Background

Endoscopic aqueductoplasty with aqueductal stenting is an effective surgical procedure for the treatment of isolated fourth ventricle (IFV). Due to the rarity of the underlying pathology, it can be considered a rare procedure that can be performed with different surgical techniques and approaches.

Objectives

To assess long-term functioning of permanent aqueductal stents implanted in children affected by hydrocephalus and IFV and to describe some variations of the same procedure.

Methods

We reviewed retrospectively all the patients presenting at our institution in the years 1999–2019 for symptoms of isolated fourth ventricle who underwent a surgical procedure of endoscopic aqueductoplasty and/or aqueductal stent. Surgical reports, radiological images, and surgical videos were retrospectively analyzed.

Results

Thirty-three patients with symptomatic isolated fourth ventricle (IFV) underwent fifty (50) neuroendoscopic procedures in the period observed. The median age of the patients at the time of first surgery was 7 months, with 22 premature babies. In twenty-nine patients (87.8%), a precoronal approach was performed, while four patients received a suboccipital burr hole. Ten patients were never reoperated since. Twenty-three patients underwent further surgeries: a new aqueductoplasty with aqueductal stent was performed in 13 cases. The remaining 10 patients required a combination of other procedures for management of hydrocephalus. Long-term follow-up showed a permanent stent functioning rate of 87% at 2 years and 73% at 4 years, remaining stable afterwards at very long term (20 years).

Conclusion

Endoscopic aqueductoplasty and stenting is a reliable procedure in the long-term management of isolated fourth ventricle.

中文翻译：

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内镜导水管成形术和支架置入术治疗儿童孤立性第四脑室：20 年的机构经验

背景

带导水管支架的内窥镜导水管成形术是治疗孤立性第四脑室 (IFV) 的有效外科手术。由于潜在病理的罕见性，它可以被认为是一种罕见的手术，可以用不同的手术技术和方法进行。

目标

评估植入受脑积水和 IFV 影响的儿童的永久性导水管支架的长期功能，并描述相同程序的一些变化。

方法

我们回顾性审查了 1999-2019 年在我们机构就诊的所有患者，这些患者因孤立的第四脑室症状而接受了内窥镜导水管成形术和/或导水管支架手术。回顾性分析手术报告、放射影像和手术视频。

结果

在观察期间，三十三名有症状的孤立性第四脑室 (IFV) 患者接受了五十 (50) 次神经内窥镜手术。首次手术时患者的中位年龄为 7 个月，有 22 名早产儿。在 29 名患者 (87.8%) 中，进行了冠状前入路，而 4 名患者接受了枕下钻孔。从那以后，10 名患者再也没有接受过再次手术。23 名患者接受了进一步手术：13 例患者进行了新的带导水管支架的导水管成形术。其余 10 名患者需要结合其他程序来治疗脑积水。长期随访显示，2 年支架永久性功能率为 87%，4 年为 73%，此后很长一段时间（20 年）保持稳定。

结论

内窥镜导水管成形术和支架置入术是孤立的第四脑室长期管理的可靠方法。