Video: Endoscopic Transventricular Lamina Terminalis Fenestration Video 1

Intraoperative endoscopic video of the lamina terminalis fenestration procedure. The video starts with a standard endoscopic third ventriculostomy and exploration of the basal cisterns. Very limited space for adequate CSF flow within the cisterns was noted. Proceeding with the LT fenestration, the tip of the flexible neuroendoscope is bent ventraly. The optic chiasm is identified. Utilizing a closed grasping forceps for the initial fenestration, the lamina terminalis is perforated. The ostomy is slowly enlarged with the neuroendoscope itself. The anterior communicating artery complex is identified. The ostomy is further enlarged if necessary.

Ahead of Print: Endoscopy for Isolated Fourth Ventricle

BACKGROUND: Treatment of an isolated fourth ventricle should be considered when clinical symptoms or a significant mass effect occur.

OBJECTIVE: Clinical and radiographic outcome after endoscopic transaqueductal or transcisternal stent placement into the fourth ventricle is reported.

METHODS: In 19 patients (age: 34th week of gestation – 20 years; median age: 17.5 months) 22 endoscopic procedures were carried out. Either an aqueductoplasty or – in cases with a supratentorially extended fourth ventricular component – an interventricular fenestration was performed. In all patients a stent connected to the CSF diverting shunt was placed through the fenestration. Surgical complications, and radiological and clinical outcome are reported.

VIDEO: Simplified Aqueductal Stenting for Isolated Fourth Ventricle

In this video, the authors demonstrate a new method for treating isolated fourth ventricle syndrome using a fiber optic endoscope. They illustrate the technique in a 39-year-old woman with coccidiomycosis. This case demonstrates that the technique is feasible and may offer several advantages over currently applied methodologies.