Experimental third ventriculostomy performed using endovascular surgical techniques and their adaptation to percutaneous intradural neuronavigation: Proof of concept cadaver study

Michael B. Horowitz, Kamal Ramzipoor, Ajit Nair, Susan Miller, George Rappard, Richard Spiro, Phillip Purdy, Michael L. Levy, Bernard R. Bendok, L. Nelson Hopkins, Marc P. Sindou, Alan Cohen

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: Endoscopic third ventriculostomy has developed into a therapeutic alternative to shunting for the management of carefully selected patients with primarily noncommunicating hydrocephalus. This procedure, however, requires a general anesthetic and necessitates violation of the brain parenchyma and manipulation near vital neural structures to access the floor of the third ventricle. Using two cadavers and off-the-shelf angiographic catheters, we sought to determine whether it was possible to navigate a catheter, angioplasty balloon, and stent percutaneously through the sub-arachnoid space from the thecal sac into the third ventricle so as to perform a third ventriculostomy from below. METHODS: Using biplane angiography and off-the-shelf angiographic catheters along with angioplasty balloons and stents, we were able to pass a stent coaxially from the thecal sac to and across the floor of the third ventricle so as to achieve a third ventriculostomy from below. RESULTS: Coaxial catheter techniques allowed for the percutaneous insertion of a stent across the floor of the third ventricle. Ventriculostomy was confirmed by injecting contrast medium into the lateral ventricle and seeing it pass through the stent and into the chiasmatic cistern. CONCLUSION: We describe the performance of third ventriculostomies in two cadavers by use of the new concept of percutaneous intradural neuronavigation. This procedure may obviate the need for general anesthetic and minimize the potential for brain and vascular injury, especially if ultimately combined with magnetic resonance fluoroscopy.

Original languageEnglish (US)
Pages (from-to)387-391
Number of pages5
JournalNeurosurgery
Volume53
Issue number2
StatePublished - Aug 1 2003
Externally publishedYes

Fingerprint

Neuronavigation
Ventriculostomy
Endovascular Procedures
Cadaver
Third Ventricle
Stents
Catheters
General Anesthetics
Balloon Angioplasty
Cerebrovascular Trauma
Arachnoid
Lateral Ventricles
Fluoroscopy
Hydrocephalus
Contrast Media
Angiography
Magnetic Resonance Spectroscopy
Brain

Keywords

  • Hydrocephalus
  • Percutaneous intradural neuronavigation
  • Third ventriculostomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Experimental third ventriculostomy performed using endovascular surgical techniques and their adaptation to percutaneous intradural neuronavigation : Proof of concept cadaver study. / Horowitz, Michael B.; Ramzipoor, Kamal; Nair, Ajit; Miller, Susan; Rappard, George; Spiro, Richard; Purdy, Phillip; Levy, Michael L.; Bendok, Bernard R.; Hopkins, L. Nelson; Sindou, Marc P.; Cohen, Alan.

In: Neurosurgery, Vol. 53, No. 2, 01.08.2003, p. 387-391.

Research output: Contribution to journalArticle

Horowitz, MB, Ramzipoor, K, Nair, A, Miller, S, Rappard, G, Spiro, R, Purdy, P, Levy, ML, Bendok, BR, Hopkins, LN, Sindou, MP & Cohen, A 2003, 'Experimental third ventriculostomy performed using endovascular surgical techniques and their adaptation to percutaneous intradural neuronavigation: Proof of concept cadaver study', Neurosurgery, vol. 53, no. 2, pp. 387-391.
Horowitz, Michael B. ; Ramzipoor, Kamal ; Nair, Ajit ; Miller, Susan ; Rappard, George ; Spiro, Richard ; Purdy, Phillip ; Levy, Michael L. ; Bendok, Bernard R. ; Hopkins, L. Nelson ; Sindou, Marc P. ; Cohen, Alan. / Experimental third ventriculostomy performed using endovascular surgical techniques and their adaptation to percutaneous intradural neuronavigation : Proof of concept cadaver study. In: Neurosurgery. 2003 ; Vol. 53, No. 2. pp. 387-391.
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AU - Spiro, Richard

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AB - OBJECTIVE: Endoscopic third ventriculostomy has developed into a therapeutic alternative to shunting for the management of carefully selected patients with primarily noncommunicating hydrocephalus. This procedure, however, requires a general anesthetic and necessitates violation of the brain parenchyma and manipulation near vital neural structures to access the floor of the third ventricle. Using two cadavers and off-the-shelf angiographic catheters, we sought to determine whether it was possible to navigate a catheter, angioplasty balloon, and stent percutaneously through the sub-arachnoid space from the thecal sac into the third ventricle so as to perform a third ventriculostomy from below. METHODS: Using biplane angiography and off-the-shelf angiographic catheters along with angioplasty balloons and stents, we were able to pass a stent coaxially from the thecal sac to and across the floor of the third ventricle so as to achieve a third ventriculostomy from below. RESULTS: Coaxial catheter techniques allowed for the percutaneous insertion of a stent across the floor of the third ventricle. Ventriculostomy was confirmed by injecting contrast medium into the lateral ventricle and seeing it pass through the stent and into the chiasmatic cistern. CONCLUSION: We describe the performance of third ventriculostomies in two cadavers by use of the new concept of percutaneous intradural neuronavigation. This procedure may obviate the need for general anesthetic and minimize the potential for brain and vascular injury, especially if ultimately combined with magnetic resonance fluoroscopy.

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