Endoscopic aqueductoplasty: Technique and results

OBJECTIVE: The purpose of this study was to determine the safety and effica cy of endoscopic aqueductoplasty in patients with hydrocephalus caused by a queductal stenosis. The controversy of third ventriculostomy and aqueductop lasty is discussed. METHODS: A series of 17 patients who underwent endoscopic aqueductoplasty i s reported, Rigid rod-lens scopes were used for inspecting the aqueductal e ntry and performing balloon aqueductoplasty. With the aid of a 2.5-mm flexi ble endoscope, the aqueduct and fourth ventricle were explored and aqueduct al membranous obstructions were perforated. Third ventriculostomies were pe rformed simultaneously in nine patients. One aqueductal stent was inserted. In six patients, frameless computerized neuronavigation was used for an ac curate approach to the aqueduct. The average duration of the endoscopic pro cedures was 59 minutes (range, 25-100 min). RESULTS: There was no endoscopy-related mortality. Surgical complications i ncluded an asymptomatic fornix contusion and two injuries to the aqueductal roof, which resulted in permanent diplopia due to dysconjugate eye movemen t (one patient) and transient trochlear palsy (one patient). In addition, t wo patients developed transient dysconjugate eye movements, and one patient had an asymptomatic epidural hematoma. Eleven patients showed improvement in their symptoms. The conditions of five patients were unchanged. One pati ent died of stroke 1 month after the operation. No patient required shuntin g. The ventricles decreased in size in nine patients and were unchanged in the remaining eight patients. CONCLUSION: Endoscopic aqueductoplasty is an effective alternative to third ventriculostomy for the treatment of hydrocephalus caused by short aqueduc tal stenosis. However, longer follow-up periods are necessary to evaluate l ong-term aqueductal patency after aqueductoplasty.