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Endoscopic cerebral aqueductoplasty: a trans-fourth ventricle approach.
[hydrocephalus with stenosis of the aqueduct of sylvius]
Advances
in
endoscopic
technology
have
afforded
the
neurosurgeon
new
avenues
in
the
treatment
of
hydrocephalus
,
rendering
many
patients
independent
of
shunts
,
thus
averting
shunt
complications
and
failure
.
Cerebral
aqueductoplasty
has
gained
popularity
as
an
effective
treatment
for
membranous
and
short
-segment
stenoses
of
the
sylvian
aqueduct
.
Traditionally
,
this
procedure
has
been
performed
via
a
coronal
approach
,
passing
through
the
lateral
ventricle
,
foramen
of
Monro
,
and
third
ventricle
into
the
aqueduct
.
The
authors
report
on
the
success
of
a
novel
technique
for
this
operation
,
in
which
they
use
a
suboccipital
foramen
magnum
trans-
fourth
ventricle
approach
.
A
retrospective
chart
review
was
performed
to
document
the
success
of
cerebral
aqueductoplasty
procedures
via
the
foramen
magnum
trans-
fourth
ventricle
approach
in
patients
who
had
membranous
or
short
-segment
stenosis
of
the
cerebral
aqueduct
.
Nine
patients
underwent
11
cerebral
aqueductoplasty
procedures
.
At
a
mean
of
21
months
of
postoperative
follow
up
,
all
patients
demonstrated
resolution
of
their
preoperative
symptoms
.
The
only
surgical
complication
was
transient
vertical
diplopia
or
upgaze
weakness
in
two
patients
.
There
was
no
permanent
morbidity
.
Recurrent
aqueductal
stenosis
developed
in
one
patient
twice
,
requiring
the
placement
of
an
aqueductal
stent
via
the
same
approach
.
The
authors
state
that
in
their
experience
,
performing
cerebral
aqueductoplasty
via
the
foramen
magnum
trans-
fourth
ventricle
approach
is
both
effective
and
safe
.
They
advocate
the
use
of
this
technique
,
if
performed
by
an
experienced
neuroendoscopist
,
for
select
cases
involving
membranous
or
short
-segment
stenosis
of
the
cerebral
aqueduct
,
a
trapped
fourth
ventricle
,
or
aqueductal
stent
placement
.
Diseases
Validation
Diseases presenting
"transient vertical diplopia"
symptom
hydrocephalus with stenosis of the aqueduct of sylvius
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