Aqueduct Stent Placement: Indications, Technique, and Clinical Experience

Abstract

Objective: Complicated hydrocephalus, such as trapped fourth ventricle, is challenging. Aqueduct stent placement is a possible alternative to the conventional multiple shunts approach. This article discusses the indications, techniques, and clinical experiences of aqueduct stent placement.

Methods: We retrospectively analyzed a series of 10 consecutive patients with hydrocephalus and had aqueduct stent placement between February 2009 and May 2014. The clinical and imaging data were collected and the indications, technique, and clinical experience of aqueduct stent placement were analyzed and discussed.

Results: Among the 10 patients (mean age, 38 years; range, 5 months-69 years), 8 patients harbored an obstructive hydrocephalus caused by aqueductal obstruction. The underlying pathology consisted of intraventricular tumor in 3 patients, intraventricular cysticercosis in 2, and membranous or inflammatory obstruction in 3 patients. Two patients presented with trapped fourth ventricle, which resulted from Dandy-Walker malformation and shunt placement, respectively. Aqueduct stents were placed endoscopically in 8 patients, whereas the other 2 were placed microscopically. There were no deaths due to aqueduct stent placement. Postoperatively, all of the patients showed improvement or resolution of their symptoms. After an average follow-up period of 27 months (range, 1-51 months), recurrence of aqueductal obstruction has not been observed. In 1 patient, there was a complication of transient oculomotor paralysis after aqueduct stent placement. A stent migration was observed in 1 patient after remaining stable for 4 years.

Conclusions: Aqueduct stent placement is technically feasible and can be useful in selected patients either with endoscopy or open surgery.

Keywords: Aqueduct stent placement; Aqueductal stenosis; Cerebrospinal fluid; Third ventriculostomy; Trapped fourth ventricle.