Professional Documents
Culture Documents
Hid Rose Falus
Hid Rose Falus
Abstract
Endoscopic treatment for hydrocephalus started in the early 20th century, but could not thrive due to poor
illumination and magnification of the scope. In the 1950s, ventriculoperitoneal (VP) shunt became widely
acceptable as standard treatment for hydrocephalus owing to the invention of well-designed valves and discovery
of silicone, a biocompatible material for manufacturing shunt catheters. However, shunting is still far from being
an ideal treatment because of its associated complications such as catheter malposition, blockage, and over- or
under-drainage of cerebrospinal fluid. The shunt revision rates remained high in recent series. At the same time,
endoscopy has undergone tremendous improvement in the latter half of the century and has emerged as an
attractive alternative since the early 1990s. The article described the usage of endoscopy in the treatment of
hydrocephalus, such as endoscopic third ventriculostomy, fenestration of multi-loculated hydrocephalus, and
fenestration of septum pellucidum prior to VP shunting.
Keywords: Endoscopy, Hydrocephalus, Shunt, Third ventriculostomy
203
204
Fig. 1. A: Sagittal MRI, T1 sequence post-contrast showing an enhancing tumour in the pineal region causing
obstructive hydrocephalus. The lateral and third ventricles were dilated but the forth ventricle was of normal
size. B: Coronal MRI, T1 post-contrast showing similar findings. C: Axial MRI, FLAIR sequence, showing dilated
lateral ventricles and CSF transudation. D: Axial MRI, FLAIR sequence, showing dilated third ventricle which
made third ventriculostomy possible.
MRI: Magnetic resonance imaging
CSF: Cerebrospinal fluid
FLAIR: Fluid attenuated inversion recovery
Fig. 2. Snapshot of the navigation screen showing the selection of an entry point (lateral/
superficial crosshair) at the frontal region and a trajectory that will bring the endoscope to
the foramen of Monro (medial/deep crosshair) and then to the floor of the third ventricle with
minimum angulation.
205
Review
206
^ success rate at 36 months; * 65% at one year, 52% at five years; f only included patients with tumour-related obstructive hydrocephalus.
207
Review
The
common
causes
of
multiloculated
hydrocephalus are ventriculitis and intraventricular
haemorrhage. Tumours that grow in the CSF
pathway may also result in obstruction of CSF
Fig. 5. Left: T2 sequence axial magnetic resonance imaging (MRI) showing loculation of the
right frontal horn. Right: MRI taken after the endoscopic fenestration of the right frontal
loculation and septum pellucidum. Both lateral ventricles were adequately decompressed.
208
Fig. 6. A: Picture showing a rigid ventriculoscope. The patient has been positioned and draped for
a ventriculoperitoneal shunt surgery. B: A burr hole has been made. The lateral ventricle was first
cannulated with a Dandy needle. C: The ventriculoscope was introduced through the same path
created by the Dandy needle. D: The camera was introduced.
209
Review
Fig. 7. The ventriculoscope has been registered to the navigation system. The
axial and coronal views of the navigation screen showed that the structure
seen from the scope camera was the septum pellucidum.
210
1.
211
Review
19. Hoffman HJ. The advantages of percutaneous third
ventriculostomy over other forms of surgical treatment
for infantile obstructive hydrocephalus, in Morley TP (ed):
Current controversies in neurosurgery. Philadelphia. WB
Saunders; 1976, pp 691703.
20. Patterson RH Jr, Bergland RM. The selection of patients
for third ventriculostomy based on experience with 33
operations. J Neurosurg 1968;29(3):2524.
21. Grunert P, Charalampaki P, Hopf N, Filippi R. The role of
third ventriculostomy in the management of obstructive
hydrocephalus. Minim Invasive Neurosurg 2003;46(1):16
21.
22. Hopf NJ, Grunert P, Fries G, Resch KD, Perneczky A.
Endoscopic third ventriculostomy: outcome analysis
of 100 consecutive procedures. Neurosurgery
1999;44(4):795804.
23. Ray P, Jallo GI, Kim RY, Kim BS, Wilson S, Kothbauer K, et
al. Endoscopic third ventriculostomy for tumor-related
hydro-cephalus in a pediatric population. Neurosurg
Focus 2005;19(6): E8.
24. Ruggiero C, Cinalli G, Spennato P, Aliberti F, Cianciulli E,
Trischitta V, et al. Endoscopic third ventriculostomy in the
treatment of hydrocephalus in posterior fossa tumors in
children. Childs Nerv Syst 2004;20:82833.
25. Tamburrini G, Pettorini BL, Massimi L, Caldarelli M, Di
Rocco C. Endoscopic third ventriculostomy: The best
option in the treatment of persistent hydrocephalus after
posterior cranial fossa tumour removal? Childs Nerv Syst
2008;24(12):140512.
26. Shimizu T, Luciano MG, Fukuhara T. Role of endoscopic
third ventriculostomy at infected cerebrospinal fluid
shunt removal. J Neurosurg Pediatr 2012;9(3):3206.
27. Paidakakos N, Borgarello S, Naddeo M. Indications for
endoscopicthird ventriculostomy in normal pressure
hydrocephalus Acta Neurochir Suppl 2012;113:1237.
28. Oertel JM, Mondorf Y, Baldauf J, Schroeder HW, Gaab
MR. Endoscopic third ventriculostomy for obstructive
hydrocephalus due to intracranial hemorrhage with
intraventricular extension. J Neurosurg 2009;111(6):1119
26.
29. Fukuhara T, Shimizu T, Namba Y. Limited efficacy of
endoscopic third ventriculostomy for hydrocephalus
following aneurysmal subarachnoid hemorrhage. Neurol
Med Chir (Tokyo) 2009;49(10):44955.
30. Rangel-Castilla L, Barber S, Zhang YJ. The role of
endoscopic third ventriculostomy in the treatment
of communicating hydrocephalus. World Neurosurg
2012;77(34):55560.
31. Gangemi M, Maiuri F, Colella G, Magro F, Seneca V, de
Divitiis E. Is endoscopic third ventriculostomy an internal
shunt alone? Minim Invasive Neurosurg 2007;50(1):47
50.
32. Pinto FC, Saad F, Oliveira MF, Pereira RM, Miranda FL, Tornai
JB, et al. Role of endoscopic third ventriculostomy and
ventriculoperitoneal shunt in idiopathic normal pressure
hydrocephalus: Preliminary results of a randomized
clinical trial. Neurosurgery 2013;72(5):84553.
33. Brockmeyer D, Abtin K, Carey L, Walker ML. Endoscopic
third ventriculostomy: An outcome analysis. Pediatr
Neurosurg 1998;28(5):23640.
34. Gorayeb RP, Cavalheiro S, Zymberg ST. Endoscopic third
ventriculostomy in children younger than 1 year of age. J
Neurosurg 2004;100:4279.
35. Kadrian D, van Gelder J, Florida D, Jones R, Vonau M,
Teo C, et al. Long-term reliability of endoscopic third
ventriculostomy. Neurosurgery 2008;62:61421.
212