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Endoscopic placement of a triventricular stent for complex hydrocephalus and isolated fourth ventricle: illustrative
V Jane Horak1,2, Beste Gulsuna1,3, Melissa A LoPresti1
12Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Insights
Endoscopic triventricular stenting offers a solution for complex pediatric hydrocephalus with trapped ventricles. This minimally invasive approach successfully resolved the trapped fourth ventricle and improved symptoms.
Area of Science:
- Pediatric Neurosurgery
- Neuroendoscopy
- Hydrocephalus Management
Background:
- Hydrocephalus is a common challenge in pediatric neurosurgery, particularly with complex cases involving loculated or trapped ventricles.
- Patients with complex hydrocephalus often have a history of multiple failed shunt surgeries, increasing management difficulties.
Purpose of the Study:
- To examine the efficacy of endoscopic triventricular stent placement in a pediatric patient with complex hydrocephalus and a trapped fourth ventricle.
- To highlight a unique neurosurgical approach for managing refractory hydrocephalus.
Main Methods:
- Endoscopic placement of a triventricular aqueductal stent was performed in a pediatric patient with a history of over 15 surgeries for shunted hydrocephalus.
- The case details the surgical technique, nuances, and learning points associated with this endoscopic intervention.
Main Results:
- The endoscopic triventricular stent successfully restored cerebrospinal fluid circulation across the cerebral aqueduct.
- Communication between the ventricles was promoted, leading to the resolution of the trapped fourth ventricle.
Conclusions:
- Endoscopic triventricular stenting can simplify complex shunt systems and effectively manage hydrocephalus with trapped ventricles.
- This technique offers a viable treatment option, resulting in symptomatic improvement and successful resolution of ventricular trapping in pediatric patients.
Background:
Hydrocephalus is commonly encountered in pediatric neurosurgery. The etiology is diverse, and complexity in management increases in patients with loculated or trapped ventricles. The authors sought to examine a treatment option of endoscopic placement of a triventricular stent in a pediatric patient with complex hydrocephalus and a trapped fourth ventricle.
Observations:
In this case, the authors present the treatment of complex hydrocephalus with a trapped fourth ventricle in a pediatric patient using endoscopic placement of a triventricular aqueductal stent. The patient had a complex neurosurgical history, which included over 15 surgeries for shunted hydrocephalus. This case highlights the unique approach used, and the authors discuss surgical nuances of the technique, as well as learning points.
Lessons:
Complex hydrocephalus can be difficult to manage because patients often have multiple catheters, loculated or trapped ventricles, and extensive surgical histories. Endoscopic placement of a triventricular stent can decrease shunt system complexity, restore normal cerebrospinal fluid pathway circulation across the cerebral aqueduct, and promote communication between the ventricles. The authors' treatment modality resulted in the successful resolution of the trapped fourth ventricle and symptomatic improvement in hydrocephalus.
