The Anterior Ventriculo-Cisternostomy: The Pioneers' Work Revisited

Abstract

Background There is no satisfactory medical treatment for hydrocephalus and most often surgical treatment is necessary, including shunting or endoscopic third ventriculostomy (ETV), both with their well-known advantages and drawbacks. The objective of this study is to describe a contemporary series of anterior ventriculocisternostomy.

Patients Twenty-two patients with hydrocephalus treated at two institutions between 2005 and 2009 were presented. The authors employed a technique called anterior ventriculocisternostomy to treat selected cases. This technique includes supraciliary incision, small craniotomy, and fenestration of the lamina terminalis and Liliquist membrane. Hydrocephalus was secondary to hemorrhage from arteriovenous malformation (3 cases), spontaneous subarachnoid hemorrhage (2 cases), posterior fossa tumors (4 cases), head injury (1 case), basilar aneurysm (1 case), and posterior fossa hemorrhage (1 case). Eight patients had a normal-pressure hydrocephalus syndrome and one patient a slit ventricle syndrome. Aqueduct obstruction was noticed in one patient. Patients were followed up for 20.2 months (range: 10 to 46 months).

Results No hemorrhagic complications or parenchymal injury were observed. One cerebrospinal fluid leakage occurred. No infection, mortality, and neurological morbidity were reported. Improvements were noticed in 18 cases. Eighty-two percent of the patients remained independent of shunt.

Conclusion Anterior ventriculocisternostomy integrates old views of open ventriculocisternostomy with contemporary concepts of minimally invasive neurosurgery. It provides the most straightforward anatomical and physiological alternative to treat many types of hydrocephalus with no significant morbidity. Compared with conventional procedures, it has several advantages. This procedure is an important option to manage hydrocephalus and constitutes a safe, effective, and relatively inexpensive alternative to ETV and shunts.

Keywords

hydrocephalus - endoscopic surgery - minimally invasive neurosurgery - subfrontal approach - ventriculostomy - ventriculo-peritoneal shunt

• References

• 1 Pople IK, Edwards RJ, Aquilina K. Endoscopic methods of hydrocephalus treatment. Neurosurg Clin N Am 2001; 12 (4) 719-735 , viii
• 2 Walker ML. History of ventriculostomy. Neurosurg Clin N Am 2001; 12 (1) 101-110 , viii
• 3 Li V. Methods and complications in surgical cerebrospinal fluid shunting. Neurosurg Clin N Am 2001; 12 (4) 685-693 , viii
• 4 Brockmeyer D, Abtin K, Carey L, Walker ML. Endoscopic third ventriculostomy: an outcome analysis. Pediatr Neurosurg 1998; 28 (5) 236-240
• 5 Buxton N, Macarthur D, Mallucci C, Punt J, Vloeberghs M. Neuroendoscopic third ventriculostomy in patients less than 1 year old. Pediatr Neurosurg 1998; 29 (2) 73-76
• 6 Hopf NJ, Grunert P, Darabi K, Busert C, Bettag M. Frameless neuronavigation applied to endoscopic neurosurgery. Minim Invasive Neurosurg 1999; 42 (4) 187-193
• 7 Hopf NJ, Grunert P, Fries G, Resch KD, Perneczky A. Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures. Neurosurgery 1999; 44 (4) 795-804 , discussion 804–806
• 8 Jones RF, Kwok BC, Stening WA, Vonau M. The current status of endoscopic third ventriculostomy in the management of non-communicating hydrocephalus. Minim Invasive Neurosurg 1994; 37 (1) 28-36
• 9 Dandy WE. An operative procedure for hydrocephalus. Bull Johns Hopkins Hosp 1922; 33: 189-190
• 10 Figueiredo EG, Deshmukh P, Nakaji P , et al. Anterior selective amygdalohippocampectomy: technical description and microsurgical anatomy. Neurosurgery 2010; 66 (3, Suppl Operative) 45-53
• 11 Figueiredo EG, Paiva WS, Gomes M, Castro Flores JA, Wen HT, Teixeira MJ. Modified abbreviated transcavernous approach to basilar artery aneurysms—case report. Surg Neurol 2009; 71 (1) 25-29
• 12 Figueiredo EG, Deshmukh P, Nakaji P , et al. The minipterional craniotomy: technical description and anatomic assessment. Neurosurgery 2007; 61 (5) (Suppl. 02) 256-264 , discussion 264–265
• 13 Figueiredo EG, Deshmukh V, Nakaji P , et al. An anatomical evaluation of the mini-supraorbital approach and comparison with standard craniotomies. Neurosurgery 2006; 59 (4) (Suppl. 02) ONS212-ONS220 , discussion ONS220
• 14 Figueiredo EG, Castillo De la Cruz M, Theodore N, Deshmukh P, Preul MC. Modified cervical laminoforaminotomy based on anatomic landmarks reduces need for bony removal. Minim Invasive Neurosurg 2006; 49 (1) 37-42
• 15 Fries G, Perneczky A. Endoscope-assisted brain surgery: part 2—analysis of 380 procedures. Neurosurgery 1998; 42 (2) 226-231 , discussion 231–232
• 16 Menovsky T, Grotenhuis JA, de Vries J, Bartels RH. Endoscope-assisted supraorbital craniotomy for lesions of the interpeduncular fossa. Neurosurgery 1999; 44 (1) 106-110 , discussion 110–112
• 17 van Lindert EJ. Microsurgical third ventriculocisternostomy as an alternative to ETV: report of two cases. Childs Nerv Syst 2008; 24 (6) 757-761
• 18 Krause F. Chirurgie des Gehirns und R ü ckenmarks nach eigenen Erfahrungen. Vol. 1. Urban & Schwarzenberg, Berlin; 1908
• 19 Brock M, Dietz H. The small frontolateral approach for the microsurgical treatment of intracranial aneurysms. Neurochirurgia (Stuttg) 1978; 21 (6) 185-191
• 20 Jane JA, Park TS, Pobereskin LH, Winn HR, Butler AB. The supraorbital approach: technical note. Neurosurgery 1982; 11 (4) 537-542
• 21 Delfini R, Raco A, Artico M, Salvati M, Ciappetta P. A two-step supraorbital approach to lesions of the orbital apex. Technical note. J Neurosurg 1992; 77 (6) 959-961
• 22 Al-Mefty O. Supraorbital-pterional approach to skull base lesions. Neurosurgery 1987; 21 (4) 474-477
• 23 Smith RR, Al-Mefty O, Middleton TH. An orbitocranial approach to complex aneurysms of the anterior circulation. Neurosurgery 1989; 24 (3) 385-391
• 24 Czirják S, Szeifert GT. Surgical experience with frontolateral keyhole craniotomy through a superciliary skin incision. Neurosurgery 2001; 48 (1) 145-149 , discussion 149–150
• 25 Czirják S, Nyáry I, Futó J, Szeifert GT. Bilateral supraorbital keyhole approach for multiple aneurysms via superciliary skin incisions. Surg Neurol 2002; 57 (5) 314-323 , discussion 323–324
• 26 Ramos-Zúñiga R, Velázquez H, Barajas MA, López R, Sánchez E, Trejo S. Trans-supraorbital approach to supratentorial aneurysms. Neurosurgery 2002; 51 (1) 125-130 , discussion 130–131
• 27 Stookey B, Scarff J. Occlusion of the aqueduct of Sylvius because of neoplastic and non-neoplastic processes with a rational surgical treatment for relief of the resultant obstructive hydrocephalus. Bulletin of the Neurological Institute of New York 1936; 5: 348-377
• 28 Guillaume J, Mazars G. Indications and results of sub-optical ventriculostomy in hydrocephalus of the adult. Rev Neurol (Paris) 1950; 82 (5) 421-424
• 29 Morello G, Migliavacca F. Third ventriculostomy (Stookey and Scarff operation) in the treatment of benign aqueductal stenosis. Acta Neurochir (Wien) 1959; 7: 417-424
• 30 Scarff J. Treatment of obstructive hydrocephalus by puncture of the lamina terminalis and floor of the third ventricle. J Neurosurg 1970; 33: 1-18