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. 2023 Nov 6;6(19):CASE23153.
doi: 10.3171/CASE23153. Print 2023 Nov 6.

Endoscopic placement of a triventricular stent for complex hydrocephalus and isolated fourth ventricle: illustrative case

V Jane Horak  1   2 , Beste Gulsuna  1   3 , Melissa A LoPresti  1 , Michael DeCuypere  4   1
Affiliations

Endoscopic placement of a triventricular stent for complex hydrocephalus and isolated fourth ventricle: illustrative case

V Jane Horak et al. J Neurosurg Case Lessons. .

Abstract

Background: Hydrocephalus is commonly encountered in pediatric neurosurgery. The etiology is diverse, and complexity in management increases in patients with loculated or trapped ventricles. The authors sought to examine a treatment option of endoscopic placement of a triventricular stent in a pediatric patient with complex hydrocephalus and a trapped fourth ventricle.

Observations: In this case, the authors present the treatment of complex hydrocephalus with a trapped fourth ventricle in a pediatric patient using endoscopic placement of a triventricular aqueductal stent. The patient had a complex neurosurgical history, which included over 15 surgeries for shunted hydrocephalus. This case highlights the unique approach used, and the authors discuss surgical nuances of the technique, as well as learning points.

Lessons: Complex hydrocephalus can be difficult to manage because patients often have multiple catheters, loculated or trapped ventricles, and extensive surgical histories. Endoscopic placement of a triventricular stent can decrease shunt system complexity, restore normal cerebrospinal fluid pathway circulation across the cerebral aqueduct, and promote communication between the ventricles. The authors' treatment modality resulted in the successful resolution of the trapped fourth ventricle and symptomatic improvement in hydrocephalus.

Keywords: aqueductal stent; complex hydrocephalus; pediatric neurosurgery; trapped fourth ventricle.

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Conflict of interest statement

Disclosures Dr. Gulsuna received an international traveling fellowship grant from the Joint Pediatric Neurosurgery Section of the American Association of Neurological Surgeons and Congress of Neurological Surgeons for her time in Lurie Children’s Hospital.

Figures

FIG. 1
FIG. 1
Sagittal (A) and axial (B) T2-weighted MRI scans 3 months prior to surgery. Preoperative sagittal (C) and axial (D) T2-weighted MRI sections showing dilatation of the fourth ventricle and development of syringomyelia. Postoperative sagittal (E) and axial (F) computed tomography immediately after surgery, showing the stent spanning the lateral, third, and fourth ventricles. Two-week postoperative sagittal (G) and axial (H) T2-weighted MRI sequences show reduced dilatation of the fourth ventricle and syringomyelia in the upper cervical spinal cord as compared with the preoperative image (C).
FIG. 2
FIG. 2
Neuronavigation images from the preoperative surgical approach planning. Three-dimensional skull reconstruction demonstrates the entry point (A), and axial (B), sagittal (C), and coronal (D) MRI sections show the planned trajectory through the foramen of Monro.
FIG. 3
FIG. 3
The Storz ShuntScope and stent. The stent was cut according to the preoperative measurement and fenestrated as described in the text.
See this image and copyright information in PMC

References

    1. Ferrer E, de Notaris M. Third ventriculostomy and fourth ventricle outlets obstruction. World Neurosurg. 2013;79(2 Suppl):S20.e9–e13. - PubMed
    1. Bock HC, Dreha-Kulaczewski SF, Alaid A, Gärtner J, Ludwig HC. Upward movement of cerebrospinal fluid in obstructive hydrocephalus—revision of an old concept. Childs Nerv Syst. 2019;35(5):833–841. - PubMed
    1. Cherian S, Whitelaw A, Thoresen M, Love S. The pathogenesis of neonatal post-hemorrhagic hydrocephalus. Brain Pathol. 2004;14(3):305–311. - PMC - PubMed
    1. Milde T, Rodriguez FJ, Barnholtz-Sloan JS, Patil N, Eberhart CG, Gutmann DH. Reimagining pilocytic astrocytomas in the context of pediatric low-grade gliomas. Neuro Oncol. 2021;23(10):1634–1646. - PMC - PubMed
    1. Peraio S, Amen MM, Ali NM, Zaher A, Mohamed Taha AN, Tamburrini G. Endoscopic management of pediatric complex hydrocephalus. World Neurosurg. 2018;119:e482–e490. - PubMed

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