A new device for endoscopic third ventriculostomy - Technical note

Since its description by Dandy in 1922, several techniques have been used t o perform third ventriculostomy under endoscopic control. Except for the bl unt technique, in which the endoscope is used by itself to create the openi ng in the floor of the third ventricle, the other techniques require more t han one instrument to perforate the floor of the ventricle and enlarge the ventriculostomy. The new device described is a sterilizable modified forcep s that allows both the opening of the floor and the enlargement of the vent riculostomy in a simple and effective way. The new device has the following characteristics: 1) the tip of the forceps is thin enough to allow the easy perforation of the floor of the ventricle ; 2) the inner surface of the jaws is smooth to avoid catching Vessels of t he basal cistern; and 3) the outer surface of the jaws has indentations tha t catch the edges of the opening to prevent them from slipping along the in strument's jaws. The ventricle floor is opened by gentle pressure of the fo rceps, which is slowly opened so that the edges of the aperture are caught by the distal outer indentation of the jaws, leading to an approximately 4- mm opening of the floor. This device has been used successfully in 10 conse cutive patients. This new device allows surgeons to perform third ventriculostomy under endo scopic control in a very simple, quick, and effective way, avoiding the nee d for additional single-use instruments.