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Lai PY, Li CH, Yang MT, Feng PH, Kuok CM. Case Report: Occlusion of the foramen of Monro treated with endoscopic septostomy and foraminotomy in a preterm neonate. Front Surg 2023; 10:1257679. [PMID: 38162092 PMCID: PMC10754961 DOI: 10.3389/fsurg.2023.1257679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024] Open
Abstract
Background Hydrocephalus is a brain abnormality frequently encountered in neonates. There are several known etiologies of hydrocephalus, which can be classified as either congenital or acquired. Occlusion of the foramen of Monro (FOM) is a cause of hydrocephalus and can be either congenital or secondary to various disorders. Idiopathic obstruction of the FOM presenting as prenatal ventriculomegaly is extremely rare but has been reported. Case presentation We present the case of a preterm newborn with severe bilateral hydrocephalus due to FOM occlusion in the prenatal period. Although the neonate had normal head circumference and no clinical symptoms after birth, brain sonography revealed progressive ventriculomegaly. Further image revealed bilateral ventriculomegaly with normal-sized third and fourth ventricles. We suspected a complete obstruction of the right and a partial obstruction of the left of the FOM. The neonate underwent endoscopic septostomy and foraminotomy, resulting in improvement. Conclusion We report a case of preterm FOM occlusion in the youngest and smallest neonate to date. Endoscopic septostomy and foraminotomy were performed in order to avoid ventriculoperitoneal shunt-related complications, highlighting the viability of endoscopic procedures which should be the primary treatment in preterm neonates with FOM occlusion.
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Affiliation(s)
- Po-Yu Lai
- Division of Neurosurgery Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Cheng-Hao Li
- Division of Neurosurgery Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Ming-Tao Yang
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei, Taiwan
- Department of Chemical Engineering and Materials Science, Yuan Ze University, Taoyuan, Taiwan
| | - Pao-Hui Feng
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Chi-Man Kuok
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei, Taiwan
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Neuroendoscopic septostomy in unilateral and bilateral ventricular hydrocephalus. Childs Nerv Syst 2023; 39:197-203. [PMID: 36161520 DOI: 10.1007/s00381-022-05690-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/20/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This study describes the results of septostomy (SPT) in terms of success and analysis of follow-up in a series of pediatric patients diagnosed with unilateral ventricular hydrocephalus (UHV) and biventricular hydrocephalus (BVH). METHODS A total of 29 pediatric patients diagnosed with UVH or BVH were included in this study. In UVH, a neuroendoscopic SPT was performed (sometimes accompanied by NEFPFMO). In those diagnosed with BVH, an SPT combined with VPS was carried out. Demographic, etiological, clinical, and diagnostic variables and percentage of treatment success were collected. RESULTS SPT was successful during follow-up when no VPS was required in UVH and only unilateral VPS was implanted in BVH. At the time of surgery, 16 patients needed a ventriculoperitoneal shunt. The first SPT was successful in 22 patients, requiring a second surgery in 7 patients, from the oncology group diagnosed with BHV. CONCLUSIONS The surgical management of UVH and BVH still has some disclosure points to be reviewed. However, SPT seems to be a secure, non-traumatic, and efficient procedure.
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Gabbita AC, Raju S. Management of Complex Hydrocephalus. Neurol India 2021; 69:S350-S356. [PMID: 35102987 DOI: 10.4103/0028-3886.332284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Management of complex/multiloculated/septated hydrocephalus is challenging. Neuroendoscopy has been well-established when compared to multiple shunt placements in management of multiloculated hydrocephalus (MH). The main aim of neuroendoscopy is to convert multiple locules into a single locule and drain it by either third ventriculostomy or ventriculoperitoneal shunt. Objective The objective is to reduce the number of surgical procedures and improve the quality of life. Neuroendoscopy avoids multiple shunt placement and need for revision of shunt. Methods Literature review regarding natural history, pathogenesis, classification and management of complex/uni/multiloculated hydrocephalus was extensively done and our minimal experience with these cases has been taken into consideration. Conclusion Neuroendoscopy when combined with frameless neuronavigation is reliable, accurate, and extremely useful in maintaining orientation and localizing the appropriate fenestration site in MH where anatomical landmarks are grossly distorted.
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Affiliation(s)
- Abhirama Chandra Gabbita
- Department of Neurosurgery, Institute of Neurosciences, AIG Hospitals, Mindspace Road, Gachibowli, Hyderabad, Telangana, India
| | - Subodh Raju
- Department of Neurosurgery, Institute of Neurosciences, AIG Hospitals, Mindspace Road, Gachibowli, Hyderabad, Telangana, India
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Padayachy L, Ford L, Dlamini N, Mazwi A. Surgical treatment of post-infectious hydrocephalus in infants. Childs Nerv Syst 2021; 37:3397-3406. [PMID: 34148129 DOI: 10.1007/s00381-021-05237-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/27/2021] [Indexed: 11/29/2022]
Abstract
The management of post-infective hydrocephalus in infants remains a challenging task for the pediatric neurosurgeon. The decision-making curve is often complex in that appropriate temporizing measures need to be implemented to properly clear any infection within the CSF before any decision can be made regarding a permanent solution. The etiology differs at varying stages of neonatal development, and the weight of the child, skin fragility, and relevant surgical treatment options are often important limiting factors. Deciding on the optimal treatment option involves assessing the etiology, age, and clinical and radiological features of the individual case and selecting the most appropriate surgical option.
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Affiliation(s)
- L Padayachy
- Pediatric Neurosurgery Unit, Department of Neurosurgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa.
| | - L Ford
- Pediatric Neurosurgery Unit, Department of Neurosurgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - N Dlamini
- Pediatric Neurosurgery Unit, Department of Neurosurgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - A Mazwi
- Department of Neurosurgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
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Lateral Temporal Approach for Image-Guided Stereotactic Biopsy of Pineal Region Tumors. World Neurosurg 2020; 147:144-149. [PMID: 33307256 DOI: 10.1016/j.wneu.2020.11.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Biopsy of pineal region neoplasms is frequently accomplished by way of endoscopic transventricular access or using an image-guided, computer-assisted stereotactic approach. METHODS We evaluated a nonorthogonal lateral temporal approach for stereotactic biopsy of pineal region tumors as a variation of previously described stereotactic methods. Magnetic resonance imaging-guided frameless stereotaxy was used to plan and perform biopsies of pineal region tumors using a nonorthogonal trajectory extending from the superior or middle temporal gyri through the temporal stem, anterior to the atrium of the lateral ventricle, and posterior to the corticospinal tract. RESULTS All patients had an uncomplicated postoperative course and remained at neurologic baseline. No parenchymal or ventricular hemorrhage was present on postoperative scans. A tissue diagnosis was obtained in all patients. CONCLUSIONS This method appears to be a safe alternative to stereotactic biopsy using other trajectories and provides adequate tissue for definitive diagnosis.
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Peraio S, Amen MM, Ali NM, Zaher A, Mohamed Taha AN, Tamburrini G. Endoscopic Management of Pediatric Complex Hydrocephalus. World Neurosurg 2018; 119:e482-e490. [DOI: 10.1016/j.wneu.2018.07.187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/22/2018] [Accepted: 07/23/2018] [Indexed: 11/24/2022]
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Giammattei L, Aureli V, Daniel RT, Messerer M. Neuroendoscopic septostomy: Indications and surgical technique. Neurochirurgie 2018; 64:190-193. [PMID: 29709371 DOI: 10.1016/j.neuchi.2018.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 12/12/2017] [Accepted: 02/17/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Endoscopic septostomy is the treatment of choice for monolateral obstruction of the foramen of Monro. Common causes of this condition include: neoplasms, hemorrages, infections, congenital atresia, idiopathic occlusion. METHOD All the steps for performing a safe endoscopic pellucidotomy are presented. A brief discussion about the most common technical variations and their rationale is added. CONCLUSION Endoscopic pellucidotomy is a safe and effective treatment when a thorough understanding of anatomy is achieved.
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Affiliation(s)
- L Giammattei
- Department of Neurosurgery, University Hospital of Lausanne, 1010 Lausanne, Switzerland.
| | - V Aureli
- Department of Neurosurgery, University Hospital of Lausanne, 1010 Lausanne, Switzerland
| | - R-T Daniel
- Department of Neurosurgery, University Hospital of Lausanne, 1010 Lausanne, Switzerland
| | - M Messerer
- Department of Neurosurgery, University Hospital of Lausanne, 1010 Lausanne, Switzerland
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Manjila S, Mencattelli M, Rosa B, Price K, Fagogenis G, Dupont PE. A multiport MR-compatible neuroendoscope: spanning the gap between rigid and flexible scopes. Neurosurg Focus 2017; 41:E13. [PMID: 27581309 DOI: 10.3171/2016.7.focus16181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Rigid endoscopes enable minimally invasive access to the ventricular system; however, the operative field is limited to the instrument tip, necessitating rotation of the entire instrument and causing consequent tissue compression while reaching around corners. Although flexible endoscopes offer tip steerability to address this limitation, they are more difficult to control and provide fewer and smaller working channels. A middle ground between these instruments-a rigid endoscope that possesses multiple instrument ports (for example, one at the tip and one on the side)-is proposed in this article, and a prototype device is evaluated in the context of a third ventricular colloid cyst resection combined with septostomy. METHODS A prototype neuroendoscope was designed and fabricated to include 2 optical ports, one located at the instrument tip and one located laterally. Each optical port includes its own complementary metal-oxide semiconductor (CMOS) chip camera, light-emitting diode (LED) illumination, and working channels. The tip port incorporates a clear silicone optical window that provides 2 additional features. First, for enhanced safety during tool insertion, instruments can be initially seen inside the window before they extend from the scope tip. Second, the compliant tip can be pressed against tissue to enable visualization even in a blood-filled field. These capabilities were tested in fresh porcine brains. The image quality of the multiport endoscope was evaluated using test targets positioned at clinically relevant distances from each imaging port, comparing it with those of clinical rigid and flexible neuroendoscopes. Human cadaver testing was used to demonstrate third ventricular colloid cyst phantom resection through the tip port and a septostomy performed through the lateral port. To extend its utility in the treatment of periventricular tumors using MR-guided laser therapy, the device was designed to be MR compatible. Its functionality and compatibility inside a 3-T clinical scanner were also tested in a brain from a freshly euthanized female pig. RESULTS Testing in porcine brains confirmed the multiport endoscope's ability to visualize tissue in a blood-filled field and to operate inside a 3-T MRI scanner. Cadaver testing confirmed the device's utility in operating through both of its ports and performing combined third ventricular colloid cyst resection and septostomy with an endoscope rotation of less than 5°. CONCLUSIONS The proposed design provides freedom in selecting both the number and orientation of imaging and instrument ports, which can be customized for each ventricular pathological entity. The lightweight, easily manipulated device can provide added steerability while reducing the potential for the serious brain distortion that happens with rigid endoscope navigation. This capability would be particularly valuable in treating hydrocephalus, both primary and secondary (due to tumors, cysts, and so forth). Magnetic resonance compatibility can aid in endoscope-assisted ventricular aqueductal plasty and stenting, the management of multiloculated complex hydrocephalus, and postinflammatory hydrocephalus in which scarring obscures the ventricular anatomy.
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Affiliation(s)
- Sunil Manjila
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Margherita Mencattelli
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benoit Rosa
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karl Price
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Georgios Fagogenis
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pierre E Dupont
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Shukla D. Neuroendoscopic treatment of idiopathic occlusion of unilateral foramen of Monro presenting as chronic headache. J Neurosci Rural Pract 2016; 7:128-30. [PMID: 26933359 PMCID: PMC4750309 DOI: 10.4103/0976-3147.172152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Asymmetric ventriculomegly due to idiopathic occlusion of the foramen of Monro is rare. Such patients present with clinical features of raised intracranial pressure (ICP). Presentation as chronic headache has not been previously described. In the absence of raised ICP, pursuing surgical treatment raises a clinical dilemma as the headache may be a primary headache with no improvement after surgery. A 21-year-old woman presented with chronic headache. She was found to have asymmetric ventriculomegaly due to the occlusion of the foramen of Monro. She underwent endoscopic septostomy and widening of the foramen of Monro. Her headache subsided after surgery. At 15 months of follow-up, she was free from headache without medications. Unilateral occlusion of the foramen of Monro can present with asymmetric ventriculomegaly resulting in chronic headache. Though the symptoms of raised ICP may not be present, still endoscopic relief of ventriculomegaly leads to cure of headache.
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Affiliation(s)
- Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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