Minim Invas Neurosur
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Minim Invas Neurosur · Sep 2000
Endoscopic treatment of para- and intraventricular cerebrospinal fluid cysts.
This study has been made to define the role of endoscopy and the most appropriate approach and technique of endoscopic fenestration of paraventricular and intraventricular CSF cysts according to the cyst size and location. Twenty-two patients with intraventricular (13 cases) and paraventricular (9 cases) CSF cysts, operated upon by endoscopic technique in three Italian neurosurgical centers, are reviewed. Paraventricular hemispheric cysts have been treated by endoscopic fenestration from the cyst to the lateral ventricle. ⋯ Cysts of the choroid plexus have been fenestrated from the homolateral enlarged ventricle (4 cases) or from the contralateral compressed ventricle (2 cases). Twenty patients (more than 90%) were definitively cured by the endoscopic procedure, whereas only 2 patients required a shunt or a direct approach. We think that the endoscopic fenestration must be considered the treatment of choice of intraventricular and paraventricular CSF cysts.
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Minim Invas Neurosur · Sep 2000
Anomalies and variants of the endoscopic anatomy for third ventriculostomy.
Endoscopic third ventriculostomy (ETV) is an alternative to shunt placement in occlusive hydrocephalus. The negative impact of anatomic anomalies and variants on ETV have been sporadically reported but not yet investigated systematically. Therefore, the objectives of the present study are 1) to evaluate the frequency of endoscopic anatomic anomalies of the ventricular system, 2) to define their potential to complicate the procedure and to compromise the surgical results, and 3) to investigate the value of preoperative magnetic resonance (MR) imaging for their detection. ⋯ Anatomic anomalies are a frequent finding during ETV. Successful perforation and control of the hydrocephalus correlates with the absence of anatomic anomalies. Most anatomic variants have the potential to increase the operative risk. With the exception of the thickened third ventricular floor, MR imaging allows us to identify all anatomic anomalies preoperatively, and enables the neurosurgeon to weigh the operative risk in a patient with an anatomic anomaly against the chance to perform ETV successfully.