What is it about?
Is it safe to perform an endoscopic third ventriculostomy in case the prepontine interval is very narrow (that is, in case the pon sis pushed anteriorly against the clivus)? Is there a way to make such procedures safer?
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Why is it important?
Endoscopic third ventriculostomy is the preferred treatment for differnet types of (obstructive) hydrocephalus, avoiding the problems associated with ventriculo-peritoneal shunts. However, anatomy may not be optimal for (safe) ETV, for example a very narrow foramen of Monro, or a very narrow prepontine interval (in case something is pressing the pons against the clivus). We suggest a technique to optimize anatomy before going in with the scope, so these patients can be treated safely and effectively with an ETV.
Perspectives
We'd rather be safe than sorry, and believe the proposed technique is safer than going in directly with the scope and performing an ETV just behind the dorsum sellae. One does need a second surgery (the first one to relieve the pressure using a ventriculo-subgaleal shunt, the second one to perform the actual ETV) and a second MRI scan (to see whether the first intervention had indeed optimized the anatomical configuration of the third ventricular floor); however, the same incision and burr hole are used limiting the invasiveness of the second procedure. We believe this is a safe alternative to the technique of direct ETV over the dorsum sellae, and all the more for the less experienced neuroendoscopist.
Dr Erwin MJ Cornips
Maastricht University
Read the Original
This page is a summary of: Letter to the Editor: Endoscopic third ventriculostomy, Journal of Neurosurgery Pediatrics, July 2011, Journal of Neurosurgery Publishing Group (JNSPG),
DOI: 10.3171/2010.3.peds10136.
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