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Simplified aqueductal stenting for isolated fourth ventricle using a small-caliber flexible endoscope in a patient with neurococcidiomycosis: technical case report.
- Source :
-
Neurosurgery [Neurosurgery] 2010 Jun; Vol. 66 (6 Suppl Operative), pp. 373-4; discussion 374. - Publication Year :
- 2010
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Abstract
- Objective: Endoscopic aqueductoplasty and stenting are a preferred treatment for isolated fourth ventricle syndrome related to membranous aqueductal obstruction. We describe a technique using a small-caliber flexible endoscope that may address some limitations of current strategies.<br />Clinical Presentation: A 39-year-old woman with hydrocephalus caused by neurococcidiomycosis and a functional right frontal ventriculoperitoneal shunt presented with vomiting and an isolated fourth ventricle. Magnetic resonance imaging showed an enlarged fourth ventricle and exuberant basilar arachnoiditis obstructing the outlet foramina of the fourth ventricle. Ventriculography indicated aqueductal obstruction.<br />Intervention: Aqueductoplasty was planned to allow spinal fluid to flow from the fourth ventricle to the ventriculoperitoneal shunt. A stent-endoscope construct was prepared by feeding a flexible endoscope through a ventricular catheter cut 4 cm from the tip. The flexible endoscope was contoured to fit the anatomy of the aqueduct. Uncomplicated aqueductoplasty was performed through a single left frontal burr hole using the stent-endoscope construct to perforate a membranous veil and inspect the fourth ventricle. The stent was deployed over the endoscope using the proximal end of the catheter to deliver and secure the stent as the endoscope was withdrawn.<br />Conclusion: Aqueductoplasty and stenting using a small-caliber flexible endoscope is feasible. The endoscope can be contoured to suit the anatomy of the aqueduct and improves visualization of the leading edge of the stent during deployment. Furthermore, when the endoscope is used to create the perforation, the target is not obscured by the shaft of the device used to make the perforation.
- Subjects :
- Adult
Arachnoiditis pathology
Arachnoiditis physiopathology
Arachnoiditis surgery
Brain Stem pathology
Brain Stem physiopathology
Central Nervous System Fungal Infections complications
Cerebral Aqueduct microbiology
Cerebral Aqueduct pathology
Coccidioidomycosis complications
Female
Fourth Ventricle pathology
Fourth Ventricle physiopathology
Humans
Hydrocephalus etiology
Hydrocephalus physiopathology
Ventriculostomy instrumentation
Central Nervous System Fungal Infections surgery
Cerebral Aqueduct surgery
Coccidioidomycosis surgery
Endoscopy methods
Fourth Ventricle surgery
Hydrocephalus surgery
Stents standards
Ventriculostomy methods
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4040
- Volume :
- 66
- Issue :
- 6 Suppl Operative
- Database :
- MEDLINE
- Journal :
- Neurosurgery
- Publication Type :
- Academic Journal
- Accession number :
- 20489531
- Full Text :
- https://doi.org/10.1227/01.NEU.0000369651.19081.0D