title: Endoscopic transaqueductal removal of fourth ventricular neurocysticercosis with an angiographic catheter.
abstract: OBJECTIVE
  Fourth ventricular neurocysticercosis (FVNCC) usually presents with obstructive hydrocephalus. Available treatment options are medical, external cerebrospinal fluid diversion, microsurgical, or endoscopic removal alone or in combination. We present our experience of transaqueductal removal of FVNCC by angiographic catheter with endoscopic third ventriculostomy with a rigid endoscope.
  
  
  METHODS
  Ten patients (five male and five female patients; age range, 12-45 yr; mean, 23.2 years) with FVNCC with obstructive hydrocephalus underwent endoscopic removal along with endoscopic third ventriculostomy in a single sitting, through a frontal precoronal burr hole. Diagnosis was established on imaging and confirmed on histology in all of the cases. The Gaab Universal Endoscope System along with 4-mm, 30-degree rigid telescopes was used to enter the third ventricle, and a cut length of angiographic catheter was negotiated through the aqueduct for removal of FVNCC.
  
  
  RESULTS
  Removal of the cyst was performed in all cases. A 30-degree rigid telescope provided excellent image quality, with the ability to address intra-FVNCC through the dilated aqueduct with a curved-tip catheter. None of these patients required any further surgery. There were no significant operative or postoperative complications in any of the cases. All of the patients were asymptomatic, with an average follow-up of 18 months.
  
  
  CONCLUSIONS
  Transaqueductal removal of an intra-fourth ventricular cyst along with endoscopic third ventriculostomy with a rigid endoscope and catheter is an effective treatment and obviates the need for posterior cranial fossa exploration.
authors.affiliation: Department of Neurosurgery, King George's Medical University, Lucknow, India. mazharhusainlucknow@yahoo.com
authors.forename: Mazhar
authors.initials: M
authors.lastname: Husain
authors.forename: Manu
authors.initials: M
authors.lastname: Rastogi
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Jha
authors.forename: Nuzhat
authors.initials: N
authors.lastname: Husain
authors.forename: Rakesh K
authors.initials: RK
authors.lastname: Gupta
mesh_terms: D000293:Adolescent; D000328:Adult; D002404:Catheterization / Q000295:instrumentation*; D002535:Cerebral Aqueduct / Q000601:surgery*; D002648:Child; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D020546:Fourth Ventricle / Q000469:parasitology / Q000601:surgery*; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D020019:Neurocysticercosis / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000295:instrumentation / Q000379:methods; D014741:Video Recording