Images in Clinical Medicine

Kim Eagle, M.D., Editor

Endoscopic Laser Third Ventriculostomy

Alan R. Cohen, M.D.

N Engl J Med 1993; 328:552February 25, 1993

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Article

Figure 1 Endoscopic Laser Third Ventriculostomy.

A 37-year-old woman was admitted to the hospital because she had had headaches for two years. A neurologic examination was remarkable for the absence of retinal venous pulsations. Magnetic resonance imaging of the brain (Panel A) showed noncommunicating hydrocephalus due to stenosis of the caudal aqueduct of Sylvius (open arrow), with enlargement of the third ventricle and attenuation of its floor (solid arrow). Endoscopic laser third ventriculostomy (Panel B) was performed in an effort to control hydrocephalus without the use of a ventricular shunt. The right lateral ventricle was cannulated through a coronal burr hole, and an endoscope was inserted through the foramen of Monro into the third ventricle. A fiberoptic neodymium:yttrium-aluminum-garnet laser was used to fenestrate the floor of the third ventricle anterior to the mamillary bodies, allowing cerebrospinal fluid to escape into the subarachnoid space and bypass the obstruction at the aqueduct. B denotes basilar artery, VS ventricular system, and LA laser. The endoscope was then passed through the third ventriculostomy (Panel C), and the basilar artery and its pontine perforating branches were visualized in the prepontine cistern. F indicates the edge of the hole created by the laser in the third ventricular floor. The patient's headaches resolved, and the ventricular size decreased on follow-up magnetic resonance imaging.

Kim Eagle, M.D.

Alan R. Cohen, M.D.
New England Medical Center, Boston, MA 02111

Citing Articles (8)

Citing Articles

1. 1

   H. C. Ludwig, T. Kruschat, T. Knobloch, H.-O. Teichmann, K. Rostasy, V. Rohde. (2007) First experiences with a 2.0-μm near infrared laser system for neuroendoscopy. Neurosurgical Review 30:3, 195-201
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2. 2

   Dieter Hellwig, Joachim Andreas Grotenhuis, Wuttipong Tirakotai, Thomas Riegel, Dirk Michael Schulte, Bernhard Ludwig Bauer, Helmut Bertalanffy. (2004) Endoscopic third ventriculostomy for obstructive hydrocephalus. Neurosurgical Review
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   SHEKAR N. KURPAD, ALAN R. COHEN. (1999) Endoscopic Third Ventriculostomy. Pediatric Endosurgery & Innovative Techniques 3:3, 117-121
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   Michael L. Levy. (1998) Virtual Endoscopic Simulations in Neurosurgery: Technical Considerations and Methodology. Neurosurgery 43:3, 538-548
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   Ludwig M. Auer, Dorothee P. Auer. (1998) Virtual Endoscopy for Planning and Simulation of Minimally Invasive Neurosurgery. Neurosurgery 43:3, 529-537
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   D. Hellwig, T. Riegel, H. Bertalanffy. (1998) Neuroendoscopic techniques in treatment of intracranial lesions. Minimally Invasive Therapy & Allied Technologies 7:2, 123-135
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   R.L. Patrick Rhoten, Mark G. Luciano, Gene H. Barnett. (1997) Computer-assisted Endoscopy for Neurosurgical Procedures: Technical Note. Neurosurgery 40:3, 632-638
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8. 8

   (1993) Endoscopic Laser Third Ventriculostomy. New England Journal of Medicine 329:3, 207-208
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