how should primary Aqueductal Stenosis in adults be treated a review

In 10% of adult patients with hydrocephalus, the cause is because of Aqueductal Stenosis (AS), causing enlargement of the lateral and third ventricles. There are currently two alternate forms of surgical treatment for AS; shunt surgery and ventriculostomy. Shunt surgery is associated with high complication rates and many patients need revisions, but the effectiveness is high. Endoscopic third ventriculostomy (ETV), re-establishing a physiological route of CSF dynamics, has become the treatment of choice for AS in most neurosurgical centers. ETV has fewer complications and revisions are rare, but some patients need shunt surgery to improve despite a patent ventriculostomy. There are today no common criteria for patient selection to either ETV or ventriculo-peritoneal shunt surgery.

neurological symptoms and signs in adult Aqueductal Stenosis

Objective – To comprehensively describe and compare prospectively (pre/postoperatively) the symptomatology in Aqueductal Stenosis (AS) vs idiopathic normal pressure hydrocephalus (INPH).

Methods – Twenty-seven patients with AS and 39 patients with INPH were consecutively included. Postural functions, gait, wakefulness, cognitive functions, urinary continence and headache were examined before and 3 months after treatment with shunt operation or endoscopic ventriculostomy.

Results – The AS patients had better postural functions, walked faster, performed better cognitively and had a higher wakefulness than INPH patients, but these differences were explained by age differences between groups. The frequency of incontinence was similar in the two patients groups. Headache occurred more frequently in AS, but independently of the other symptoms. Most symptoms and signs improved after surgery.

Conclusion – Patients with AS had a higher frequency of headaches than INPH patients, but otherwise the symptomology of the two groups was not found to differ after correcting for age differences.

how effective is endoscopic third ventriculostomy in treating adult hydrocephalus caused by primary Aqueductal Stenosis

OBJECTIVE: To evaluate the long-term efficacy of third ventriculostomies for adult patients with hydrocephalus caused by primary Aqueductal Stenosis. METHODS: Eighteen of 64 patients who underwent endoscopic third ventriculostomies (ETVs) between June 1991 and July 1995 were treated because of primary Aqueductal Stenosis. All of these patients accepted follow-up investigations, which were performed 3 months to 5 years after surgery. If hydrocephalic symptoms persisted, the patency of the ventriculostomy was investigated; in cases of open ventriculostomies, the patients were offered shunt surgery. The effects of the shunt surgery were evaluated after 3 months. RESULTS: After ETV, nine of the patients exhibited excellent improvements, two exhibited slight improvements, one displayed no change, and six demonstrated temporary improvements. The ventriculostomies were patent in all nine patients who experienced less than excellent results. Subsequent ventriculoperitoneal shunt placement produced improvements for all seven patients who accepted the surgery. CONCLUSION: In our experience, the long-term effectiveness of ETVs for adult patients with noncommunicating hydrocephalus was sufficient in only 50% of the cases. One-third of the patients exhibited temporary improvements, lasting 1 to 12 months (average duration, 5 mo) after the ETVs, and then demonstrated deterioration to even worse clinical conditions, despite patent ventriculostomies. All patients who did not exhibit permanent improvements after the ETVs benefited from shunt surgery. Efforts should be made to establish methods for the selection of patients for ETV or ventriculoperitoneal shunt surgery.

neurological symptoms and signs in adult Aqueductal Stenosis

Objective – To comprehensively describe and compare prospectively (pre/postoperatively) the symptomatology in Aqueductal Stenosis (AS) vs idiopathic normal pressure hydrocephalus (INPH).

Methods – Twenty-seven patients with AS and 39 patients with INPH were consecutively included. Postural functions, gait, wakefulness, cognitive functions, urinary continence and headache were examined before and 3 months after treatment with shunt operation or endoscopic ventriculostomy.

Results – The AS patients had better postural functions, walked faster, performed better cognitively and had a higher wakefulness than INPH patients, but these differences were explained by age differences between groups. The frequency of incontinence was similar in the two patients groups. Headache occurred more frequently in AS, but independently of the other symptoms. Most symptoms and signs improved after surgery.

Conclusion – Patients with AS had a higher frequency of headaches than INPH patients, but otherwise the symptomology of the two groups was not found to differ after correcting for age differences.

how effective is endoscopic third ventriculostomy in treating adult hydrocephalus caused by primary Aqueductal Stenosis

OBJECTIVE: To evaluate the long-term efficacy of third ventriculostomies for adult patients with hydrocephalus caused by primary Aqueductal Stenosis. METHODS: Eighteen of 64 patients who underwent endoscopic third ventriculostomies (ETVs) between June 1991 and July 1995 were treated because of primary Aqueductal Stenosis. All of these patients accepted follow-up investigations, which were performed 3 months to 5 years after surgery. If hydrocephalic symptoms persisted, the patency of the ventriculostomy was investigated; in cases of open ventriculostomies, the patients were offered shunt surgery. The effects of the shunt surgery were evaluated after 3 months. RESULTS: After ETV, nine of the patients exhibited excellent improvements, two exhibited slight improvements, one displayed no change, and six demonstrated temporary improvements. The ventriculostomies were patent in all nine patients who experienced less than excellent results. Subsequent ventriculoperitoneal shunt placement produced improvements for all seven patients who accepted the surgery. CONCLUSION: In our experience, the long-term effectiveness of ETVs for adult patients with noncommunicating hydrocephalus was sufficient in only 50% of the cases. One-third of the patients exhibited temporary improvements, lasting 1 to 12 months (average duration, 5 mo) after the ETVs, and then demonstrated deterioration to even worse clinical conditions, despite patent ventriculostomies. All patients who did not exhibit permanent improvements after the ETVs benefited from shunt surgery. Efforts should be made to establish methods for the selection of patients for ETV or ventriculoperitoneal shunt surgery.

unusual mesencephalic developmental venous anomaly causing obstructive hydrocephalus due to Aqueductal Stenosis

Developmental venous anomalies (DVAs) are benign vascular malformations that rarely become symptomatic. They are anatomical variations of the venous drainage system and most are incidentally discovered. Mechanical (obstruction and compression of cerebral and neural structures) and flow-related pathological mechanisms have been described in rare cases of symptomatic DVAs. The authors present the case of a 10-month-old boy with a mesencephalic DVA compressing the aqueduct and causing occlusive hydrocephalus. Endoscopic inspection confirmed the venous malformation causing Aqueductal Stenosis. The authors successfully performed endoscopic third ventriculostomy, resulting in decrease in the size of the ventricles. At the 6-month follow-up after surgery, the patient had significantly progressed in his psychomotor development. One year postsurgery the patient is doing fine, with no neurological or developmental deficits.

Endoscopic aqueductoplasty in the treatment of Aqueductal Stenosis.

Endoscopic aqueductoplasty is an option in the treatment of obstructive hydrocephalus caused by Aqueductal stenoses. We report on our experience with this endoscopic technique, focussing on indications, operative technique, and results.
A series of 39 endoscopic aqueductoplasties was performed in 33 patients harbouring a hydrocephalus caused by Aqueductal Stenosis. In 13 patients, a third ventriculostomy was simultaneously performed. There was no endoscopy-related mortality. One aqueductoplasty had to be abandoned. In 7 patients, reclosure of the restored aqueduct required an endoscopic revision. In 25 patients (76%), the hydrocephalus-related symptoms resolved or improved. The condition was unchanged in 8 patients. Four patients needed to be shunted. The ventricles decreased in size in 22 patients (67%), were larger in 2, and unchanged in the remaining 9 patients.
Endoscopic aqueductoplasty is a treatment option in patients with hydrocephalus caused by membranous Aqueductal Stenosis. Unfortunately, the reclosure rate is higher than initially expected. More experience and longer follow-up are necessary to determine the value of endoscopic aqueductoplasty in the treatment of hydrocephalus caused by Aqueductal Stenosis.