gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Endoscopic aqueductoplasty: Is there an indication?

Indikation der endoskopischen Aquäduktoplastie im Vergleich zur endoskopischen Third Ventrikulostomie

Meeting Abstract

Suche in Medline nach

  • corresponding author M. J. Fritsch - Klinik für Neurochirurgie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel
  • H. M. Mehdorn - Klinik für Neurochirurgie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc09.05.-16.04

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0079.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Fritsch et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Endoscopic aqueductoplasty has become one possible treatment modality for hydrocephalus caused by aqueductal stenosis (AS). Controversy exists regarding the indication of the procedure and its advantages / disadvantages compared to Endoscopic Third Ventriculostomy (ETV).

Methods

We retrospectively analyzed treatment and outcome of 24 patients who underwent endoscopic aqueductoplasty without or with stent. Surgeries were performed between July 1996 and December 2003. Mean age at time of surgery was 8 years and 8 months (4 months – 36 years). Mean follow-up is 24 months (12 – 84 months). Considering the aetiology and morphology of the AS we divided the patients into 3 groups: periaqueductal tumor associated AS (n=4), distal membranous AS (n=6), AS associated with isolated 4th ventricle (n=14).

Results

In patients with AS due to periaqueductal tumor subsequent re-stenosis of the aqueduct occurred early. We concluded that ETV presents a better choice for this entity.

Four out of 6 patients with distal membranous AS were sufficiently treated by aqueductoplasty. Two re-stenoses and 1 significant complication (3rd nerve paresis) occurred in this group. Further follow-up is warranted in order to define the long-term success and complication rate.

Out of 14 patients with AS associated with isolated 4th ventricle we operated 10 primarily with aqueductoplasty alone and had a restenosis in 5 patients (4 underwent re-aqueductoplasty and stenting, 1 underwent re-aqueductoplasty). Four patients underwent primarily a stenting procedure. There were only minor complications. All patients in this group already had a conventional VP-shunt in place.

Conclusions

The only patient group that clearly benefits from Endoscopic Aqueductoplasty is the group AS associated with isolated 4th ventricle. Placement of a stent is mandatory to reduce or avoid early reclosure and the need for revisions. ETV does not present an alternative because it would not drain the isolated 4th ventricle compartment.