ENDOSCOPIC TREATMENT OF CEREBROSPINAL FLUID PATHWAY OBSTRUCTIONS

Abstract

This article describes our endoscopic techniques developed for the treatment of various obstructions of cerebrospinal fluid pathways. Blocked cerebrospinal fluid pathways result in ventricular dilation in front of the obstruction, which may cause acute or chronic symptoms of hydrocephalus. The traditional treatment is insertion of a shunt. Because of the high failure rate in the long term, shunts should be avoided whenever possible. Our techniques of septum pellucidum fenestration, third ventriculostomy, lamina terminalis fenestration, temporal ventriculostomy, foraminoplasty of the foramen of Monro, aqueductoplasty, aqueductal stenting, and retrograde aqueductoplasty for trapped fourth ventricle are presented. Neuroendoscopic techniques can effectively treat obstructive hydrocephalus by restoration of the obstructed cerebrospinal fluid pathway or creating a bypass into the ventricles or subarachnoid spaces.