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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

Dual-trajectory operative approach(Top) Double burr hole placement at Kocher’s point (K) and extended anteriorly in the mid-pupillary line to just behind the hairline to facilitate the dual-trajectory operative approach. (Bottom) Planned dual-trajectories for ETV (green) and endoscopic third ventricular cyst fenestration (red) utilizing the StealthStation® AxiEMTM frameless image-guided surgical navigation system.
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FIG3: Dual-trajectory operative approach(Top) Double burr hole placement at Kocher’s point (K) and extended anteriorly in the mid-pupillary line to just behind the hairline to facilitate the dual-trajectory operative approach. (Bottom) Planned dual-trajectories for ETV (green) and endoscopic third ventricular cyst fenestration (red) utilizing the StealthStation® AxiEMTM frameless image-guided surgical navigation system.

Mentions: After endotracheal intubation, the patient was placed supine on the operating table under general anesthesia. The head was secured in a gel donut in the supine position. The StealthStation® AxiEMTM frameless image guidance system (Medtronic, Minneapolis, MN, USA) was initiated with CT imaging and facial registration. A standard trajectory was planned with the entry point at Kocher’s point for the ETV. However, the approach to the cyst necessitated a more anteriorly placed entry point so that the endoscope could be directed posteriorly to the cyst without stretching the fornices. The second entry point was determined utilizing the trajectory view while planning to optimize direct visualization of the cyst. An incision was made at the mid-pupillary line on the right side over Kocher’s point that was extended anteriorly to the end of the hairline. Burr holes were made at both Kocher’s point and anteriorly at the hairline (Figure 3).


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)

Dual-trajectory operative approach(Top) Double burr hole placement at Kocher’s point (K) and extended anteriorly in the mid-pupillary line to just behind the hairline to facilitate the dual-trajectory operative approach. (Bottom) Planned dual-trajectories for ETV (green) and endoscopic third ventricular cyst fenestration (red) utilizing the StealthStation® AxiEMTM frameless image-guided surgical navigation system.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

FIG3: Dual-trajectory operative approach(Top) Double burr hole placement at Kocher’s point (K) and extended anteriorly in the mid-pupillary line to just behind the hairline to facilitate the dual-trajectory operative approach. (Bottom) Planned dual-trajectories for ETV (green) and endoscopic third ventricular cyst fenestration (red) utilizing the StealthStation® AxiEMTM frameless image-guided surgical navigation system.
Mentions: After endotracheal intubation, the patient was placed supine on the operating table under general anesthesia. The head was secured in a gel donut in the supine position. The StealthStation® AxiEMTM frameless image guidance system (Medtronic, Minneapolis, MN, USA) was initiated with CT imaging and facial registration. A standard trajectory was planned with the entry point at Kocher’s point for the ETV. However, the approach to the cyst necessitated a more anteriorly placed entry point so that the endoscope could be directed posteriorly to the cyst without stretching the fornices. The second entry point was determined utilizing the trajectory view while planning to optimize direct visualization of the cyst. An incision was made at the mid-pupillary line on the right side over Kocher’s point that was extended anteriorly to the end of the hairline. Burr holes were made at both Kocher’s point and anteriorly at the hairline (Figure 3).

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