Endoscopic Treatment of the Trapped Fourth Ventricle

Endoscopic Treatment of the Trapped Fourth Ventricle AbstractOBJECTIVETo propose endoscopic treatment as an effective initial alternative for patients with a trapped fourth ventricle.METHODSWe reviewed the records of the last 16 consecutive patients with a symptomatic trapped fourth ventricle seen at the Arkansas Children's Hospital. The first eight patients underwent a shunt procedure; the next eight had endoscopic procedures. The shunt procedures consisted of either separate shunts or combined supra- and infratentorial shunts with shared distal catheters. The endoscopic procedures consisted of either fenestration into the lateral ventricle or aqueductal plasty with or without a stent.RESULTSAll patients underwent successful procedures with good outcomes, although the patients with shunts appeared to have a higher-than-expected rate of revision (50%). Seven revisions were performed on four patients, with a complication rate of 25%. Of the patients who had endoscopic procedures, one eventually required a shunt. The overall complication rate for patients who had endoscopic procedures was also 25%.CONCLUSIONEndoscopic treatment of the trapped fourth ventricle is effective in most cases. In view of the higher-than-expected revision rate with fourth ventricular shunts and an equivalent complication rate, endoscopic treatment is a reasonable initial treatment option for patients with a trapped fourth ventricle. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Endoscopic Treatment of the Trapped Fourth Ventricle

Endoscopic Treatment of the Trapped Fourth Ventricle

TECHNIQUE APPLICATIONS Charles Teo, M .D ., Tim Burson, M .D., Sanjay Misra, M.D. Department ot Pediatric Neurosurgery (CT, TB), Arkansas Children's Hospital and Department ot Neurosurgery (SM), University of Arkansas for Medical Sciences, Little Rock, Arkansas OBJECTIVE: T o p r o p o s e e n d o s c o p i c t r e a t m e n t a s a n e f f e c t iv e in itia l a l t e r n a t i v e fo r p a t ie n t s w i t h a t r a p p e d f o u r t h ventricle. METHODS: W e r e v i e w e d t h e r e c o r d s o f t h e last 1 6 c o n s e c u t i v e p a t ie n t s w it h a s y m p t o m a t i c t r a p p e d f o u r t h v e n t r i c l e seen at the A r k a n s a s C h i l d r e n ' s H o s p i t a l . T h e first e ig h t p a t ie n t s u n d e r w e n t a s h u n t p r o c e d u r e ; th e n e x t e ig h t h a d endoscopic p r o c e d u r e s . T h e s h u n t p r o c e d u r e s c o n s i s t e d o f e i t h e r s e p a r a t e s h u n t s o r c o m b i n e d s u p r a - a n d infratentorial s h u n t s w i t h s h a r e d d is t a l c a t h e t e r s . T h e e n d o s c o p i c p r o c e d u r e s c o n s i s t e d o f e i t h e r f e n e s t r a t i o n in to the lateral v e n t r i c l e o r a q u e d u c t a l p la s t y w i t h o r w i t h o u t a s te n t. RESULTS: All p a t ie n t s u n d e r w e n t s u c c e s s f u l p r o c e d u r e s w it h g o o d o u t c o m e s , a lt h o u g h th e p a t ie n t s w i t h s h u n t s appeared to h a v e a h ig h e r - t h a n - e x p e c t e d rate o f rev isio n ( 5 0 % ) . S e v e n re v isio n s w e r e p e r fo r m e d on fo u r p atien ts, with a c o m p lic a t io n ra te o f 2 5 % . O f th e p a tie n ts w h o had e n d o s c o p ic p r o c e d u r e s , o n e e v e n t u a lly r e q u ir e d a sh u n t. The overall c o m p l i c a t io n ra te fo r p a tie n ts w h o had e n d o s c o p ic p r o c e d u r e s w a s a lso 2 5 % . C O N C L U S I O N : E n d o s c o p i c t r e a t m e n t o f t h e t r a p...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199906000-00049
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVETo propose endoscopic treatment as an effective initial alternative for patients with a trapped fourth ventricle.METHODSWe reviewed the records of the last 16 consecutive patients with a symptomatic trapped fourth ventricle seen at the Arkansas Children's Hospital. The first eight patients underwent a shunt procedure; the next eight had endoscopic procedures. The shunt procedures consisted of either separate shunts or combined supra- and infratentorial shunts with shared distal catheters. The endoscopic procedures consisted of either fenestration into the lateral ventricle or aqueductal plasty with or without a stent.RESULTSAll patients underwent successful procedures with good outcomes, although the patients with shunts appeared to have a higher-than-expected rate of revision (50%). Seven revisions were performed on four patients, with a complication rate of 25%. Of the patients who had endoscopic procedures, one eventually required a shunt. The overall complication rate for patients who had endoscopic procedures was also 25%.CONCLUSIONEndoscopic treatment of the trapped fourth ventricle is effective in most cases. In view of the higher-than-expected revision rate with fourth ventricular shunts and an equivalent complication rate, endoscopic treatment is a reasonable initial treatment option for patients with a trapped fourth ventricle.

Journal

NeurosurgeryOxford University Press

Published: Jun 1, 1999

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