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Minim Invasive Neurosurg 2003; 46(4): 202-204
DOI: 10.1055/s-2003-42349
Original Article
© Georg Thieme Verlag Stuttgart · New York

The Mechanism of Fornix Lesions in 3rd Ventriculostomy

U.  Kehler1 , J.  Regelsberger1 , J.  Gliemroth2
  • 1Neurosurgical Department, University Hospital Hamburg Eppendorf, Germany
  • 2Neurosurgical Department, Medical University Lübeck, Germany
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Publication History

Publication Date:
24 September 2003 (online)

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Abstract

Fornix lesions as a complication of 3rd ventriculostomy are rare and almost not reported. However, in our series of 94 procedures we observed 5 fornix lesions. Although we did not find any clinical deterioration, we were alarmed by these unexpected incidences and analysed the mechanism. All fornix lesions occurred using an endoscope sheath with separated channels for the endoscope itself, the instruments and for rinsing and suction. The limited field of view suggests the surgeon to be already inside the 3rd ventricle while the tip of the scope is still in the lateral ventricle just before the foramen of Monro. The instrument enters the optic field - depending on the used optic - as lately as 2 to 3 mm. The analysis showed that the lesions happened when the instruments were in the blind angle of the endoscope's optic which itself was outside of the foramen of Monro. Being aware of this mechanism with its potential risks it did not occurred again.

Key words

Third ventriculostomy - hydrocephalus - fornix - complications

References

  • 1 Barlow P, Ching H S. An economic argument in favour of endoscopic third ventriculostomy as a treatment for obstructive hydrocephalus.  Minim Invas Neurosurg. 1997;  40 37-38
    PubMedSearch in Google Scholar
  • 2 Cohen A R. Cranial endoscopy. Illustrative case.  Techniques in Neurosurg. 1995;  1 144-147
    PubMedSearch in Google Scholar
  • 3 Drake J M. Ventriculostomy for treatment of hydrocephalus.  Neurosurg Clin North Am. 1993;  4 657-666
    PubMedSearch in Google Scholar
  • 4 Hopf N J, Grunert P, Fries G, Resch K DM, Perneczky A. Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures.  Neurosurg. 1999;  44 795-806
    CrossrefPubMedSearch in Google Scholar
  • 5 Jones R FC, Teo C, Stening W A, Kwok B CT. Neuroendoscopic third ventriculostomy. In: Manwaring KH, Crone KR (eds). Neuroendoscopy. New York: Mary Ann Liebert, Inc., Publishers 1992 1: 63-77
    Search in Google Scholar
  • 6 Kehler U, Gliemroth J, Wagner R, Arnold H. 3rd ventriculostomy versus ventriculoperitoneal shunt. An analysis of results, complications, and costs. Zentralbl Neurochir 1996 Suppl: 84 (abstract)
    Search in Google Scholar
  • 7 Kelly P J. Stereotactic third ventriculostomy in patients with nontumoral adolescent/ adult onset aqueductal stenosis and symptomatic hydrocephalus.  J Neurosurg. 1991;  75 865-873
    CrossrefPubMedSearch in Google Scholar
  • 8 Kunz U, Goldmann A, Bader C, Waldbaur H, Oldenkott P. Endoscopic fenestration of the 3rd ventricular floor in aqueductal stenosis.  Minim Invasiv Neurosurg. 1994;  37 42-47
    PubMedSearch in Google Scholar
  • 9 Oka K, Yamamoto M, Ikeda K, Tomonaga M. Flexible endoneurosurgical therapy for aqueductal stenosis.  Neurosurg. 1993;  33 236-242
    CrossrefPubMedSearch in Google Scholar
  • 10 Sainte-Rose C. Third ventriculostomy. In: Manwaring KH, Crone KR (eds.). Neuroendoscopy. New York: Mary Ann Liebert 1992 1: 47-62
    Search in Google Scholar
  • 11 Teo C. Third ventriculostomy in the treatment of hydrocephalus. Experience with more than 120 cases. In: Hellwig D, Bauer BL (eds.). Minimally Invasive Techniques for Neurosurgery. Berlin, Heidelberg, Berlin: Springer Verlag 1998: 73-76
    Search in Google Scholar
  • 12 Handler M H, Abbott R, Lee M. A near-fatal complication of endoscopic third ventriculostomy: case report.  Neurosurg. 1994;  35 525-527
    CrossrefPubMedSearch in Google Scholar
  • 13 Hirsch J F. Percutaneous ventriculocisternostomies in non-communicating hydrocephalus.  Monogr Neurol Sci. 1982;  8 170-178
    PubMedSearch in Google Scholar
  • 14 Kehler U, Gliemroth J, Arnold H. Endoskopische Behandlung des Verschlusshydrocephalus.  Focus MUL. 1996;  13, Heft 2 82-87
    PubMedSearch in Google Scholar
  • 15 McLaughlin M R, Wahlig J B, Kaufmann A M, Albright A L. Traumatic basilar aneurysm after endoscopic third ventriculostomy: case report.  Neurosurg. 1976;  41 1400-1403
    PubMedSearch in Google Scholar
  • 16 Mohanty A, Anandh B, Reddy M S, Sastry K VR. Contralateral massive acute subdural collection after endoscopic third ventriculostomy - a case report.  Minim Invas Neurosurg. 1997;  40 59-61
    PubMedSearch in Google Scholar
  • 17 Sayers M P, Kosnik E J. Percutaneous third ventriculostomy: Experience and technique.  Childs Brain. 1976;  2 24-30
    PubMedSearch in Google Scholar
  • 18 Zamorano L, Chavantes C, Dujovny M, Malik G, Ausman J. Stereotatic endoscopic interventions in cystic and intraventricular brain lesions.  Acta Neurochir Suppl. 1992;  54 69-76
    PubMedSearch in Google Scholar
  • 19 Hader W J, Drake J, Cochrane D, Sparrow O, Johnson E S, Kestle J. Death after late failure of third ventriculostomy in children. Report of three cases.  J Neurosurg. 2002;  97 211-215
    CrossrefPubMedSearch in Google Scholar
  • 20 Benabarre A, Ibánez J, Boget T, Obiols J, Martinéz-Aran A, Vieta E. Neuropsychological and psychiatric complications in endoscopic third ventriculostomy: a clinical case report.  J Neurol Neurosurg Psychiatry. 2001;  71 268-271
    CrossrefPubMedSearch in Google Scholar
  • 21 Schröder H W, Niendorf W R, Gaab M R. Complications of endoscopic third ventriculostomy.  J Neurosurg. 2002;  96 1032-1040
    PubMedSearch in Google Scholar

Priv.-Doz. Dr. Uwe Kehler

Klinik für Neurochirurgie · Universitätsklinikum Eppendorf

Martinistr. 52

20246 Hamburg

Germany

Phone: +49-40/42803-2751

Fax: +49-40/42803-8121

Email: kehler@uke.uni-hamburg.de