Document Detail

Experimental third ventriculostomy performed using endovascular surgical techniques and their adaptation to percutaneous intradural neuronavigation: proof of concept cadaver study.
MedLine Citation:
PMID:  12925257     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Endoscopic third ventriculostomy has developed into a therapeutic alternative to shunting for the management of carefully selected patients with primarily noncommunicating hydrocephalus. This procedure, however, requires a general anesthetic and necessitates violation of the brain parenchyma and manipulation near vital neural structures to access the floor of the third ventricle. Using two cadavers and off-the-shelf angiographic catheters, we sought to determine whether it was possible to navigate a catheter, angioplasty balloon, and stent percutaneously through the subarachnoid space from the thecal sac into the third ventricle so as to perform a third ventriculostomy from below. METHODS: Using biplane angiography and off-the-shelf angiographic catheters along with angioplasty balloons and stents, we were able to pass a stent coaxially from the thecal sac to and across the floor of the third ventricle so as to achieve a third ventriculostomy from below. RESULTS: Coaxial catheter techniques allowed for the percutaneous insertion of a stent across the floor of the third ventricle. Ventriculostomy was confirmed by injecting contrast medium into the lateral ventricle and seeing it pass through the stent and into the chiasmatic cistern. CONCLUSION: We describe the performance of third ventriculostomies in two cadavers by use of the new concept of percutaneous intradural neuronavigation. This procedure may obviate the need for general anesthetic and minimize the potential for brain and vascular injury, especially if ultimately combined with magnetic resonance fluoroscopy.
Michael B Horowitz; Kamal Ramzipoor; Ajit Nair; Susan Miller; George Rappard; Richard Spiro; Phillip Purdy
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  53     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-08-19     Completed Date:  2003-09-17     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  387-90; discussion 390-2     Citation Subset:  IM    
Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
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MeSH Terms
Angioplasty, Balloon / methods*
Balloon Dilatation / methods*
Blood Vessel Prosthesis Implantation / methods*
Cerebral Angiography
Dura Mater / pathology,  radiography,  surgery*
Hydrocephalus / pathology,  radiography,  therapy*
Neuronavigation / methods*
Third Ventricle / pathology,  radiography,  surgery*
Ventriculostomy / methods*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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