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Guil-Ibáñez JJ, Gomar-Alba M, García-Pérez F, Saucedo L, Narro-Donate JM, Vargas-López AJ, Parrón-Carreño T, Castro-Luna GM, Contreras-Jiménez A, Masegosa-González J. Neuroendoscopic access to the third ventricle in patients with narrow foramen of monro without stenosis/obstruction: role of foraminoplasty. Acta Neurochir (Wien) 2024; 166:197. [PMID: 38683412 DOI: 10.1007/s00701-024-06077-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/06/2024] [Indexed: 05/01/2024]
Abstract
OBJECT One of the critical steps for the success of intraventricular neuroendoscopic procedures is the entry into the third ventricle and passage of the endoscopy system through the foramen of Monro (FM). A diameter larger than that of the instrument used is considered a prerequisite for safely performing the technique, as damage to this structure can lead to alterations in the fornix and vascular structures. When the foramen diameter is narrow and there is no obstruction/stenosis, the role of foraminoplasty in reducing the risk of complications has not been adequately assessed in the literature. METHODS A review of endoscopic procedures conducted at our center since 2018 was undertaken. Cases in which preoperative imaging indicated a FM diameter < 6 mm and foraminoplasty technique was applied were examined to determine the technical and functional success of the procedure. The technical success was determined by completing the neuroendoscopic procedure with the absence of macroscopic lesions in the various structures comprising the foramen and without complications in the follow-up imaging tests. Functional success was defined as the absence of cognitive/memory alterations during the 3-month postoperative follow-up. Additionally, a review of the various forms of foraminoplasty described in the literature is conducted. RESULTS In our cohort, six patients were identified with a preoperative FM diameter < 6 mm without obstruction or stenosis. Foraminoplasty was planned for these cases to facilitate various intraventricular neuroendoscopic procedures. In all instances, the technique was successfully performed without causing macroscopic damage to the structures comprising the foramen. Follow-up visits included various cognitive tests to assess potential sequelae related to microscopic damage to the fornix. None of the patients exhibited anomalies. CONCLUSION Foraminoplasty in patients with a narrow FM without signs of stenosis/obstruction is a useful technique to reduce the risk of complications during the passage of the endoscopy system through this structure, enabling the safe performance of neuroendoscopic procedures.
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Affiliation(s)
- José Javier Guil-Ibáñez
- Department of Neurosurgery, Torrecárdenas University Hospital, Hermandad Donantes de Sangre Street, 04009, Almería, Spain.
- Department of Health Science, University of Almería, Almería, Spain.
| | - Mario Gomar-Alba
- Department of Neurosurgery, Torrecárdenas University Hospital, Hermandad Donantes de Sangre Street, 04009, Almería, Spain
- Department of Health Science, University of Almería, Almería, Spain
- Microneurosurgical and Skull Base Training Laboratory, University of Almería, Almería, Spain
| | - Fernando García-Pérez
- Department of Neurosurgery, Torrecárdenas University Hospital, Hermandad Donantes de Sangre Street, 04009, Almería, Spain
| | - Leandro Saucedo
- Department of Neurosurgery, Torrecárdenas University Hospital, Hermandad Donantes de Sangre Street, 04009, Almería, Spain
| | - José María Narro-Donate
- Department of Neurosurgery, Torrecárdenas University Hospital, Hermandad Donantes de Sangre Street, 04009, Almería, Spain
| | - Antonio José Vargas-López
- Department of Neurosurgery, Torrecárdenas University Hospital, Hermandad Donantes de Sangre Street, 04009, Almería, Spain
- Department of Health Science, University of Almería, Almería, Spain
- Microneurosurgical and Skull Base Training Laboratory, University of Almería, Almería, Spain
| | | | | | - Ascensión Contreras-Jiménez
- Department of Neurosurgery, Torrecárdenas University Hospital, Hermandad Donantes de Sangre Street, 04009, Almería, Spain
| | - José Masegosa-González
- Department of Neurosurgery, Torrecárdenas University Hospital, Hermandad Donantes de Sangre Street, 04009, Almería, Spain
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Guil-Ibáñez JJ, Parrón-Carreño T, Gomar-Alba M, Narro-Donate JM, Masegosa-González J. Neuronavigated endoscopic aqueductoplasty with panventricular stent plus septostomy for isolated fourth ventricle in complex hydrocephalus and syringomyelia associated with myelomeningocele: how I do it. Acta Neurochir (Wien) 2023; 165:2333-2338. [PMID: 37280421 DOI: 10.1007/s00701-023-05649-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/18/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Isolated fourth ventricle (IFV) is a challenging entity to manage. In recent years, endoscopic treatment for aqueductoplasty has been on the rise. However, in patients with complex hydrocephalus and distorted ventricular system, its implementation can be complex. METHODS We present a 3-year-old patient with myelomeningocele and postnatal hydrocephalus treated by ventriculoperitoneal shunt. In follow-up, a progressive IFV and isolated lateral ventricle with symptoms of the posterior fossa developed. An endoscopic aqueductoplasty (EA) with panventricular stent plus septostomy guided with neuronavigation was decided due to the complexity of the ventricular system. CONCLUSION In IFV associated with complex hydrocephalus with distortion of the ventricular system, navigation can be of great help for planning and as a guide for performing EA.
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Affiliation(s)
- José Javier Guil-Ibáñez
- Department of Neurosurgery, Torrecárdenas University Hospital, Calle Hermandad Donantes de Sangre s, /n 04009, Almería, Spain.
- Department of Health Science, University of Almería, Almería, Spain.
| | | | - Mario Gomar-Alba
- Department of Neurosurgery, Torrecárdenas University Hospital, Calle Hermandad Donantes de Sangre s, /n 04009, Almería, Spain
| | - José María Narro-Donate
- Department of Neurosurgery, Torrecárdenas University Hospital, Calle Hermandad Donantes de Sangre s, /n 04009, Almería, Spain
| | - José Masegosa-González
- Department of Neurosurgery, Torrecárdenas University Hospital, Calle Hermandad Donantes de Sangre s, /n 04009, Almería, Spain
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Gomar-Alba M, Parrón-Carreño T, Guil-Ibáñez JJ, Vargas-López AJ, Castelló-Ruiz MJ, García-Pérez F, Masegosa-González J. Role of Endoscopic Aqueductoplasty With Panventricular Stent in the Treatment of Isolated Fourth Ventricle During Shunt Malfunction: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00652. [PMID: 36929773 DOI: 10.1227/ons.0000000000000682] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/17/2023] [Indexed: 03/18/2023] Open
Affiliation(s)
- Mario Gomar-Alba
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Almería, Spain.,University of Almería, Almería, Spain
| | | | | | - Antonio José Vargas-López
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Almería, Spain.,University of Almería, Almería, Spain
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Panagopoulos D, Karydakis P, Themistocleous M. Slit ventricle syndrome: Historical considerations, diagnosis, pathophysiology, and treatment review. Brain Circ 2021; 7:167-177. [PMID: 34667900 PMCID: PMC8459697 DOI: 10.4103/bc.bc_29_21] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/08/2021] [Accepted: 05/21/2021] [Indexed: 11/06/2022] Open
Abstract
After the introduction of shunt treatment for the management of childhood hydrocephalus, a wide variety of complications related to this treatment modality have been recognized. The entity of slit ventricle syndrome (alternatively, symptomatic ventricular coaptation) is one of them, is frequently encountered in the pediatric population and its symptom complex resembles that of shunt failure. We conducted research on PubMed®, MEDLINE®, and Web of Science®, using the keywords: “slit ventricles,” “slit ventricle syndrome,” “SVS” and “ventricular coaptation.” The aim of our review was to trace the advances made through the past decades, concerning our knowledge about the clinical characteristics, pathophysiology, and treatment options of this entity. The discrepancy among researchers about the offending etiology and the optimum treatment algorithm of this entity, as well as the necessity of an updated concept regarding shunt over drainage is analyzed. The multiple treatment modalities proposed and pathophysiologic mechanisms implicated for the treatment of slit ventricle syndrome illustrate the complexity of this entity. Consequently, the issue requires more detailed evaluation. In this review, we comment on all the main facets related to shunt over drainage and the resultant slit ventricle syndrome.
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Affiliation(s)
- Dimitrios Panagopoulos
- Department of Neurosurgery, Pediatric Hospital of Athens, "Agia Sophia,", Athens, Greece
| | | | - Marios Themistocleous
- Department of Neurosurgery, Pediatric Hospital of Athens, "Agia Sophia,", Athens, Greece
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