Endoscopic aqueductoplasty and interventriculostomy for the treatment of isolated fourth ventricle in children.
OBJECTIVE
There are different approaches for the treatment of isolated fourth ventricle in children, including a suboccipital ventriculoperitoneal shunt, suboccipital craniotomy with microsurgical fenestration, and endoscopic fenestration. We discuss the indications, surgical methods, and outcome of 18 patients who underwent endoscopic treatment for isolated fourth ventricle.


METHODS
We retrospectively reviewed the medical histories of 18 patients with an isolated fourth ventricle. Surgical procedures included endoscopic aqueductoplasty, endoscopic aqueductoplasty with a stent, endoscopic interventriculostomy (lateral ventricle or third ventricle to fourth ventricle), and endoscopic interventriculostomy with a stent. Operations were performed between July 1997 and June 2002. The mean age of the patients at the time of surgery was 3 years. The mean follow-up was 29 months. All patients had a supratentorial ventriculoperitoneal shunt.


RESULTS
Clinical symptoms (impairment of consciousness, tetraparesis, and ataxia) improved in all patients. Reduction of the size of the fourth ventricle was observed in all patients. Seven patients required reoperation because of restenosis (39% revision rate). Restenosis occurred between 2 weeks and 7 months after surgery (average, 3 mo). Four patients underwent reoperation with stent placement, and three patients underwent reaqueductoplasty. We had the following complications: one infection, one asymptomatic subdural hygroma, one transient oculomotor paresis, and one permanent oculomotor paresis (4 [22%] of 18 patients).


CONCLUSIONS
The significant failure rate of fourth ventricle shunts has led to the development of alternative treatment methods. Endoscopic aqueductoplasty or interventriculostomy presents an effective, minimally invasive, and safe procedure for the treatment of isolated fourth ventricle in pediatric patients. Compared with suboccipital craniotomy and microsurgical fenestration, endoscopic aqueductoplasty is less invasive, and compared with fourth ventricle shunts, it is more reliable and effective.
Department of Neurosurgery, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany. fritschm@nch.uni-kiel.de
Michael J
MJ
Fritsch
Sven
S
Kienke
Kim H
KH
Manwaring
H Maximilian
HM
Mehdorn
D000293:Adolescent; D002535:Cerebral Aqueduct / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000601:surgery; D005500:Follow-Up Studies; D020546:Fourth Ventricle / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D020547:Lateral Ventricles / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D015607:Stents; D020542:Third Ventricle / Q000601:surgery*; D017287:Ventriculoperitoneal Shunt; D014696:Ventriculostomy