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Endoscopic third ventriculostomy for VP shunt malfunction during the third trimester of pregnancy: illustrative case

Ahmad K. Alhaj, Tariq Al-Saadi, Marie-Noëlle Hébert-Blouin, Kevin Petrecca, and Roy W. R. Dudley

Endoscopic third ventriculostomy (ETV) is an effective treatment for noncommunicating hydrocephalus. 1–3 As predicted by the ETV Success Score (ETVSS), its effectiveness depends on patient age, the pathology causing hydrocephalus, and whether the patient had a previous ventriculoperitoneal (VP) shunt. Success rates reach 90% in well-selected candidates. 4 ETV has also been found to be a valuable salvage option for VP shunt malfunction, with success rates of 60%–80%. 5–10 In VP shunt–dependent women, the physiological changes of pregnancy may impair shunt

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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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Endoscopic third ventriculostomy in hydrocephalus patients with functioning ventriculoperitoneal shunts: challenging the dictum that shunts treat all types of hydrocephalus. Patient series

Gersham J Rainone, Cody Woodhouse, Dallas Kramer, Shahed Elhamdani, and Jody Leonardo

peritoneum (ventriculoperitoneal shunt [VPS]). 2 A patent shunt indicates that there is an active mechanism for appropriate CSF diversion and, in theory, should adequately treat all forms of hydrocephalus. However, even with a patent shunt, there is still a possibility that there can be over- or underdrainage. Endoscopic third ventriculostomy (ETV) is another safe and effective means of treating hydrocephalus, specifically in cases of aqueductal obstruction. 3 ETV should be considered in all appropriate cases, because it avoids shunt-related complications such as

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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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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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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

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Postnatal myelomeningocele closure in smallest reported neonate: illustrative case

Momin M Mohis, Kevin Cordeiro, Sarah Larson, Catharine Garland, and James A Stadler III

clinically stable. At 16 months, he developed increased secretions, increased pooling of secretions, and enlarged ventricles. He subsequently underwent endoscopic third ventriculostomy with choroid plexus cauterization to treat his hydrocephalus. We performed this procedure in the hope of potentially avoiding a future shunt placement. FIG. 1 Preoperative MMC 5 days after birth. FIG. 2 Postoperative MMC 24 days after birth. At his most recent neurosurgery follow-up at 30 months of age, he was eating without difficulty, walking without support, and

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Enlarged tumefactive perivascular, or Virchow-Robin, spaces and hydrocephalus: do we need to treat? Illustrative cases

Belal Neyazi, Vanessa Magdalena Swiatek, Klaus-Peter Stein, Karl Hartmann, Ali Rashidi, Seraphine Zubel, Amir Amini, and I. Erol Sandalcioglu

instability. Diagnostic testing included MRI, which revealed a multicystic lesion in the area of the right basal ganglia and extending into the mesencephalon and pedunculus cerebelli ( Fig. 1B ). Importantly, there were no signs of hydrocephalus. Prior to presenting at our clinic, the patient had already undergone endoscopic third ventriculostomy and biopsy at a different hospital. Postoperatively, there was neither improvement nor a worsening of symptoms, and MRI findings remained stable. This case underscores the challenges associated with managing multicystic lesions in

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Pineal parenchymal tumor of intermediate differentiation with late spinal dissemination 13 years after initial surgery: illustrative case

Hiroyuki Kato, Takafumi Tanei, Yusuke Nishimura, Yoshitaka Nagashima, Motonori Ishii, Tomoya Nishii, Nobuhisa Fukaya, Takashi Abe, and Ryuta Saito

intracranial PPTID. Illustrative Case A 14-year-old female presented with headache and diplopia. Bilateral papilledema and left eye abduction disorders were also observed. Magnetic resonance imaging (MRI) revealed a solitary mass lesion in the pineal region with contrast enhancement on T1-weighted imaging, which induced obstructive hydrocephalus ( Fig. 1 ). The patient had no relevant medical or family history. Initially, a biopsy of the lesion and endoscopic third ventriculostomy were performed. Histological examination revealed hypercellular proliferation, small