Endoscopy in the treatment of slit ventricle syndrome

Abstract

The present study aimed to investigate the efficacy of endoscopy in the treatment of post-shunt placement for slit ventricle syndrome (SVS). Endoscopic surgery was performed on 18 patients with SVS between October 2004 and December 2012. Sex, age, causes of the hydrocephalus, ventricular size and imaging data were collected and analyzed. All patients were divided into two groups according to ventricular size and underwent endoscopic surgeries, including endoscopic third ventriculostomy (ETV), endoscopic aqueductoplasty and cystocisternostomy. All treated patients were observed postoperatively for a period of 2 to 3 weeks, and outpatient follow-up was subsequently scheduled for >12 months. Clinical results, including catheter adherence, shunt removal and complications, were analyzed during the follow-up period. The success rate of endoscopic surgery was indicated to be 82.7%. Syndromes caused by aqueductal stenosis in 15 patients who underwent ETV were relieved; however, syndromes in the 3 patients with cerebral cysticercosis, suprasellar arachnoid cysts, pinea larea glioma and communicating hydrocephalus, respectively, were not relieved and underwent shunt placement again. Brain parenchyma, choroid plexus and ependymal tissue were the predominant causes for catheter obstruction and the obstruction rate was indicated to be 77.8% (14/18). Complications, such as pseudobulbar paralysis, infection and intraventricular hemorrhage arose in 3 patients. The present study indicates that endoscopic treatments are effective and ETV may be considered as a recommended option in the treatment of post-shunt placement SVS in hydrocephalus patients.

Keywords: endoscopy; hydrocephalus; slit ventricle syndrome; ventriculoperitoneal shunt.

Figure 1.

Fornix contusion was caused by endoscopy when the foramen of Monro was very narrow. (A and B) Fornix contusion was caused by the rigid endoscope. (C and D) Fornix contusion was caused by fiber endoscope. 1, foramen of Monro; 2, choroid plexus; 3, shunt catheter; 4, fornix contusion. *Indicates the thalamostriate vein.

Figure 2.

MRI of one patient who was subjected to VP shunting a week later, due to hydrocephalus following the resection of pineal larea glima at the age of 10. Infection of central nervous system was recurrent for 12 years. (A) MRI indicated that the third ventricle of this patient had no normal anatomic structure and two cystic structures existed in the rear of the third ventricle and corpora quadrigemina. (B) Colostomy of the top of cystic structure was performed on the right side of the foramen of Monro. (C-F) Colostomy below the cystic structure was performed and the fiber endoscope entered into the midbrain aqueduct and smoothly into the fourth ventricle following ventricular mild expansion 7 days post-ligation. MRI, magnetic resonance imaging; 1, the foramen of Monro; 2, the cystic structures existed in the rear of the third ventricle; 3, the fistula between the top and below cyst; 4, the weak region in the front of cyst; 5, weak area of fistula; 6, choroid plexus into the fourth ventricle; *the cystic structures existed in the rear of corpora quadrigemina.

Figure 3.

Ventricle images of a female patient with SVS (age 22). (A) Imaging demonstrated an alternate state of slit-ventricle after 6 years with a VP shunt. (B) Imaging indicated an alternate state of ventricle expansion after 8 years with a VP shunt. SVS, slit ventricle syndrome; VP, ventriculoperitoneal.

Figure 4.

Ventricle images of a female patient with SVS (age 22). (A) Imaging indicated that the ventricle end of the shunt was in close contact with the ventricle wall (arrow). (B) Paraventricular edema was caused by chronic ventricular infection after VP shunting and the ventricle was in slit state (arrow). SVS, slit ventricle syndrome; VP, ventriculoperitoneal.

Figure 5.

The foramen of the shunt catheter was obstructed. (A) The foramen of the shunt catheter in this patient was covered by ependymal tissue. 1, the ventricular end of shunt catheter; 2, the foramen of Monro; 3, septum pellucidum vein; 4, high grain venous; 5, choroid plexus. (B) The foramen of the shunt catheter of patients was wrapped with ependymal tissue. 1, the ventricular end of shunt catheter; 2, hyperplasia of the nerves and blood vessels; 3, the foramen of Monro. (C) Ependymal serrated hyperplasia appeared at the foramen of the shunt catheter. (D) The foramen of the shunt catheter of this patient was obstructed by the choroid plexus. 1, shunt catheter; 2, ependymal serrated hyperplasia; 3, hyperplasia of the nerves and blood vessels; *choroid plexus.