Article
Trapped IV ventricle and endoscopic intubation of the aqueduct
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Authors
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C. Mottolese
- Hôpital Neurologique et Neurochirurgical, Pierre Wertheimer, Lyon, France
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S. Boetto
- Neurosurgical service of « Pourpan » hospital, Toulouse, France
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G. Lena
- Pediatric Neurosurgery. «La Timone » hospital Marseille, France
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A. C. Ricci
- Hôpital Neurologique et Neurochirurgical, Pierre Wertheimer, Lyon, France
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A. Szathmari
- Hôpital Neurologique et Neurochirurgical, Pierre Wertheimer, Lyon, France
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C. Ginguené
- Hôpital Neurologique et Neurochirurgical, Pierre Wertheimer, Lyon, France
| Published: | May 4, 2005 |
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Outline
Text
Objective
Canulation of the sylvius aqueduct was proposed for the treatement of aqueductal stenosis for third ventricular hydrocephalus. Endoscopic third ventriculostomy rendered obsolete this technique. We propose the canulation of the aqueuct assisted by the endosurgery for the trapped IVth ventricule syndrome. Trapped IVth ventricle is usually a well known complication of long-term hydrocepahlus treatment. It can be a complication of treatment of intraventricular tumor or hemorrhage localised in the fourth ventricle. The best therapeutic option of symptomatic trapped fourth ventricle remains yet controversial : cyst peritoneal shunt, revising of the previous shunt, acqueduct intubation, acqueduct plasty.
Methods
We report a series of 10 patients (8 childs and 2 adults, 7 males and 3 females) treated with endoscopic intubation of the acqueduct for a trapped ventricle. It was always the complication of the treatment of different etiology hydrocephalus. In the pediatric age group, hydrocephalus was congenital (8 patients): post infectious (2 patients), post haemorrhagic (3 patients) and malformative (3 patients). In adult patients, the etiology of the hydrocephalus was acqueductal stenoses. Eight patients were operated in sitting position and two others in ventral position. The age distribution in the pediatric age group ranged from 1 to 16 years. The others patients were between 54 and 59 years old.
Results
The clinical outcome was judged excellent in all patients with regression of clinicals symptomes without any aggravation. No complications were observed. Radiological results showed a decrease of the size of the IV ventricle to normal in 8 patients while it remained stable in 2 patients.
Conclusions
Our experience shows that the endoscopic intubation of the acqueduct is a sure surgical technique for trapped IVth ventricle, in experienced hands. We observed a low morbidity and any mortality. The endoscope permits to follow the good trajetory according to an ideal plane. The study of MRI allows to have in mind the good direction to attain the III ventricle avoiding complications due to a bad trajectory. For this particular indication endoscopic cannulation of the aqueduct of Silvius can ne performed keeping in mind that endoscopic third ventriculocysternostomy is the treatement of choix for aqueductal stenoses with triventricular hydrocephalus.
