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Endoscopic aqueductoplasty and placement of a stent in the cerebral aqueduct in the management of isolated fourth ventricle in children.
[hydrocephalus with stenosis of the aqueduct of sylvius]
In
this
study
the
authors
conducted
a
retrospective
evaluation
of
the
effectiveness
of
endoscopic
aqueductoplasty
,
performed
alone
or
accompanied
by
placement
of
a
stent
,
in
the
treatment
of
an
isolated
fourth
ventricle
(
IFV
)
in
seven
patients
afflicted
with
loculated
hydrocephalus
after
a
hemorrhage
or
infection
.
Seven
children
with
symptomatic
IFV
and
membranous
aqueductal
stenosis
underwent
endoscopic
aqueductoplasty
alone
or
combined
with
placement
of
a
stent
in
the
cerebral
aqueduct
.
The
mean
age
of
the
patients
at
the
time
of
surgery
was
10
months
.
The
mean
duration
of
follow
up
was
26
months
.
In
all
patients
a
supratentorial
shunt
had
already
been
implanted
,
and
in
five
patients
neuroendoscopy
had
already
been
performed
because
other
isolated
compartments
had
been
present
inside
the
ventricular
system
.
Aqueductoplasty
alone
was
performed
in
three
patients
and
aqueductoplasty
and
aqueductal
stent
placement
in
four
.
A
precoronal
approach
was
performed
in
five
patients
and
a
suboccipital
approach
in
two
.
Signs
and
symptoms
of
intracranial
hypertension
resolved
in
all
cases
.
Stent
placement
was
successful
in
all
five
cases
,
resulting
in
clinical
and
neuroimaging-confirmed
improvements
in
the
IFV
.
Restenosis
of
the
aqueduct
occurred
in
two
patients
in
whom
stents
had
not
been
placed
.
In
one
of
these
patients
restenosis
was
managed
by
an
endoscopic
procedure
,
during
which
the
aqueduct
was
reopened
and
a
stent
implanted
;
in
the
other
patient
a
shunt
was
placed
in
the
fourth
ventricle
.
Hydrocephalus
was
controlled
by
a
single
shunt
in
six
cases
(
86
%
)
and
by
a
double
shunt
in
one
case
.
Endoscopic
placement
of
a
stent
in
the
aqueduct
is
more
effective
in
preventing
the
repeated
occlusion
of
the
aqueduct
than
aqueductoplasty
alone
and
should
be
indicated
as
the
initial
treatment
in
each
case
of
compatible
anatomy
.