gms | German Medical Science

Objective: Patients with symptomatic aqueductal stenosis and / or isolated fourth ventricle benefit from surgical therapy. If conventional endoscopic third ventriculostomy is not sufficient alternative strategies to reduce intracranial pressure are necessary. Therefore, the reconnection of supra- and infratentorial CSF compartments by aqueductal stenting has been described to be a promising method. In this study, the ShuntScope was used to place a catheter into the fourth ventricle via a frontal transventricular approach.

Method: The intra-catheter endoscope with its small outer diameter of 1.0 mm was passed through a conventional ventricle catheter (VC) which was cut open at the distal end. This allows the endoscope to protrude a few millimeters beyond the catheter tip for inspection. A frontal borehole was drilled, and the catheter-shielded endoscope was used for ventricle puncture. Under direct view the VC was advanced through the foramen of Monro and through the aqueduct into the fourth ventricle. After intraoperative confirmation of correct placement, the endoscope was withdrawn while VC was fixed at the borehole.

Results: This technique was applied in 6 patients suffering from aqueductal stenosis and consecutive isolated fourth ventricle. One procedure had to be abandoned as obstructing membranes in the aqueduct could not be bypassed. In the other 5 patients stenting procedure was successful and multicompartimental catheter was connected to a ventriculoperitoneal shunt system. In postoperative imaging, all VC showed a straight trajectory from the borehole through the foramen of Monro and aqueduct to the fourth ventricle.

Conclusions: The ShuntScope-assisted aqueductal stenting via a frontal transventricular approach is a feasible and safe method. Limitations occur in the presence of long-sectional aqueductal obstructions.