Recanalization of Sylvian aqueduct

Disorders of the free passage of the C.S.F. through the Sylvian aqueduct are among the common causes of intracranial hypertension. After the partial or complete obstruction of the aqueduct, the intracranial hypertension may be produced by three different mechanisms - a) by hypertensive hydrocephalus of the third and lateral ventricles, b) by the combination of hydrocephalus and the space-occupying lesion or c) by the acute obstruction of the aqueduct with acute dilatation of the third and lateral ventricles. The supratentorial hypertension may be, in some cases, transferred to the posterior fossa via the incisura tentorii. For many years, neurosurgeons have been trying to restore the free passage of C.S.F by different surgical techniques which could make possible free outflow of supratentorial hypertension. The number of procedures suggested has proved the importance of the obstruction of the Sylvian aqueduct and difficulties in its treatment (5, 6, 14, 15, 16, 17, 18, 19). Since 1972, the selective ventriculography of the third and fourth ventricles with Conray 60 (1, 2, 3, 4, 7, 8, 9, 10, 11, 12, 13, 20, 21) was performed by the author in 1005 patients and pathological findings were proved in 602. Our of 602 patients with pathological findings, the aqueductal stenosis was proved in 39 and complete obstruction of aqueduct in 168 patients, i.e. in 28 per cent of all pathological findings. The new techniques of interventriculostomy (third to fourth ventricle shunt) using Seldinger's technique is described, presented and documented by x-ray pictures. This technique has been used on 5 patients successfully treated upto now.