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Year : 2012  |  Volume : 60  |  Issue : 4  |  Page : 455-

The endoscopic trans-fourth ventricle aqueductoplasty and stent placement for the treatment of trapped fourth ventricle; stent blockage complications under estimated?

Yad R Yadav, Vijay Parihar 
 Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India

Correspondence Address:
Yad R Yadav
Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh
India




How to cite this article:
Yadav YR, Parihar V. The endoscopic trans-fourth ventricle aqueductoplasty and stent placement for the treatment of trapped fourth ventricle; stent blockage complications under estimated?.Neurol India 2012;60:455-455


How to cite this URL:
Yadav YR, Parihar V. The endoscopic trans-fourth ventricle aqueductoplasty and stent placement for the treatment of trapped fourth ventricle; stent blockage complications under estimated?. Neurol India [serial online] 2012 [cited 2021 Oct 25 ];60:455-455
Available from: https://www.neurologyindia.com/text.asp?2012/60/4/455/100743


Full Text

Sir,

I read the article entitled "endoscopic trans fourth ventricle aqueductoplasty and stent placement for the treatment of trapped fourth ventricle" with interest and congratulate the authors for their good results.[1] The trapped fourth ventricle can be treated by two different methods. One way is to put in ventriculo-peritoneal (VP) shunt and communicate fourth ventricle with cisterna magna if there is long segment aqueductal stenosis. The other way is by communicating fourth ventricle with third ventricle and cisterna magna which do not require VP shunt unless there is a complex hydrocephalus (defect in permeation of cerebrospinal fluid in the basal cisterns or the defect in the absorption).[2],[3]

Authors of this paper[1] have made two communications: between fourth and third ventricle and fourth ventricle and cisterna magna. In this condition, a patient should remain asymptomatic even if the VP shunt gets blocked. There were five patients of shunt block, requiring shunt revision, suggesting that one of the communications between fourth and third ventricle or fourth ventricle and the cisterna magna was blocked. Shunt revisions in the absence of complex hydrocephalus suggest that the aqueductoplasties or the communications between fourth ventricle and cisterna magna in five patients were blocked which should be mentioned in their results.

In my opinion, the prone position is better compared to the sitting position. Apart from the risk of air embolism and post operative pneumocephalus in the sitting position, the air may get trapped in the ventricle and interfere in intraoperative visualization.

References

1Gallo P, Szathmari A, Simon E, Ricci-Franchi A, Rousselle C, Hermier M, et al. The endoscopic trans-fourth ventricle aqueductoplasty and stent placement for the treatment of trapped fourth ventricle: Long-term results in a series of 18 consecutive patients. Neurol India 2012; 60:271-7.
2Yadav YR, Mukerji G, Parihar V, Sinha M, Pandey S. Complex hydrocephalus (combination of communicating and obstructive type): an important cause of failed endoscopic third ventriculostomy. BMC Res Notes 2009;2:137.
3Yadav YR, Parihar V, Agrawal M, Bhatele PR. Endoscopic third ventriculostomy in tubercular meningitis with hydrocephalus. Neurol India 2011;59:855-60.