Lymphoplasmacyte-Rich Meningioma of the Third Ventricle: Case Report

Introduction Meningiomas are the most common primary intracranial tumors, accounting for up to 35% of the neoplasms in this category. Approximately 10­20% of these neoplasms are histologically atypical, and the lymphoplasmacyte-rich meningioma (LPM) corresponds to a very rare subtype of meningioma that is characterized histopathologically by massive infiltrates of inflammatory cells. The case described in the present study is the sixth case of an intraventricular LPM found in the literature and the first case considering the location in the third ventricle. Case Description A 21-year-old male without previous comorbidities sought medical attention due to visual impairment (complaining of intermittent visual blur) for 2 months. A magnetic resonance imaging of the brain confirmed the presence of a well-delimited solid mass in the third ventricle of 3.0 2.3 cmwith a cystic component that extended itself inferiorly and distorted the visual pathway anatomy. Neurosurgeons decided to access the lesion using an interhemispheric transcallosal approach with a transforaminal access, and the lesion was resected completely. The patient has an ambulatorial endocrinological follow-up and is neurologically stable 6 months after the procedure. No new visual deficits were noted. Conclusion Lymphoplasmacyte-rich meningioma is a very rare intracranial tumor, and the involvement of the third ventricle make this case unique.

Suprasellar chordoid glioma: a report of two cases

SUMMARY Chordoid glioma (CG) is considered a slow growing glial neoplasm. We report two new cases with endocrinological presentation, management and outcome. Case reports: 1) An 18 year-old female patient was admitted due to headaches, nausea and vomiting and visual abnormalities. She was in amenorrhea. A brain magnetic resonance imaging (MRI) demonstrated a 35 mm-diameter sellar and suprasellar mass. An emergency ventricular peritoneal valve was placed due to obstructive hydrocephalus. Transcraneal surgery was performed. The patient developed central hypothyroidism, adrenal insufficiency and transient diabetes insipidus; she never recovered spontaneous menstrual cycles. Histopathologic study showed cells in cords, inside a mucinous stroma, positive for glial fibrillary acidic protein (GFAP). Due to residual tumor gamma knife radiosurgery was performed. Three years after surgery, the patient is lucid, with hypopituitarism under replacement. 2) A 46 year-old woman complained about a three year-history of amenorrhea, galactorrhea and headache. An MRI showed a solid-cystic sellar mass 40 mm-diameter that extended to the suprasellar cistern. She had hypogonatropic hypogonadism and mild hyperprolactinemia. The tumor mass was removed via nasal endoscopic approach. Histopathological study reported cellular proliferation of glial lineage positive for GFAP. The patient evolved with central hypothyroidism and diabetes insipidus. She was re-operated for fistula and again under the diagnosis of extradural abscess. She evolved with cardiorespiratory descompensation and death, suspected to be due to a thromboembolism. In conclusion, the first case confirms that best treatment for CG is surgery considering radiotherapy as an adjuvant therapy. The other case, on the contrary, illustrates the potentially fatal evolution due to surgical complications.

Choroid plexus coagulation for pediatric hydrocephalus: review of historical aspects and rebirth

This study aims to review historical aspects and rebirth of the endoscopic choroid plexus coagulation (CPC) for pediatric hydrocephalus. The first CPC procedure goes back to early 1930s. After the development of other treatment methods and the understanding of CSF dynamics, the application of CPC dramatically decreased by 1970s. In 2000s, there was a rebirth of CPC in combination with endoscopic third ventriculostomy (ETV), and remains one of the options for the treatment of pediatric hydrocephalus in selected cases. CPC might provide a temporary reduction in CSF production to allow the further development of CSF absorption in infant, and adding to ETV for infants with communicating hydrocephalus may increase the shunt independent rate thus avoiding the consequence of late complication related to the shunt device. This is important for patients who are difficult to be followed up, due to geographical and/or socioeconomic difficulties. And also adding CPC to ETV for obstructive hydrocephalus in infants younger than 1 year of age may also increase the successful rate. Furthermore, CPC may be an option for cases with high chance of shunt complication such as multiloculated hydrocephalus, extreme hydrocephalus and hydranencephaly. In comparison with the traditional treatment of CSF shunting, the role of CPC needs to be further evaluated in particular concerning the neurocognitive development.

Modelo anatômico de ventriculomegalia para treinamento neuroendoscópico / Ventriculomegaly anatomical models for neuroendoscopy training

OBJETIVO: Desenvolver peças anatômicas que simulem uma condição real de ventriculomegalia para serem utilizadas como uma ferramenta no treinamento dos neurocirurgiões nas técnicas de neuroendoscopia e viabilizar estudo anatômico dos ventrículos. MÉTODO: Foram utilizadas vinte peças anatômicas de encéfalo de cadáveres de indigentes, com a aprovação do Comitê de Ética em pesquisa da FMUSP sob o número 046/10. As peças foram retiradas da base do crânio com a persistência da superfície óssea (parte da calvária) para serem submetidas aos seguintes procedimentos: canulação do IV ventrículo por meio da abertura mediana do IV ventrículo (forame de Magendie); tomografias pré-experimento e injeção de água destilada no sistema ventricular. A água injetada estava à temperatura ambiente e os cérebros foram resfriados até 4º C e, após 12 horas, foram congelados a uma temperatura de 0º C (no estado sólido) por 24 horas. Esses procedimentos foram realizados na frequência de três vezes. Após o experimento, foram realizadas tomografias pós-experimento e procedimentos neuroendoscópicos ventriculares. Foram excluídos encéfalos com lesões traumáticas ou antecedentes de enfermidades transmissíveis. Não foram critérios de exclusão o sexo e a idade. Foram avaliadas, nas imagens tomográficas, a variação pré e pós-experimento dos seguintes parâmetros: coeficiente corno frontal/diâmetro interno; índice de Evan; e tamanho do corno temporal. As análises estatísticas foram realizadas no programa SPSS (Statistical Package for the Social Sciences) versão 13, para ambos os grupos. RESULTADOS: A avaliação da relação Corno frontal/Diâmetro interno, antes e pós-experimento apresentou média de 11,98% e 19,46%, respectivamente. Estudo estatístico (t Student) mostrou diferença estatística (t= -5142, gl =19; p < 0,01). O Índice de Evan também apresentou diferença significativa (t = -5,172, gl = 9; p < 0,01) entre os resultados antes (média de 10,86%) e após experimento (média de 18,35%). A análise...

PURPOSE: To develop anatomical models which simulate real conditions of ventriculomegaly and to use them as tools to train neuroendoscopic techniques and allow the study of the ventricles. METHODS: A total of twenty brains, with the approval of the Ethics in Research Committee from FMUSP (046/10) were used to perform this research. The brains were separated from the skull base, but keeping part of the calvaria, and then underwent the following procedures: cannulation of the fourth ventricle through the median open of the fourth ventricle (foramen of Magendie); CT scans performed before the experiment; and then injection of distilled water into the ventricular system. The water was injected at room temperature, and then the brains were cooled to 4ºC. After 12 hours, they were then frozen at 0ºC for 24 hours.These procedures were repeated three times. After the experiment,CT scans were performed after the injections and neuroendoscopic procedures. Brains, which had traumatic injuries or history of infectious diseases, were excluded. Gender and age were not exclusion criteria. The statistical analysis was performed with the SPSS program (Statistical Package for the Social Sciences) version 13, for both groups. To assess the variation of the frontal horn (FH)/internal diameter (ID) coefficient, such as Evan's index's variation, and to analyze the temporal horn (TH) size, thet-Student test was used. RESULTS: The results of the t-Student test showed that the FH/ID, with an average of 11.98% before the experiment, had significant difference (t = -5.142, gl = 19; p < 0.01) after the experiment, with an average of19.46%. The Evan's index also showed a significant difference (t = -5.172, gl = 9; p < 0,01) with an initial average of 10.86% and a final average of 18.35%. The analysis of the temporal horn size showed a significant difference between the size before and after the experiment (t = -2.297, gl = 9; p < 0.01), indicating the significant increase of the temporal...

Endoscopic third ventriculostomy has no higher costs than ventriculoperitoneal shunt / Terceiro ventriculostomia endoscópica não apresenta custos mais elevados do que a derivação ventrículo peritoneal

Objective: To evaluate the cost of endoscopic third ventriculostomy (ETV) compared to ventriculoperitoneal shunt (VPS) in the treatment of hydrocephalus in children. Method: We studied 103 children with hydrocephalus, 52 of which were treated with ETV and 51 with VPS in a prospective cohort. Treatment costs were compared within the first year after surgery, including subsequent surgery or hospitalization. Results: Twenty (38.4%) of the 52 children treated with VPS needed another procedure due to shunt failure, compared to 11 (21.5%) of 51 children in the ETV group. The average costs per patient in the group treated with ETV was USD$ 2,177,66±517.73 compared to USD$ 2,890.68±2,835.02 for the VPS group. Conclusions: In this series there was no significant difference in costs between the ETV and VPS groups. .

Objetivo: Avaliar os custos da terceiro ventriculostomia endoscópica (TVE) comparada à derivação ventrículo peritoneal (DVP) no tratamento da hidrocefalia em crianças. Método: Foram estudadas 103 crianças com hidrocefalia, 52 das quais tratadas com TVE e 51 com DVP numa coorte prospectiva. Foram comparados os custos do tratamento no primeiro ano após a cirurgia, incluindo cirurgias ou internações subsequentes. Resultados: Vinte (38,4%) das 52 crianças tratadas com DVP necessitaram de outro procedimento por disfunção da válvula, em comparação a 11 (21,5%) das 51 crianças do grupo tratado com TVE. Os custos médios por paciente no grupo tratado com TVE foram de USD$ 2,177.66±517.73 comparados a USD$ 2.890,68±2.835,02 para o grupo DVP. Conclusões: Nesta série não houve diferença significativa de custos entre o grupo TVE e DVP. .

Endoscopic third ventriculostomy is a safe and effective procedure for the treatment of Blake's pouch cyst / Terceiroventriculostomia endoscopica e um procedimento efetivo e seguro para o tratamento dos cistos da bolsa de Blake

OBJECTIVE: Blake's pouch cyst (BPC) is a midline cystic malformation of the posterior fossa, within Dandy-Walker's complex (DWC), often associated with hydrocephalus. Endoscopic third ventriculostomy (ETV) has been an alternative to conventional methods for BPC treatment. This study aimed at reporting our experience with ETV in a series of patients with BPC. METHODS: Of 33 patients diagnosed with midline posterior fossa cyst, 26 met the protocol criteria for DWC, and eight subjects with BPC were selected (aged one month to two years old). All cases were treated with ETV. RESULTS: Five patients were male; and three were prenatally diagnosed. They had hydrocephalus and motor deficiencies. Motor assessment at a five-year follow-up yielded normal findings. All patients improved, and only one had residual cognitive dysfunction, despite overall neurological improvement. There were no complications. CONCLUSIONS: ETV was a safe and effective procedure, reducing risks and morbidity associated with open surgery and shunt-related problems. .

OBJETIVO: O cisto da bolsa de Blake (CBB) é uma malformação cística mediana da fossa posterior, dentro do complexo de Dandy-Walker (CDW), frequentemente associada à hidrocefalia. A terceiroventriculostomia endoscópica (TVE) tem sido considerada uma alternativa aos métodos convencionais de tratamento do CBB. Este estudo teve como objetivo relatar nossa experiência com TVE em uma série de pacientes com CBB. MÉTODOS: Dos 33 pacientes diagnosticados com cisto mediano da fossa posterior, 26 preencheram os critérios do protocolo para CDW, dos quais oito foram selecionados com CBB (idades variando entre um mês a dois anos). Todos os casos foram tratados com TVE. RESULTADOS: Cinco pacientes eram do sexo masculino, três tiveram diagnóstico no pré-natal; e todos apresentavam hidrocefalia e alterações motoras. A avaliação motora após cinco anos apresentou resultados normais. Todos os pacientes melhoraram, e apenas um apresentou um leve déficit cognitivo, apesar da melhora neurológica geral. Não houve complicações. CONCLUSÕES: A TVE foi um procedimento seguro e eficaz, reduzindo riscos e morbidade associados à cirurgia aberta e a problemas relacionados aos shunts.

Endoscopic third ventriculostomy may have long term efficacy in low birth weight preterm newborns / Terceiro-ventriculostomia endoscópica pode ter eficácia em longo prazo em pacientes pré-termos e de baixo peso

Endoscopic third ventriculostomy (ETV) is an established treatment for hydrocephalus and is an alternative method avoiding shunts and its complications. There is still controversy regarding the higher risk of failure in younger infants. NARF was a male preterm newborn of 33 weeks old, with Moebius syndrome and 1,800 grams at birth. Detailed neonatal evaluation revealed hydrocephalus with bilateral ventricular index of 0.6. It was then decided, in spite of prematurity and low birth weight to perform ETV with the age of 25 days, with 1,850 grams. After discharge, follow-up was lost due to family moving to another city. By chance, after seven years child returned to our medical facility and a follow-up magnetic resonance revealed pervious ETV with high flow, demonstrating functionality of ventriculostomy. Patient?s age and etiology of hydrocephalus are the most important factors influencing the success rate of ETV. Recently, the age between 6 months and 1 year old became a cutoff below which failure rates are reported to be particularly high and there are dichotomized experience. The results in low birth weight and preterm infants is not widely known and can be poor. Our case illustrates a successful ETV in a both preterm and low birth weight newborn and a satisfactory long term result, reinforcing the security and efficacy of ETV even in newborns...

A terceiro-ventriculostomia endoscópica (TV) é um tratamento estabelecido para hidrocefalia e é um método alternativo para evitar próteses e suas complicações. Ainda há controvérsia a respeito de seu uso e falha em crianças menores. NARF foi um pré-termo nascido com 33 semanas de gestação, apresentava síndrome de Moebius e 1.800 gramas ao nascer. Avaliação neonatal detalhada revelou hidrocefalia com índice ventricular bilateral de 0,6. Foi submetido à TV com 25 dias de vida e 1.850 gramas. Após alta hospitalar, o seguimento foi perdido, pois a família se mudou de cidade. Após sete anos, a criança retornou ao hospital para tratamento de pneumonia, e a ressonância magnética de controle demonstrou trajeto endoscópico pérvio e com alto fluxo. A idade do paciente e a causa da hidrocefalia são os fatores mais importantes na taxa de sucesso da TV. Recentemente, vários casos vêm sendo publicados de crianças com menos de 1 ano. Os resultados em crianças pré-termo e de baixo peso ainda são desconhecidos. Nosso caso ilustra uma TV com trajeto pérvio sete anos após a cirurgia, denotando bom status em longo prazo...

Approaches to the third ventricle / Acessos ao terceiro ventrículo

The authors review the main technical approaches to the third ventricle, the most common surgical indications and their results. The traditional open techniques are characterized by low rate of residual lesion and risk, although low, epilepsy postoperatively. Endoscopic techniques has gained wide acceptance by patients and neurosurgeons because of the low rates of complications and reduced hospital stay, however one still observes a higher rate of residual lesions, even asymptomatic. All the techniques mentioned have excellent results for surgical approaches to the third ventricle. We observe that the choice of technique will depend mainly on the familiarity of the surgeon and his service with each of these techniques.

Os autores revisaram as principais formas de abordagem do terceiro ventrículo, as indicações cirúrgicas mais comuns e seus resultados. As técnicas abertas tradicionais são caracterizadas pelo baixo índice de lesões residuais e baixo risco de epilepsia pós-operatória. As técnicas endoscópicas têm ganhado espaço pelas baixas taxas de complicações e redução de dias de internamento, apesar de taxas maiores de lesões residuais, mesmo assintomáticas. Todas as técnicas mencionadas para os acessos ao terceiro ventrículo têm excelentes resultados. Observamos que a escolha da técnica utilizada dependerá, principalmente, da familiaridade do cirurgião e do seu serviço com cada uma delas.

Endoscopic third ventriculostomy in the treatment of hydrocephalus secondary to posterior fossa tumours in children

The purpose of the present study is to describe our experience with endoscopic third ventriculostomy in children with obstructive hydrocephalus secondary to posterior fossa tumours. Between January 2000 and January 2006, 42 children with posterior fossa tumour were treated. Thirty patients had symptomatic hydrocephalus. Third ventriculostomy was performed to relieve intracranial pressure in all cases as an urgent procedure after admission. The other 12 cases had no hydrocephalus or non symptomatic mild dilatation of ventricles. They were excluded from the study. Pre craniectomy endoscopic third ventriculostomy procedures were technically successful. One case was complicated with infection. The procedure resolved the increased intracranial pressure before posterior fossa surgery in all cases. One case developed post operative hydrocephalus and was treated by ventriculo-peritoneal shunt insertion. Endoscopic third ventriculostomy is a plausible choice for the emergency control of severe hydrocephalus caused by posterior fossa tumours. It can quickly eliminate symptoms. In addition, it eliminates the risks of cerebrospinal fluid infection related to external drainage, minimizes the risk of over drainage because it provides more physiological cerebrospinal fluid drainage than the other procedures and avoids the complications of shunting procedures

[Primary results of neuroendoscopy in neurosurgery department]

Endoscopic third ventriculostomy [ETV] is currently being performed for patients with obstructive hydrocephalus, who also have preservation of communication between the subarachnoid space and the venous system, and in whom the basilar cisterns are still open. Despite the shunt complications, most children are shunt dependent permenantly or for many years. Recently, neuroendoscope is used to treat some of brain tumors, arachnoid cysts, some of congenital disorders and medullary diseases. The aime of this study was to evaluate primary results of neuroendoscopy in neurosurgery department. In this prospective study, all of the patients who were operated by neuroendoscope in neurosurgical department of Ghaem Hospital for 24 months were reviewed. Age, sex, underlying diseases, clinical findings, complications, CT or MRI findings before and after neuroendoscopy were studied. Data was collected in questionnaire and the processing of the results was achieved by SPSS [11.5] and statistical analysis with descriptive methods. From 30 patients in our study, 26 had obstructive hydrocephalus [two of them had intraventricular tumors and four cases had parenchymal tumors], 3 had arachnoid cysts, and one patient had loculated hydrocephalus. All of them have been operated by neuroendoscopy. From 26 patients with obstructive hydrocephalus, 4 had been operated by VP shunt before. From 26 patients undergoing neuroendoscopy for obstructive hydrocephalus, 14 cases within one week and 10 cases whitin one month after neuroedoscopic third ventriculostomy had normal size ventricules. The results were excellent in treatment of arachnoid cysts, intraventricular tumors, and loculated hydrocephalus too. With respect to excellent results of neuroendoscopy in treatment of obstructive hydrocephalus, arachnoid cysts, and shunt malfunction; and in regard to many complications and severe dependency in shunt surgery, neuroendoscope is recommended as the first step of treatment of these diseases

Endoscopic third ventriculostomy in infants.

BACKGROUND: Endoscopic third Ventriculostomy (ETV) is one of the surgical options for obstructive hydrocephalus. There are varying opinions about results of ETV in infants. We are therefore presenting the results of ETV in 54 infants. MATERIALS AND METHODS: A prospective study of 54 infants undergoing ETV in our institution in the last 2 years was carried out. There were 48 cases of congenital hydrocephalus with aqueductal stenosis, 6 of post tubercular meningitis hydrocephalus. Average follow up was 18 months. RESULTS: There was 83.3% (45 cases) clinical success rate in our study. Infection, persistent cerebro-spinal fluid (CSF) leak and bleeding occurred in 4 (8%) cases each while blockage of stoma was observed in 8 (14.8%) patients. Majority of ETV stoma closure (6 out of total 8) occurred following infection (4) or bleeding during surgery (2). One patient (2%) had transient diabetes insipidus. Overall failure rate in our study was 16.7% (8 stoma blocks and 1 procedure abandoned). Low birth weight pre mature infants had higher failure rate (3 out of 5 infants 60%) compared to full term infants with normal birth weight (12.3%). Age did not have any impact on the success rate (P>0.05). Success rates were not significanlty different in patients with aqueductal stenosis (85.4%) and TBM (66.6%) (Fisher's exact test, P=0.3). CONCLUSION: ETV was fairly safe and effective in full term normal birth weight infants while the results in low birth weight pre mature infants were poor.

Anatomia microquirurgica en 3D de la fisura coroidea. Abordajes quirurgicos y aplicacion clinica / 3D microsurgical anatomy of the coroideal fissure. Surgical approaches and clinical application

Objetivo: Describir la anatomia de la fisura coroidea, mostrar los diferentes abordajes a traves de la misma, presentar las fotos anatomicas en tres dimensiones (3D). Material y metodo: Se disecaron cuatro cabezas de cadaveres adultos, fijadas en formol e inyectadas con siliconas coloreadas y cuatro encefalos de cadaveres adultos, fijados en formol, fueron disecados utilizando microscopio quirurgico con magnificacion 6 a 25 X. Resultados: El sistema coroideo supratentorial esta constituido por los plexos coroideos, la tela coroidea superior y la fisura coroidea. Los plexos coroideos se ubican a nivel del techo del tercer ventriculo y en el cuerpo (tapan la tenia coroidea), atrio (tapan la tenia fornicis) y cuerno temporal (tapan la tenia fimbriae) del ventriculo lateral. La tela coroidea superior es una prolongacion de la piamadre que recubre las estructuras neurales que se ubican en las cisternas ambiens y cuadrigeminal; posee cuatro sectores: a nivel del techo del tercer ventriculo, a nivel del cuerpo del ventriculo lateral, a nivel del atrio del ventriculo lateral y a nivel del cuerpo temporal. La fisura coroidea es una grieta natural entre el talamo (tenia coroidea) y el fornix (tenia fornicis /fimbriae ) que se extiende desde el agujero de Monro (incluido), pasando por el cuerpo, atrio y cuerno temporal del ventriculo lateral, hasta su terminacion a nivel del punto coroideo inferior. A traves de la FC pasan las hojas de la tela coroidea superior (para ingresar a los ventriculos laterales y asi poder envolver y fijar a los plexos coroideos), las arterias coroideas y venas subependimarias. La fisura coroidea posee tres sectores: superior (corporal), posterior (atrial) e inferior (temporal). A nivel del sector corporal, las venas que atraviesan el agujero de Monro /fisura coroidea presentan variabilidad anatomica: asi, la vena septal anterior y / o la vena talamoestriada pueden ingresar al velum interpositum atravesando el agujero de Monro o la fisura coroidea, ademas, cuando la vena talamocaudada es grande, la vena talamoestriada es pequeña. Los abordajes a traves de la fisura coroidea pueden ser realizados de la siguiente manera: a) agrandando el agujero de Monro hacia atras, b) por via subcoroidea (a traves de la tenia coroidea) y c) por via transcoroidea (a traves de la tenia fornicis / fimbriae), sigue el resumen

Tercerventriculocisternostomía por vía endoscópica / Endoscopic third ventricle cisternotomy

Las complicaciones asociadas a las cirugías de derivación ventricular y la nuev atecnología lumínica y de imagen llevaron a buscar alternativas en el tratamiento de la hidrocefalia. La tercerventriculocisternostomía endoscópica es un procedimiento efectivo en el tratamiento de ciertos tipos de hidrocefalia como la secundaria a estenosis de acueducto congénita o adquirida y por compresión del sistema ventricular debido a tumores de fosa posterior. Es una técnica segura, rápida, y de bajo costo que produce una nueva circulación del líquido ceefalorraquídeo (LCR) sin la presencia de prótesis. El objetivo de este artículo es analizar indicaciones, técnica, una breve casuística de los autores, resultados y complicaciones de la tercerventriculocisternostomía.

Endoscopic third ventriculostomy in obstructed hydrocephalus.

Forty-three ETV were performed in 46 patients of obstructive hydrocephalus. Study was divided into two groups. Group 1 was with 29 children of less than two years age. Group 2 had seventeen patients of more than 2 years, adolescent and adults. Group 1 had 70% clinical and 63% radiological improvement whereas Group 2 showed 100% clinical and 73% radiological improvement. ETV failed in relieving the symptoms of hydrocephalus in eight patients. They were eventually benefited with VP Shunt. There was one postoperative death, which was not related to the procedure. ETV is an important alternative to VP Shunt in relieving hydrocephalus due to obstruction in CSF pathway.

Ventriculostomia endoscópica del tercer ventrículo / Endoscopyc third ventriculostomy

Las complicaciones asociadas a las cirugías de derivación ventricular han renovado el interés en buscar alternativas para el manejo de la hidrocefalia. La ventriculostomía endoscópica del tercer ventrículo es un procedimiento efectivo en el manejo de ciertos tipos de hidrocefalia como la secundaria a estenosis acueductal congénita o adquirida, compresión del sistema ventricular debida a tumores, lesiones en fosa posterior. Reportes recientes incluyen otros tipos de hidrocefalia tanto comunicante como no comunicante. El objetivo de este artículo es revisar la ventriculostomía endoscópica, sus complicaciones, indicaciones y fallas. Este es un procedimiento seguro con baja morbilidad y buenos resultados. Sin embargo, es necesario definir los candidatos ideales para el procedimiento.

Acesso endoscópico transepto-interforniceal para cistos colóides: relato de caso / Endoscopic transepto-interforniceal approach to colloid cysts: case report

A abordagem endoscópica de cistos colóides ainda é matéria controversa. As opçoes de tratamento sao variadas: observaçao com exames seriados, tratamento da hidrocefalia, aspiraçao por estereotaxia, microcirurgia e endoscopia. O autor relata o caso de um paciente com cisto colóide do terceiro ventrículo, localizado em posiçao retroforaminal, no teto diencefálico, dissecando os dois fornices projetando-se supero-posteriormente em direçao ao assoalho do ventrículo lateral, por dentro do cavum do septo pelúcido. A lesao foi alcançada com neuroendoscópio rígido, através de um orifício de trépano pré-coronal situado a 2,5 cm da linha média (ponto de Kocher). Seguindo por via transventricular, a lâmina direita do septo pelúcido foi aberta, posterior à veia septal. A lesao, muito endurecida, situada entre os dois fórnices, foi parcialmente ressecada através da via endoscópica transventricular transepto-interforniceal. Realizamos também septostomia e terceiro ventriculostomia endoscópicas neste paciente. Os diferentes tipos de procedimentos cirúrgicos das patologias situadas no terceiro ventrículo sao discutidos com ênfase no papel da endoscopia

Tercer ventrículo cisternostomía en el tratamiento de la hidrocefalia en la edad pediátrica / Third ventriculostomy in the treatment of hydrocephalus in children

La hidrocefalia es la principal patología neuroquirúrgica en la población pediátrica. A partir de los años 50 los sistemas de derivación del líquido cefalorraquídeo aportaron la primera alternativa terapéutica útil en esta patología. Pero las constantes disfunciones valvulares y sus complicaciones producen una importante discapacidad en este tipo de pacientes. El desarrollo de la Tercer Ventrículo Cisternostomía (TVC) por vía endoscópica ha permitido en los últimos 5 años reutilizar una antigua técnica, aportando una interesante estrategia terapéutica. La fenestración practicada, solucionada definitivamente el problema de circulación del LCR en las hidrocefalias no comunicantes. Se presenta una serie de 16- enfermos tratados con este procedimiento. Los resultados globales fueron un 75 por ciento de efectividad. No se presento mortalidad y la morbilidad fue de un 25 por ciento, no hubo déficit neurológicos definitivos asociados a las complicaciones. Se presentan las principales características técnicas del equipo utilizado, se hace un análisis de la literatura respecto al procedimiento, indicaciones y complicaciones