As a first measure, a PaediGav 9/29 gravitational valve was applied because we had gained good experience with this type of valve but without any positive effect on the headaches. Although the patient did not improve after many shunt upgrading, it was felt that his headaches most likely were to be attributed to chronic overdrainage. Therefore, we sought for a means to have the patient shunt independent (after proven shunt dependency at the time). Because an ETV was considered to be impossible, a right supraorbital craniotomy with a lamina terminalis fenestration and fenestration of Liliequist’s membrane was executed and the shunt was completely removed, except for the ventricular catheter that was fixated and therefore left behind. Again, no significant change of the headache could be observed. A 24-h continuous ICP monitoring, performed after 6 weeks because of unchanged symptoms, revealed a normal ICP in supine and upright positions with a maximum nightly increase to 13 mm Hg. Two years after surgery, the patient is still shunt independent with chronic headaches, no papilledema (contrary to the first shunt explantation before MTV), and in a rehabilitation program. A computed tomography (CT) scan 1.5 years after surgery shows a minimal increase in the size of the ventricles (Fig. 3).Fig. 3

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