gms | German Medical Science

64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. - 29. Mai 2013, Düsseldorf

Endoscopic fenestration of intraventricular cerebrospinal fluid cysts: The contralateral approach

Meeting Abstract

  • Robert Reisch - Zentrum für endoskopische und minimalinvasive Neurochirurgie, Klinik Hirslanden, Zürich
  • Michael Hugelshofer - Zentrum für endoskopische und minimalinvasive Neurochirurgie, Klinik Hirslanden, Zürich; Institut für Neuropathologie, UniversitätsSpital Zürich
  • Hani Marcus - Zentrum für endoskopische und minimalinvasive Neurochirurgie, Klinik Hirslanden, Zürich; Imperial College Healthcare NHS Trust, London, United Kingdom
  • Ralf Kockro - Zentrum für endoskopische und minimalinvasive Neurochirurgie, Klinik Hirslanden, Zürich

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMI.16.12

doi: 10.3205/13dgnc427, urn:nbn:de:0183-13dgnc4270

Veröffentlicht: 21. Mai 2013

© 2013 Reisch 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 vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: The endoscopic fenestration of space-occupying ventricular cysts, as an alternative to cystoperitoneal shunting, has evolved into a well-accepted treatment option. However, a transcortically performed approach can cause cortical injury with subsequent neurological deficits, especially in patients with dominant-sided lesions. Objective of this study was to examine the value of the contralateral transcortical transventricular endoscopic approach in patients with dominant-sided ventricular cysts.

Method: A retrospective chart review was performed in all patients with intraventricular cystic lesions, operated by the senior author. Clinical symptoms, radiological data and operative results were evaluated.

Results: During a five-year period between 2007 and 2011, 31 patients were operated with intraventricular non-colloidal arachnoidal or ependymal cysts. 14 cysts were located on the dominant side. After meticulous planning of optimal endoscopic trajectory, 11 patients were operated via a contralateral navigation-guided transcortical transventricular approach. Follow-up data were available for all 11 patients, showing correct fenestration and no recurrent cysts over a mean period of 2 years and 3 months. Postoperative clinical outcome was excellent without permanent neurological or neuropsychological morbidity.

Conclusions: The endoscopic contralateral approach to intraventricular cystic lesions avoids approach related trauma of the dominant hemisphere. Clinical and radiological results in our series were excellent. Anatomical precondition was a suitable ventricular configuration with 1.) approachable ventricular width on the subdominant side and 2.) possible penetration of the cyst to the contralateral dominant side. Technical precondition was the intraoperative use of neuro-navigation for optimal trajectory finding.