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Dual-trajectory Approach for Simultaneous Cyst Fenestration and Endoscopic Third Ventriculostomy for Treatment of a Complex Third Ventricular Arachnoid Cyst.

Ho AL, Pendharkar AV, Sussman ES, Ravikumar VK, Li GH - Cureus (2015)

Bottom Line: We present a case of a 33-year-old woman with progressive headache and worsened vision, a known history of a multiloculated third-ventricular arachnoid cyst, and imaging findings consistent with cyst expansion and worsened obstructive hydrocephalus.We then describe the dual-trajectory approach for simultaneous cyst fenestration and endoscopic third ventriculostomy that ultimately resulted in successful treatment of her cyst and hydrocephalus.Dual-trajectory endoscopic approach utilizing double burr holes should be considered when addressing lesions of the third ventricle causing obstructive hydrocephalus.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, Stanford University School of Medicine.

ABSTRACT

Objectives: We present a case of a multiloculated third ventricular arachnoid cyst to describe a novel technique for definitive management of these lesions via direct endoscopic fenestration and CSF diversion utilizing separate trajectories that offers superior visualization and avoids forniceal injury.

Methods and results: We present a case of a 33-year-old woman with progressive headache and worsened vision, a known history of a multiloculated third-ventricular arachnoid cyst, and imaging findings consistent with cyst expansion and worsened obstructive hydrocephalus. We then describe the dual-trajectory approach for simultaneous cyst fenestration and endoscopic third ventriculostomy that ultimately resulted in successful treatment of her cyst and hydrocephalus.

Conclusions: Dual-trajectory endoscopic approach utilizing double burr holes should be considered when addressing lesions of the third ventricle causing obstructive hydrocephalus.

No MeSH data available.


Related in: MedlinePlus

Patient imaging at presentation(Left) T2 weighted sagittal brain MRI demonstrating an enlarged multi-loculated cystic structure located in the third ventricle with worsened ventriculomegaly. (Right) T1 weighted non-contrast coronal brain MRI demonstrating an enlarged multi-loculated cystic structure located in the third ventricle with worsened ventriculomegaly.
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FIG2: Patient imaging at presentation(Left) T2 weighted sagittal brain MRI demonstrating an enlarged multi-loculated cystic structure located in the third ventricle with worsened ventriculomegaly. (Right) T1 weighted non-contrast coronal brain MRI demonstrating an enlarged multi-loculated cystic structure located in the third ventricle with worsened ventriculomegaly.

Mentions: The patient is a 33-year-old woman who presented with six months of progressive headaches (worse in the morning) and blurred vision. She had a history of galactorrhea and a diagnosis of hydrocephalus and a third-ventricular cyst based off of a MRI scan done five years prior, but ultimately did not seek any follow-up care (Figure 1). Her neurologic exam was unremarkable except for papilledema. MRI demonstrated worsened ventriculomegaly and an enlarged complex cystic structure within the third ventricle consistent with an arachnoid cyst (Figure 2). The patient underwent a dual-trajectory, double burr hole approach for simultaneous cyst biopsy and fenestration and endoscopic third ventriculostomy (ETV). Final pathology was consistent with an arachnoid cyst. Postoperatively, the patient did well. All her symptoms resolved, and she remained symptom-free at her six-month follow-up.


Dual-trajectory Approach for Simultaneous Cyst Fenestration and Endoscopic Third Ventriculostomy for Treatment of a Complex Third Ventricular Arachnoid Cyst.

Ho AL, Pendharkar AV, Sussman ES, Ravikumar VK, Li GH - Cureus (2015)

Patient imaging at presentation(Left) T2 weighted sagittal brain MRI demonstrating an enlarged multi-loculated cystic structure located in the third ventricle with worsened ventriculomegaly. (Right) T1 weighted non-contrast coronal brain MRI demonstrating an enlarged multi-loculated cystic structure located in the third ventricle with worsened ventriculomegaly.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494513&req=5

FIG2: Patient imaging at presentation(Left) T2 weighted sagittal brain MRI demonstrating an enlarged multi-loculated cystic structure located in the third ventricle with worsened ventriculomegaly. (Right) T1 weighted non-contrast coronal brain MRI demonstrating an enlarged multi-loculated cystic structure located in the third ventricle with worsened ventriculomegaly.
Mentions: The patient is a 33-year-old woman who presented with six months of progressive headaches (worse in the morning) and blurred vision. She had a history of galactorrhea and a diagnosis of hydrocephalus and a third-ventricular cyst based off of a MRI scan done five years prior, but ultimately did not seek any follow-up care (Figure 1). Her neurologic exam was unremarkable except for papilledema. MRI demonstrated worsened ventriculomegaly and an enlarged complex cystic structure within the third ventricle consistent with an arachnoid cyst (Figure 2). The patient underwent a dual-trajectory, double burr hole approach for simultaneous cyst biopsy and fenestration and endoscopic third ventriculostomy (ETV). Final pathology was consistent with an arachnoid cyst. Postoperatively, the patient did well. All her symptoms resolved, and she remained symptom-free at her six-month follow-up.

Bottom Line: We present a case of a 33-year-old woman with progressive headache and worsened vision, a known history of a multiloculated third-ventricular arachnoid cyst, and imaging findings consistent with cyst expansion and worsened obstructive hydrocephalus.We then describe the dual-trajectory approach for simultaneous cyst fenestration and endoscopic third ventriculostomy that ultimately resulted in successful treatment of her cyst and hydrocephalus.Dual-trajectory endoscopic approach utilizing double burr holes should be considered when addressing lesions of the third ventricle causing obstructive hydrocephalus.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, Stanford University School of Medicine.

ABSTRACT

Objectives: We present a case of a multiloculated third ventricular arachnoid cyst to describe a novel technique for definitive management of these lesions via direct endoscopic fenestration and CSF diversion utilizing separate trajectories that offers superior visualization and avoids forniceal injury.

Methods and results: We present a case of a 33-year-old woman with progressive headache and worsened vision, a known history of a multiloculated third-ventricular arachnoid cyst, and imaging findings consistent with cyst expansion and worsened obstructive hydrocephalus. We then describe the dual-trajectory approach for simultaneous cyst fenestration and endoscopic third ventriculostomy that ultimately resulted in successful treatment of her cyst and hydrocephalus.

Conclusions: Dual-trajectory endoscopic approach utilizing double burr holes should be considered when addressing lesions of the third ventricle causing obstructive hydrocephalus.

No MeSH data available.


Related in: MedlinePlus