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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 arachnoid cyst fenestrationIntraoperative neuroendoscopy image captures demonstrating visualization of the foramen of Monro (FoM) with choroid (Ch) and anterior septal vein (ASV) landmarks (top left), direct visualization of the posterior third ventricle and overlying arachnoid cyst (top right and bottom left, Cyst), and fenestration of arachnoid cyst (bottom right, Fenestr.).
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FIG5: Endoscopic arachnoid cyst fenestrationIntraoperative neuroendoscopy image captures demonstrating visualization of the foramen of Monro (FoM) with choroid (Ch) and anterior septal vein (ASV) landmarks (top left), direct visualization of the posterior third ventricle and overlying arachnoid cyst (top right and bottom left, Cyst), and fenestration of arachnoid cyst (bottom right, Fenestr.).

Mentions: Next, we addressed the cyst via the anterior burr hole. A 19 French peel away catheter was passed with AxiEMTM guidance from an anterior to posterior trajectory. The endoscope was placed in the Kocher’s point entry in the lateral horn to visualize the new catheter as it was entering the lateral ventricle. The endoscope was then placed through the anterior burr hole and the foramen of Monro was again visualized, but this time from a more anterior approach. After entering the foramen, we could visualize a clear, benign-appearing arachnoid cyst in the posterior third ventricle. A bugbee wire was utilized to fenestrate the cyst multiple times, and specimens were sent for permanent pathology (Figure 5). At the conclusion of the procedure, hemostasis was achieved with irrigation, and the burr holes were filled with gel foam and covered with Snythes burr hole covers. The incision was closed in a standard fashion. Postoperatively, the patient remained neurologically intact and memory was preserved.


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 arachnoid cyst fenestrationIntraoperative neuroendoscopy image captures demonstrating visualization of the foramen of Monro (FoM) with choroid (Ch) and anterior septal vein (ASV) landmarks (top left), direct visualization of the posterior third ventricle and overlying arachnoid cyst (top right and bottom left, Cyst), and fenestration of arachnoid cyst (bottom right, Fenestr.).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

FIG5: Endoscopic arachnoid cyst fenestrationIntraoperative neuroendoscopy image captures demonstrating visualization of the foramen of Monro (FoM) with choroid (Ch) and anterior septal vein (ASV) landmarks (top left), direct visualization of the posterior third ventricle and overlying arachnoid cyst (top right and bottom left, Cyst), and fenestration of arachnoid cyst (bottom right, Fenestr.).
Mentions: Next, we addressed the cyst via the anterior burr hole. A 19 French peel away catheter was passed with AxiEMTM guidance from an anterior to posterior trajectory. The endoscope was placed in the Kocher’s point entry in the lateral horn to visualize the new catheter as it was entering the lateral ventricle. The endoscope was then placed through the anterior burr hole and the foramen of Monro was again visualized, but this time from a more anterior approach. After entering the foramen, we could visualize a clear, benign-appearing arachnoid cyst in the posterior third ventricle. A bugbee wire was utilized to fenestrate the cyst multiple times, and specimens were sent for permanent pathology (Figure 5). At the conclusion of the procedure, hemostasis was achieved with irrigation, and the burr holes were filled with gel foam and covered with Snythes burr hole covers. The incision was closed in a standard fashion. Postoperatively, the patient remained neurologically intact and memory was preserved.

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