Endoscopic Third Ventriculostomy

Endoscopic third ventriculostomy (ETV) is a minimally invasive procedure commonly used to treat obstructive hydrocephalus. The objectives of the procedure are to fenestrate the floor of the third ventricle using a neuroendoscopic approach and to provide a cerebrospinal fluid (CSF) diversion. With high success rates published over the years, ETV became a routine modality for the obstructive hydrocephalus treatment. Furthermore, indications for ETV are expanding day by day and are no longer limited to obstructive hydrocephalus. Endoscopic third ventriculostomy has lower complication rate and has significant advantages compared to other CSF diversion techniques. Efficiency and safety of ETV are increasing with the advancements in technology

Full-endoscopic removal of third ventricular colloid cysts: technique, results, and limitations

IntroductionColloid cysts (CCs) are rare benign lesions that usually arise from the roof of the third ventricle. They may present with obstructive hydrocephalus and cause sudden death. Treatment options include ventriculoperitoneal shunting, cyst aspiration, and cyst resection microscopically or endoscopically. This study aims to report and discuss the full-endoscopic technique for removing colloid cysts.Materials and methodsA 25°-angled neuroendoscope with an internal working channel diameter of 3.1 mm and a length of 122 mm is used. The authors described the technique of resecting a colloid cyst by a full-endoscopic procedure and evaluated the surgical, clinical, and radiological results.ResultsTwenty-one consecutive patients underwent an operation with a transfrontal full-endoscopic approach. The swiveling technique (grasping the cyst wall and rotational movements) was used for CC resection. Of these patients, 11 were female, and ten were male (mean age, 41 years). The most frequent initial symptom was a headache. The mean cyst diameter was 13.9 mm. Thirteen patients had hydrocephalus at admission, and one needed shunting after cyst resection. Seventeen patients (81%) underwent total resection; 3 (14%), subtotal resection; and 1 (5%), partial resection. There was no mortality; one patient had permanent hemiplegia, and one had meningitis. The mean follow-up period was 14 months.ConclusionEven though microscopic resection of cysts has been widely used as a gold standard, successful endoscopic removal has been described recently with lower complication rates. Applying angled endoscopy with different techniques is essential for total resection. Our study is the first case series to show the outcomes of the swiveling technique with low recurrence and complication rates

A technique to facilitate the cannulation of the foramen ovale for balloon compression

Backgroun

Unilateral Alar Ligament Injury: Diagnostic, Clinical, and Biomechanical Features

BACKGROUND: Isolated unilateral alar ligament injury (ALI) is a very rarely diagnosed condition, with only 9 cases reported in the literature. The purpose of this study is to determine clinical, diagnostic, and biomechanical features of unilateral ALI

How I do it: ultrasound-guided placement of ommaya reservoir in a patient with small ventricles and cavum septum pellucidum

Background Intraventricular chemotherapy via Ommaya reservoir is an important part of the treatment in patients with malignant central nervous system tumors. In these patients, catheter placement can be challenging due to the normal-sized ventricles