Endoscopic aqueductoplasty: technique and results

Area of Science:

• Neurosurgery
• Minimally Invasive Procedures
• Hydrocephalus Treatment

Background:

• Hydrocephalus is often caused by aqueductal stenosis, a blockage in the cerebral aqueduct.
• Traditional treatments may involve shunting or third ventriculostomy, each with associated risks and controversies.
• Endoscopic aqueductoplasty presents a potential alternative for managing this condition.

Purpose of the Study:

• To evaluate the safety and efficacy of endoscopic aqueductoplasty for hydrocephalus secondary to aqueductal stenosis.
• To compare endoscopic aqueductoplasty with third ventriculostomy in managing aqueductal stenosis.
• To discuss the ongoing controversy surrounding treatment options for aqueductal stenosis.

Main Methods:

• A retrospective case series of 17 patients undergoing endoscopic aqueductoplasty.
• Utilized rigid rod-lens scopes for inspection and balloon dilation of the aqueduct.
• Employed flexible endoscopy for exploration of the aqueduct and fourth ventricle, including perforation of membranous obstructions.
• Simultaneous third ventriculostomies were performed in nine patients; one aqueductal stent was placed.
• Frameless computerized neuronavigation was used in six patients for precise targeting.

Main Results:

• No mortality directly related to the endoscopic procedure.
• Complications included asymptomatic fornix contusion, two aqueductal roof injuries (one permanent diplopia, one transient trochlear palsy), and transient dysconjugate eye movements.
• One patient experienced an asymptomatic epidural hematoma; another died of stroke one month post-operation.
• Eleven patients reported symptom improvement, while five remained unchanged.
• No patient required shunting; ventricular size decreased in nine patients.

Conclusions:

• Endoscopic aqueductoplasty is a viable and effective alternative to third ventriculostomy for treating hydrocephalus caused by short segment aqueductal stenosis.
• Further long-term follow-up studies are required to ascertain the durability of aqueductal patency following aqueductoplasty.
• The procedure demonstrates potential for successful management of aqueductal stenosis without the need for shunting in select cases.