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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

Endoscopic third ventriculostomy (ETV)Intraoperative neuroendoscopy image captures demonstrating visualization of the foramen of Monro (top left, FoM) with anterior septal vein (ASV), choroid (Ch) and thalamostriate vein (TsV) landmarks, visualization of the floor of the third ventricle (III) through the foramen Monro (top right), creation of third ventriculostomy via dilation of the NeuroBalloonTM (bottom left), and completed ETV (bottom right, ETV).
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FIG4: Endoscopic third ventriculostomy (ETV)Intraoperative neuroendoscopy image captures demonstrating visualization of the foramen of Monro (top left, FoM) with anterior septal vein (ASV), choroid (Ch) and thalamostriate vein (TsV) landmarks, visualization of the floor of the third ventricle (III) through the foramen Monro (top right), creation of third ventriculostomy via dilation of the NeuroBalloonTM (bottom left), and completed ETV (bottom right, ETV).

Mentions: Out of concern that the biopsy/fenestration of the cyst could lead to hemorrhage that would interfere with ETV, we chose to perform the ETV first since CSF diversion would most directly address her symptomatic hydrocephalus. AxiEMTM guidance was used to place a 19 French peel away sheath catheter into the ventricle through Kocher’s point on first pass. A MINOP® endoscope (Aesculap Inc., Center Valley, PA, USA) was placed through the peel away sheath, and the foramen of Monro was identified with choroid plexus and thalamostriate vein landmarks. The floor of the third ventricle was then identified through the foramen of Monro. A bugbee wire was utilized to fenestrate the floor of the third ventricle anterior to the mammillary bodies, and an Integra NeuroBalloonTM catheter (Integra LifeSciences Corp., Plainsboro, NJ, USA) was placed in the opening and inflated to create the ventriculostomy as previously described (Figure 4) [19].


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)

Endoscopic third ventriculostomy (ETV)Intraoperative neuroendoscopy image captures demonstrating visualization of the foramen of Monro (top left, FoM) with anterior septal vein (ASV), choroid (Ch) and thalamostriate vein (TsV) landmarks, visualization of the floor of the third ventricle (III) through the foramen Monro (top right), creation of third ventriculostomy via dilation of the NeuroBalloonTM (bottom left), and completed ETV (bottom right, ETV).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

FIG4: Endoscopic third ventriculostomy (ETV)Intraoperative neuroendoscopy image captures demonstrating visualization of the foramen of Monro (top left, FoM) with anterior septal vein (ASV), choroid (Ch) and thalamostriate vein (TsV) landmarks, visualization of the floor of the third ventricle (III) through the foramen Monro (top right), creation of third ventriculostomy via dilation of the NeuroBalloonTM (bottom left), and completed ETV (bottom right, ETV).
Mentions: Out of concern that the biopsy/fenestration of the cyst could lead to hemorrhage that would interfere with ETV, we chose to perform the ETV first since CSF diversion would most directly address her symptomatic hydrocephalus. AxiEMTM guidance was used to place a 19 French peel away sheath catheter into the ventricle through Kocher’s point on first pass. A MINOP® endoscope (Aesculap Inc., Center Valley, PA, USA) was placed through the peel away sheath, and the foramen of Monro was identified with choroid plexus and thalamostriate vein landmarks. The floor of the third ventricle was then identified through the foramen of Monro. A bugbee wire was utilized to fenestrate the floor of the third ventricle anterior to the mammillary bodies, and an Integra NeuroBalloonTM catheter (Integra LifeSciences Corp., Plainsboro, NJ, USA) was placed in the opening and inflated to create the ventriculostomy as previously described (Figure 4) [19].

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