Endoscopic aqueductoplasty through a tailored craniocervical approach

Object. Neuroendoscopy has an essential role in the management of occlusive hydrocephalus due to a membranous obstruction of the sylvian aqueduct. Well-known endoscopic methods include endoscopic third ventriculostomy (ETV) and endoscopic aqueductoplasty through a frontal burr hole. Building on their experience in the endoscopic management of hydrocephalus, the authors realized that not all of their patients with aqueductal obstruction were eligible for the aforementioned lines of treatment. Certain anatomical situations made it impossible to perform ETV or endoscopic aqueductoplasty through a frontal burr hole. Long-term complications of the shunt system led the authors to seek an alternative form of treatment for these patients. In this study, they present a new endoscopic approach to performing aqueductoplasty through the fourth ventricle. Methods. Endoscopic aqueductoplasty was performed in five patients by using a tailored craniocervical approach. In all patients a caudally located membranous obstruction of the sylvian aqueduct was present, and the authors were able to relieve the membranous obstruction in all patients without complications. All patients experienced improvement, which was demonstrated clinically and on imaging studies. Conclusions. Caudal endoscopic aqueductoplasty is a safe and effective method of treatment in the management of a caudally located membranous obstruction of the sylvian aqueduct. This should be considered as an alternative endoscopic method when other endoscopic solutions are not suitable.