Use of the NeuroBalloon catheter for endoscopic third ventriculostomy

Technical note

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Endoscopic third ventriculostomy (ETV) has become the procedure of choice for treatment of obstructive hydrocephalus. While patient selection is the most critical factor in determining the success of an ETV procedure, the technical challenge lies in the proper site of fenestration and the successful creation of a patent stoma. Positioning of a single balloon catheter at the level or below the floor of the third ventricle to achieve an optimal ventriculostomy can at times be challenging. Here, the authors describe the use of a double-barrel balloon catheter (NeuroBalloon catheter), which facilitates positioning across, as well as dilation of, the floor of the third ventricle. The surgical technique and nuances of using the NeuroBalloon catheter and the experience in more than 1000 cases are described. The occurrence of vascular injury was less than 0.1%, and the risk of balloon rupture was less than 2%. The authors found that the placement and deployment of this balloon catheter facilitate the creation of an adequate ventriculostomy in a few simple steps.

Abbreviation used in this paper:ETV = endoscopic third ventriculostomy.

Article Information

Address correspondence to: Raphael Guzman, M.D., Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, 300 Pasteur Drive, R211, Stanford, California 94305-5327. email: raphaelg@stanford.edu.

Please include this information when citing this paper: published online December 21, 2012; DOI: 10.3171/2012.10.PEDS11159.

© AANS, except where prohibited by US copyright law.

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Figures

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    Illustration depicting the deployment of the NeuroBalloon catheter in the typical 3 phases as follows: at the time of introduction through the endoscope (1), after inflation of the first 0.4–0.5 ml (2), and after full inflation of 1.0 ml (3). Printed with permission from Fabian de Kok-Mercado, Pro Atlantal Studio, LLC.

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    Illustration demonstrating the different surgical steps in performing the ETV. A: The endoscope is inserted through a 14-F peel-away sheath that has been advanced through the bur hole into the frontal horn of the right lateral ventricle. The insets show the endoscopic view of the foramen of Monro (A1) and the anatomical view of the floor of the third ventricle (A2). B: The sagittal midline cut shows the endoscope in position for the ventriculostomy procedure with the NeuroBalloon catheter advanced across the floor of the third ventricle. The insets demonstrate that the balloon gently pushes against the ventricular floor after filling the first 0.4–0.5 ml (B1) and after completion of the balloon inflation with 1 ml (B2). a. = artery; ICA = internal carotid artery; L. = left; PCA = posterior cerebral artery; PCom = posterior communicating; R. = right; v. = vein. Printed with permission from Fabian de Kok-Mercado, Pro Atlantal Studio, LLC.

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    A CT scan (A), MR images (B and C), and endoscopic images (D–F) obtained in a 3-year-old boy presenting with acute clinical symptoms of increased intracranial pressure. A: Head CT scan demonstrating hydrocephalus. The arrowheads indicate transependymal flow, and the arrows indicate the pineal region mass. B: Sagittal T2-weighted image confirming obstructive hydrocephalus caused by a pineal region mass leading to aqueductal stenosis. D: Endoscopic view of the floor of the third ventricle with the bilateral mammillary bodies and the tip of the basilar artery. The asterisk indicates the planned entry point. E: After inflation of the proximal balloon, deployment of the second balloon can be observed through the translucent balloon. F: View of the basal cisterns after completion of the ventriculostomy. C: Sagittal postoperative T2-weighted MR image showing an excellent flow void at the level of the floor of the third ventricle (arrow).

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