Intraoperative ventriculo-stomographic evaluation of endoscopic cerebrospinal fluid diversion and flow restoration procedures.
OBJECTIVE
This prospective study was designed for intra-operative demonstration of cerebrospinal fluid (CSF) flow in ventricles and cisternal spaces before and after neuroendoscopic procedure. The aim of this study was to evaluate site of obstruction of CSF flow and subsequent stomal or aqueductal patency after endoscopic third ventriculostomy (ETV) or aqueductoplasty in patients with hydrocephalus of diverse aetiology.


METHODS
Seventeen patients with hydrocephalus due to diverse aetiology underwent ETV (n = 15) and aqueductoplasty (n = 2) or cysto-ventrticulostomy (n = 1) or transaqueductal removal of neurocysticercus cyst (NCC) (n = 1). Intra-operatively, radio-opaque contrast agent (iohexol) instillation into the third ventricle was used for qualitative evaluation of obstruction and post-procedure CSF flow across the stoma into cisternal spaces.


RESULTS
11 male and 6 female patients ranging from 3 to 50 years of age were included in the study. Post-procedure intra-operative ventriculo-stomography (IOVSG) showed free flow of dye across the endoscopic stoma (n = 13) or aqueduct (n = 2) into cisternal spaces. Diagnosis of fourth ventricular NCC was made in one patient with panventriculomegaly. In two patients of tuberculous meningitis hydrocephalus, poor flow of contrast in the prepontine area and basal cisterns was seen on IOVSG. They were subjected to ventriculoperitoneal shunt insertion in the same sitting. Cine MRI confirmed the patency of stoma or aqueduct in follow-up period in all patients with successful endoscopic procedure.


CONCLUSIONS
IOVSG is a simple and safe technique that helps in confirming the adequacy of endoscopic procedure during surgery and thereby facilitates intra-operative decision about further management.
Husain
Mazhar
M
Department of Neurosurgery, Sahara Hospital, Gomti Nagar, Lucknow, India.
Singh
Deepak Kumar
DK
Rastogi
Manu
M
Ojha
Bal Krishna
BK
Chandra
Anil
A
Gupta
Rakesh K
RK
D000293:Adolescent; D000328:Adult; D002535:Cerebral Aqueduct / Q000503:physiopathology* / Q000601:surgery; D002552:Cerebral Ventricles; D002555:Cerebrospinal Fluid / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000134:cerebrospinal fluid / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods; D011446:Prospective Studies; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000379:methods*; D014696:Ventriculostomy / Q000379:methods*; D055815:Young Adult