Endoscopic Aqueductoplasty and Stenting for Isolated Fourth Ventricle

  • Cho, Won-Ho (Department of Neurosurgery, Pusan National University School of Medicine) ;
  • Lee, Sang-Weon (Department of Neurosurgery, Pusan National University School of Medicine) ;
  • Cha, Seung-Heon (Department of Neurosurgery, Pusan National University School of Medicine)
  • Published : 2006.04.30

Abstract

Isolated fourth ventricle[IFV] is a rare entity producing symptoms of a progressive posterior fossa mass lesion. It is mainly reported in a patient who undergo shunt placement as its late complication. However, its surgical management has been difficult and its optional treatment remains controversial. We had an occasion to admit 19-year-old female to our hospital due to hydrocephalus : she had a history of meningitis when she was 2 years old. Ten years later she was diagnosed as hydrocephalus and managed by lateral ventriculo-peritoneal shunting procedure. Seven years after the procedure, the patient presented with headache, nausea, truncal ataxia and nystagmus. Computed tomography and magnetic resonance image scan demonstrated markedly enlarged fourth ventricle : and thus, neuroendoscopic aqueductoplasty and aqueductal stent insertion was performed. The authors present a case of an IFV after lateral ventriculo-peritoneal shunting for hydrocephalus, which was treated successfully with a neuroendoscopic surgery. The technique of this procedure is described below.

Keywords

References

  1. Chai WX : Long-term results of fourth ventriculo-cisternostomy in complex versus simple atresias of the fourth ventricle outlets. Acta Neurochir 134: 27-34, 1995 https://doi.org/10.1007/BF01428498
  2. Coker SB : Bobble head doll syndrome due to trapped fourth ventricle and aqueduct. Pediatr Neurol 2 : 115-116, 1986 https://doi.org/10.1016/0887-8994(86)90069-X
  3. Coker SB,. Anderson CL : Occluded fourth ventricle after multiple shunt revisions for hydrocephalus. Pediatrics 83: 981-985, 1989
  4. Collada M Jr, Kott J, Kline DG : Documentation of fourth ventricle entrapment by metrizamide ventriculography with CT scanning. Report of two cases. J Neurosurg 55 : 838-840, 1981 https://doi.org/10.3171/jns.1981.55.5.0838
  5. Colli BO, Pereira CU, Assirati Junior JA, Machado HR: Isolated fourth ventricle in neurocysticercosis : pathophysiology, diagnosis, and treatment. Surg Neurol 39: 305-310, 1993 https://doi.org/10.1016/0090-3019(93)90010-X
  6. Foltz EL, DeFeo DR : Double compartment hydrocephalus-a new clinical entity. Neurosurgery 7 : 551-559, 1980 https://doi.org/10.1227/00006123-198012000-00002
  7. Foltz EL, Shurtleff DB : Conversion of communicating hydrocephalus to stenosis or occlusion of the aqueduct during ventricular shunt. J Neurosurg 24: 520-529, 1965
  8. Fritsch MJ, Kienke S, Mehdorn HM : Endoscopic aqueductoplasty : stent or not to stent? Childs Nerv Syst 20: 137-142, 2004 https://doi.org/10.1007/s00381-003-0860-8
  9. Gaab MR, Schroeder HWS : Neuroendoscopic approach to intraventricular lesions, J Neurosurg 88: 496-505, 1998 https://doi.org/10.3171/jns.1998.88.3.0496
  10. Harrison HR, Reynolds AF : Trapped fourth ventricle in coccidioidal meningitis. Surg Neurol 17: 197-199, 1982 https://doi.org/10.1016/0090-3019(82)90277-4
  11. Hawkins JC III, Hoffman HJ, Humphreys RP: Isolated fourth ventricle as a complication of ventricular shunting. Report of three cases. J Neurosurg 49: 910-913, 1978 https://doi.org/10.3171/jns.1978.49.6.0910
  12. Lee M, Leahu D, Weiner HL, Abbott R, Wisoff JH, Epstein FJ : Complications of fourth-ventricular shunts. Pediatr Neurosurg 22 : 309-313, 1995 https://doi.org/10.1159/000120921
  13. Lourie H, Shende MC, Krawchenko J, Stewart DH Jr : Trapped fourth ventricle : a report of two unusual cases. Neurosurgery 7 : 279-282, 1980 https://doi.org/10.1227/00006123-198009000-00015
  14. Mickle JP, Friedman WA : Encysted fourth ventricle. Surg Neurol 16: 150-153, 1981 https://doi.org/10.1016/0090-3019(81)90118-X
  15. Montes JL, Clarke DB, Farmer JP : Stereotatic transtentorial hiatus ventriculoperitoneal shunting for the sequestrated fourth ventricle. Technical note. J Neurosurg 80: 759-761, 1994 https://doi.org/10.3171/jns.1994.80.4.0759
  16. Oi S, Hidaka M, Honda Y, Togo K, Shinoda M, Shimoda M, et al : Neuroendoscopic surgery for specific forms of hydrocephalus. Childs Nerv Syst 15 : 56-68, 1999 https://doi.org/10.1007/s003810050330
  17. Oka K, Yamamoto M, Ikeda K, Tomonaga M: Flexible endoneurosurgical therapy for aqueductal stenosis. Neurosurgery 33: 236-243, 1993 https://doi.org/10.1227/00006123-199308000-00009
  18. Page LK, Tucci KA, Montalvo BM, Post MJD : Isolated fourth ventricular hydrocephalus. Clinical experience with seventeen cases. Concepts Pediatr Neurosurg 8: 38-40, 1988
  19. Ross D, Boland M : Three point skull clamp for infants. Neurosurgery 26 : 360, 1990
  20. Schroeder HW, Oertel J, Gaab MR : Endoscopic aqueductoplasry in the treatment of aqueductal stenosis. Childs Nerv Syst 20 : 821-827, 2004 https://doi.org/10.1007/s00381-004-0937-z
  21. Scotti G, Musgrave MA, Fitz CR, Harwood-Nash DC : The isolated fourth ventricle in children : CT and clinical review of 16 cases. AJR Am J Roentgenol 135: 1233-1238, 1980 https://doi.org/10.2214/ajr.135.6.1233
  22. Teo C, Burson T, Misra S : Endoscopic treatment of the trapped fourth ventricle. Neurosurgery 44 : 1257-1262, 1999 https://doi.org/10.1097/00006123-199906000-00049