Unsuccessful Third Ventriculostomy for Occlusive Hydrocephalus

Abstract

For non-communicating hydrocephalus, neuroendoscopic third ventriculostomy has become a major choice. But sometimes, the procedure results in failure. Typically, impairment of a distal CSF absorption, a preexisting arachnoid membrane just below the fenestrated site and a glial scarring of fenestrated site were pointed out as a factors of failure. On the other side, the intraventricular pressure dynamics of a functioning third ventriculostomy is in the process of study. Recently some reports have noticed the importance of the flow of CSF into the prepontine cistern, mimicking the flow through the aqueduct of Sylvius. We report an unsuccessful trial of third ventriculostomy in a case with huge posterior fossa tumor.

Key words

Failure - uncommunicating hydrocephalus - neuroendoscopic third ventriculostomy - prepontine cistern

Reference

• 1 Goumnerova L C, Frim D M. Treatment of hydrocephalus with third ventriculocisternostomy: outcome and CSF flow patterns.  Pediatr Neurosurg. 1997;  27 149-152
• 2 Javadpour M, Mallucci C, Brodbelt A, Golash A, May P. The impact of endoscopic third ventriculostomy on the management of newly diagnosed hydrocephalus in infants.  Pediatr Neurosurg. 2001;  35 131-135
• 3 Jones R F, Kwok B C, Stening W A, Vonau M. The current status of endoscopic third ventriculostomy in the management of non-communicating hydrocephalus.  Minim Invasive Neurosurg. 1994;  37 28-36
• 4 Kobayashi N, Kamikawa S, Miyake S, Yamamoto K, Kojima N, Tamaki N. [Treatment of hydrocephalus without shunt placement: third ventriculostomy].  No Shinkei Geka. 1997;  25 35-40
• 5 Kunz U, Goldmann A, Bader C, Waldbaur H, Oldenkott P. Endoscopic fenestration of the 3rd ventricular floor in aqueductal stenosis.  Minim Invasive Neurosurg. 1994;  37 42-47
• 6 Dalrymple S J, Kelly P J. Computer-assisted stereotactic third ventriculostomy in the management of noncommunicating hydrocephalus.  Stereotact Funct Neurosurg. 1992;  59 105-110
• 7 Bellotti A, Rapana A, laccarino C, Schonauer M. Intracranial pressure monitoring after endoscopic third ventriculostomy: an effective method to manage the ‘adaptation period’.  Clin Neurol Neurosurg. 2001;  103 223-227
• 8 Frim D M, Goumnerova L C. Telemetric intraventricular pressure measurements after third ventriculocisternostomy in a patient with noncommunicating hydrocephalus.  Neurosurgery. 1997;  41 1425-1428 discussion 1428 - 1430
• 9 Tisell M, Edsbagge M, Stephensen H, Czosnyka M, Wikkelso C. Elastance correlates with outcome after endoscopic third ventriculostomy in adults with hydrocephalus caused by primary aqueductal stenosis.  Neurosurgery. 2002;  50 70-77
• 10 Buxton N, Vloeberghs M, Punt J. Liliequist’s membrane in minimally invasive endoscopic neurosurgery.  Clin Anat. 1998;  11 187-190
• 11 Lev S, Bhadelia R A, Estin D, Heilman C B, Wolpert S M. Functional analysis of third ventriculostomy patency with phase-contrast MRI velocity measurements.  Neuroradiology. 1997;  39 175-179
• 12 Morota N, Watabe T, Inukai T, Hongo K, Nakagawa H. Anatomical variants in the floor of the third ventricle; implications for endoscopic third ventriculostomy.  J Neurol Neurosurg Psychiatry. 2000;  69 531-534
• 13 Inamura T, Muratani H, Ogami S, Hikita T, Fukui M. Neuroendoscopic third ventriculostomy in a patient with occluded foramen of Monro: a case report.  Minim Invasive Neurosurg. 2002;  45 52-54