Now a days, the endoscopic treatment of hydrocephalus is an established technique of treating hydrocephalus. Previous works of Lespinase , Dandy , Mixter, Fay and Grant had contributed in the evolution of this concept.
Lespinasse in 1910 was the first one to perform endoscopic choroid plexus fulgration for treating hydrocephalus.
Dandy described the open technique for third ventriculostomy for treatment of hydrocephalus.
In 1923, Mixter first described percutaneous ventriculostomy, and Fay Grant published the visual record of endoscopic anatomy.
The aim of this surgery is to create a passage in the floor of the third ventricle and to allow the flow of CSF into the pre pontine cistern so that obstruction at the aqueduct can be avoided. The easiest example to explain is of obstructive hydrocephalus due to aqueductal stenosis. In this condition, patient presents with enlargement of the lateral ventricles and third ventricle. The obstruction at the aqueduct causes obstructive hydrocephalus and the cerebral sulci are effaced. So, an endoscope is introduced through the frontal horn of right lateral ventricle and advanced into the third ventricle through dilated Foramen of Monro. Floor of the third ventricle is visualized and an opening is made in the floor of the third ventricle allowing the CS flow to the pre-pontine cistern.
So, high success rate is seen in aqueductal stenosis and ventricular obstructions assosciated with tumors. Low success rate is expected in post tubercular hydrocephalus due to basal exudates at the basal cisterns and thickened third ventricular floor.
A variety of endoscopic equipments with some modification are available for neuroendoscopic procedures.
Diagrammatic depiction of the anatomical structures which are to be identified by the neurosurgeon
Lespinasse in 1910 was the first one to perform endoscopic choroid plexus fulgration for treating hydrocephalus.
Dandy described the open technique for third ventriculostomy for treatment of hydrocephalus.
In 1923, Mixter first described percutaneous ventriculostomy, and Fay Grant published the visual record of endoscopic anatomy.
The aim of this surgery is to create a passage in the floor of the third ventricle and to allow the flow of CSF into the pre pontine cistern so that obstruction at the aqueduct can be avoided. The easiest example to explain is of obstructive hydrocephalus due to aqueductal stenosis. In this condition, patient presents with enlargement of the lateral ventricles and third ventricle. The obstruction at the aqueduct causes obstructive hydrocephalus and the cerebral sulci are effaced. So, an endoscope is introduced through the frontal horn of right lateral ventricle and advanced into the third ventricle through dilated Foramen of Monro. Floor of the third ventricle is visualized and an opening is made in the floor of the third ventricle allowing the CS flow to the pre-pontine cistern.
So, high success rate is seen in aqueductal stenosis and ventricular obstructions assosciated with tumors. Low success rate is expected in post tubercular hydrocephalus due to basal exudates at the basal cisterns and thickened third ventricular floor.
A variety of endoscopic equipments with some modification are available for neuroendoscopic procedures.
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| Endoscope is passed from right lateral ventricle to third ventricle through Foramen of Monro |
Intraoperative Endoscopic view of the structures at the Foramen of Monro
Diagrammatic depiction of the anatomical structures which are to be identified by the neurosurgeon
Intraoperative endoscopic view of the anatomical structures as seen at the floor of the third ventricle
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