gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Endoscopic treatment of isolated fourth ventricle – clinical and radiological outcome

Meeting Abstract

  • M. Schulz - Abteilung Kinderneurochirurgie, Charité - Universitätsmedizin Berlin
  • L. Gölz - Abteilung Kinderneurochirurgie, Charité - Universitätsmedizin Berlin
  • B. Spors - Kinderradiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin
  • H. Haberl - Abteilung Kinderneurochirurgie, Charité - Universitätsmedizin Berlin
  • U.W. Thomale - Abteilung Kinderneurochirurgie, Charité - Universitätsmedizin Berlin

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.07.11

DOI: 10.3205/11dgnc155, URN: urn:nbn:de:0183-11dgnc1550

Published: April 28, 2011

© 2011 Schulz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Treatment of isolated 4th ventricle should be considered when clinical symptoms or a significant mass effect occur. Clinical and radiographic outcome after endoscopic stent placement into the 4th ventricle is reported.

Methods: 19 patients (age: 1 month – 20 years; median 17.5 months) in whom 22 endoscopic procedures were performed, either as aqueductoplasty in cases of infratentorial manifestation or as interventriculostomy when the 4th ventricular membrane extended supratentorially. All patients received a stent connected to the CSF diverting shunt. In the follow-up, surgical complications, radiological outcome and clinical outcome of the presenting symptoms are evaluated.

Results: All 19 patients had a mean follow-up of 26.9 ± 18.2 months. No immediate neurological complications were observed. 27.3% of patients experienced complete resolution of presenting symptoms, whereas 68.3% demonstrated partial resolution. Symptoms with short duration (< 4 weeks) resolved completely, while long-asting symptoms improved only partially. Short-term shunt complications (n = 2, insufficient catheter placement and subdural hygroma) and long-term stent revisions (n = 3, outgrowing of the stent and externalization of the shunt) were observed. The mean 4th ventricular volume was reduced after surgery (44.2 ± 25.8ml to 23.1 ± 21.9ml; p < 0.01). Pontine decompression from 0.9 ± 0.3cm to 1.2 ± 0.3cm in a-p diameter (p < 0.01) was achieved after surgery. That was still valid for both parameters after a radiological follow-up of 24.4 ± 14.2 months.

Conclusions: The clinical and radiological outcome after endoscopic aqueductoplasty and interventriculostomy in children with isolated 4th ventricle indicates that the procedure is effective and safe.