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Endoscopic third ventriculostomy and biopsy of a tectal lesion using flexible neuroendoscopy and urological cup forceps: illustrative case

Meredith Yang, Daniel Wolfson, Melissa A. LoPresti, Emma Poland, Sandi Lam, and Michael DeCuypere

influence decision making. Thus, treatment goals for symptomatic tumors are twofold: CSF diversion and tissue diagnosis. Methods of sampling pineal region tumors include open biopsy or, more recently, endoscopic biopsy. 2 First described in 1997 while using a flexible neuroendoscope, 3 simultaneous endoscopic third ventriculostomy (ETV) and biopsy through a single burr hole has been demonstrated to be safe and diagnostically efficacious, allowing surgeons to procure tissue and treat hydrocephalus in one procedure. Herein, we describe our experience with single burr

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Shunt freedom in slit ventricle syndrome: using paradoxical ventriculomegaly following lumbar shunting to our advantage. Illustrative cases

Kevin Gilbert, Jillian H. Plonsker, Jessica Barnett, Omar Al Jammal, Arvin R. Wali, Mihir Gupta, and David Gonda

, although the condition may be acquired at any age after any amount of time. 3 There is a lack of consensus regarding optimal treatment of shunt failure in SVS. Placement of a ventricular catheter may require image guidance due to small ventricular chambers, while endoscopic third ventriculostomy (ETV) is challenging due to the narrow working ventricular corridor. According to a 2017 survey of pediatric neurosurgeons, the most commonly preferred treatments of SVS include ventriculoperitoneal (VP) shunting, cranial expansion, antisiphon device placement, and ETV. 4

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Symptomatic obstructive hydrocephalus caused by choroid plexus hyperplasia in a pediatric patient: illustrative case

Ana Sofia Alvarez, John P McGinnis, Rajan Patel, and Howard L Weiner

choroid plexus hyperplasia. The radiologist was concerned about a possible tumor. MRI of the spine did not show any significant findings. FIG. 1 Preoperative postcontrast sagittal T1-weighted MRI showing obstruction of the aqueduct of Sylvius by the choroid plexus. FIG. 2 Preoperative postcontrast axial T1-weighted MRI showing supratentorial hydrocephalus. Given the clinical and radiological findings, endoscopic third ventriculostomy (ETV) was indicated. The surgery was performed through a standard right frontal burr hole, and intraoperative ultrasound

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Conservative management of intraventricular migration of a gelatin sponge: illustrative case

Katherine G. Holste, Bridger Rodoni, Arushi Tripathy, Jaes C. Jones, Sara Saleh, and Hugh J. L. Garton

differentiating it from a clot was fairly straightforward. There have been a few prior reports of intraventricular migration of Gelfoam, although in these cases, CSF obstruction was observed, and retrieval of the Gelfoam was performed. One case of a 12-year-old girl who underwent an endoscopic third ventriculostomy (ETV) sustained intraventricular Gelfoam migration and subsequent obstruction of her ETV. 10 In another case, a piece of Gelfoam was found to be obstructing the cerebral aqueduct causing triventricular ventriculomegaly 3 months after endoscopic cyst fenestration

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Cronobacter brain abscess and refractory epilepsy in a newborn: role of epilepsy surgery. Illustrative case

Meredith Yang, John Tsiang, Melissa A. LoPresti, and Sandi Lam

underwent a corpus callosotomy and additional abscess debridement. Seizures resolved after surgery, with confirmatory follow-up EEG on hospital day 45, which showed no electrographic seizures. Abscess resolution was confirmed with surveillance imaging ( Fig. 4 ). The patient completed an 8-week course of intravenous cefepime and gentamicin. As a sequela of his intracranial infection, the patient had postinfectious hydrocephalus, subsequently managed by an endoscopic third ventriculostomy, septostomy, and aqueductoplasty, with a durable result at the 18-month follow

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Sinus pericranii in the setting of a posterior fossa pilocytic astrocytoma: illustrative case

Youngkyung Jung, Jennifer L. Quon, and James M. Drake

postoperative magnetic resonance venogram (MRV), likely secondary to reduced compression ( Fig. 3 ). However, the patient continued to have high EVD output, and we decided to proceed with an endoscopic third ventriculostomy, as there was some reluctance in passing a shunt tunneler near the venous network. Pathological evaluation by frozen section was consistent with a pilocytic astrocytoma. FIG. 3. Postoperative axial ( A ) and sagittal ( B ) T1-weighted MRI with contrast demonstrating interval resection of lesion with improved hydrocephalus and mass effect of fourth

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Terson syndrome secondary to aneurysmal subarachnoid hemorrhage in a child: illustrative case

Jacob M. Mazza, Parth Tank, Melissa A. LoPresti, Jonathan P. Scoville, Brenda L. Bohnsack, and Sandi Lam

patient was treated in the pediatric intensive care unit for EVD management and monitoring for vasospasm. The patient’s course was complicated by fungal meningitis treated with antimicrobial therapy for 21 days and subsequent endoscopic third ventriculostomy for hydrocephalus treatment. On post-bleed day 20, when the patient’s condition had improved to the point that he was able to verbally communicate, he reported decreased vision in his left eye. The visual acuity was 20/30 in the right eye, and he only had the ability to detect hand motion in the left eye. There were

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Subtle magnetic resonance imaging differences in tegmental pilocytic astrocytomas as a caution against attempting gross-total resection: illustrative cases

Tariq Al-Saadi, Steffen Albrecht, Jean-Pierre Farmer, Daniela Toffoli, Christine Saint-Martin, Nada Jabado, and Roy W. R. Dudley

on the T2-weighted and FLAIR sequences, and it showed very faint and patchy gadolinium enhancement. There was no restricted diffusion. His neurological examination result was normal, except for his subtle eye movement abnormalities with partial right third-nerve palsy. An uneventful endoscopic third ventriculostomy was performed the same day. It was believed that this tumor was most likely a PA. Upon discussion with our neuro-oncology group, surgery was recommended as the best option for long-term tumor control and to address his progressive symptoms. FIG. 2

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Removal of a flanged ventricular catheter: illustrative case

M. Benjamin Larkin, Tyler T. Lazaro, Howard L. Weiner, and William E. Whitehead

completing the antibiotic schedule, the patient went to the operating room for another attempt at removing the retained flanged catheter under endoscopic visualization followed by endoscopic third ventriculostomy (ETV). The flanged catheter was visualized in the body of the right lateral ventricle with minimal scarring. The right occipital incision was opened, and the distal end of the proximal flanged catheter was exposed. The catheter was slowly removed from the tethered portion of the choroid plexus using flexible wire monopolar electrocautery, gentle rotation, and

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Mixed germ cell tumor infiltrating the pineal gland without elevated tumor markers: illustrative case

Koji Shiomi, Yoshiki Arakawa, Sachiko Minamiguchi, Haruki Yamashita, Yukinori Terada, Masahiro Tanji, Yohei Mineharu, Katsutsugu Umeda, Megumi Uto, Junko Takita, Hironori Haga, Takashi Mizowaki, and Susumu Miyamoto

isointense tumor in the pineal region. Biopsy in a Local Hospital The patient was treated with endoscopic third ventriculostomy in combination with a tumor biopsy in a local hospital. On histopathological examination, tumor specimens comprised a cystic portion and a solid portion ( Fig. 2A and B ). Histopathological examination showed the cystic portion was lined by an epithelial monolayer with no atypia ( Fig. 2A and C ). The solid portion comprised sheets of uniform cells with round nuclei. The Ki-67 labeling index was higher than 1% in some parts ( Fig. 2C