Neuroendoscopic Aspiration of Blood Clots in the Cerebral Aqueduct and Third Ventricle During Posterior Fossa Surgery in the Prone Position
| Autor: | Riccardo Stanzani, Giacomo Pavesi, Giuliano Giliberto, Matteo Martinoni, Alberto Feletti, Matteo Alicandri-Ciufelli |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
Ependymoma suboccipital medicine.medical_specialty medicine.brain Fourth ventricle Cerebral Ventricles neuroendoscopy 030218 nuclear medicine & medical imaging Blood clots Prone position 03 medical and health sciences Posterior fossa Postoperative Complications 0302 clinical medicine Suboccipital Aspiration Neuroendoscopy medicine Humans Third Ventricle Fourth Ventricle Third ventricle aspiration business.industry Cerebral Aqueduct blood clots posterior fossa prone position Thrombosis Middle Aged medicine.disease Hydrocephalus Surgery medicine.anatomical_structure Ventricle Cerebral aqueduct Neurology (clinical) Optic recess business Cerebral Ventricle Neoplasms 030217 neurology & neurosurgery |
| Zdroj: | Operative Neurosurgery. 17:143-148 |
| ISSN: | 2332-4260 2332-4252 |
| DOI: | 10.1093/ons/opy324 |
| Popis: | Background During surgery in the posterior fossa in the prone position, blood can sometimes fill the surgical field, due both to the less efficient venous drainage compared to the sitting position and the horizontally positioned surgical field itself. In some cases, blood clots can wedge into the cerebral aqueduct and the third ventricle, and potentially cause acute hydrocephalus during the postoperative course. Objective To illustrate a technique that can be used in these cases: the use of a flexible scope introduced through the opened roof of the fourth ventricle with a freehand technique allows the navigation of the fourth ventricle, the cerebral aqueduct, and the third ventricle in order to explore the cerebrospinal fluid pathways and eventually aspirate blood clots and surgical debris. Methods We report on one patient affected by an ependymoma of the fourth ventricle, for whom we used a flexible neuroendoscope to explore and clear blood clots from the cerebral aqueduct and the third ventricle after the resection of the tumor in the prone position. Blood is aspirated with a syringe using the working channel of the scope as a sucker. Results A large blood clot that was lying on the roof of the third ventricle was aspirated, setting the ventricle completely free. Other clots were aspirated from the right foramen of Monro and from the optic recess. Conclusion We describe this novel technique, which represents a safe and efficient way to clear the surgical field at the end of posterior fossa surgery in the prone position. The unusual endoscopic visual perspective and instrument maneuvers are easily handled with proper neuroendoscopic training. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|