Experimental third ventriculostomy performed using endovascular surgical techniques and their adaptation to percutaneous intradural neuronavigation: proof of concept cadaver study.
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.


CONCLUSIONS
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.
Horowitz
Michael B
MB
Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA. horowitzmb@msx.upmc.edu
Ramzipoor
Kamal
K
Nair
Ajit
A
Miller
Susan
S
Rappard
George
G
Spiro
Richard
R
Purdy
Phillip
P
D000328:Adult; D000800:Angioplasty, Balloon / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002404:Catheterization / Q000379:methods*; D002533:Cerebral Angiography; D004388:Dura Mater / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005471:Fluoroscopy; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D038361:Neuronavigation / Q000379:methods*; D015607:Stents; D020542:Third Ventricle / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014696:Ventriculostomy / Q000379:methods*