Cranial expansion and aqueductoplasty for combined isolated fourth ventricle and slit-ventricle syndrome: a surgical alt
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ORIGINAL ARTICLE
Cranial expansion and aqueductoplasty for combined isolated fourth ventricle and slit-ventricle syndrome: a surgical alternative Jorge Tirado-Caballero 1,2 & Mónica Rivero-Garvia 1,2 & Gloria Moreno-Madueño 1 & Emilio Gómez-González 3 & Javier Márquez-Rivas 1,2,4 Received: 24 June 2020 / Accepted: 20 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction An isolated fourth ventricle (IFV) is a rare entity observed in shunted patients and its treatment is still uncertain. Endoscopic aqueductoplasty has shown good results for restoring CSF flux between the third and fourth ventricles. However, it needs some grade of ventricular dilation to be performed. Some patients affected by IFV show slit-ventricle morphology in CT/ MRI. Usually, the rise of opening pressure or the shunt externalization gets enough ventricular dilation. However, the lack of intracranial compliance in some patients makes these options unsuitable and high-ICP symptoms are developed without ventricular dilation. Methods We present a two cases series affected by IFV with no ventricular dilation in radiological exams. ICP sensors were implanted, observing high-ICP and establishing the diagnosis of craniocerebral disproportion. A two-stage surgical plan based on a dynamic cranial expansion followed by a supratentorial endoscopic aqueductoplasty was performed. A physical and mathematical model explaining our approach was also provided. Results Chess-table cranial expansion technique was performed in both patients. Six/seven days after the first surgery, respectively, ventricular dilation was observed in CT. Endoscopic precoronal aqueductoplasty was then performed. No postoperative complications were described. IFV symptoms improved in both patients. Eighteen and 12 months after the two-stage surgical plan, the patients remain symptom-free and void of flow is still observed between the third and the fourth ventricles in MRI. Conclusion The two-stage approach was a suitable option for the treatment of these complex patients affected by both craniocerebral disproportion and isolated fourth ventricle. Keywords Cranial expansion . Aqueductoplasty . Isolated fourth ventricle . Craniocerebral disproportion . Slit-ventricle
Abbreviations IFV Isolated fourth ventricle CSF Cerebrospinal fluid VPS Ventriculoperitoneal shunt CCD Craniocerebral disproportion ICP Intracranial pressure * Jorge Tirado-Caballero [email protected] 1
Neurosurgery Service, Virgen del Rocío University Hospital, Av. Manuel Siurot, S/N, 41013 Seville, Spain
2
Group of Applied Neuroscience, Biomedicine Institute of Seville, Seville, Spain
3
Group of Interdisciplinary Physics, Engineering School, Universidad de Sevilla, Seville, Spain
4
Advanced Neurology Center, Seville, Spain
Introduction An isolated fourth ventricle (IFV) is an uncommon entity caused by functional or structural occlusion of cerebrospinal fluid (CSF) pathways both in the Sylvian aqueduct and the foramina of Luschka and Magendie. Structural IFV has b
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