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Child's Nervous System

, Volume 35, Issue 9, pp 1565–1570 | Cite as

Interhypothalamic adhesions in endoscopic third ventriculostomy

  • David PhillipsEmail author
  • David A. Steven
  • Patrick J. McDonald
  • Jay Riva-Cambrin
  • Abhaya V. Kulkarni
  • Vivek Mehta
Original Article

Abstract

Introduction

An interhypothalamic adhesion (IHA) is a gray mater–like band of tissue traversing across the third ventricle anterior to the mammillary bodies and is similar but distinct from an interthalamic adhesion. These rare anatomic anomalies can be detected with magnetic resonance imaging or, incidentally, during endoscopic ventricular surgery.

Methods

All cases of interhypothalamic adhesions visualized during endoscopic third ventriculotomy (ETV), outside of the myelomeningocele setting, were identified from two institutions. Retrospective chart and imaging reviews were conducted and compared to intraoperative videos and photos for all cases. IHA variables collected included the following size, location, multiplicity, and associated anatomic anomalies.

Results

Four cases of interhypothalamic adhesions were identified during ETV—all of which, either partially or completely, obscured access to the third ventricular floor. The IHAs in our cohort were duplicated in two patients, large (> 3 mm and severely obstructing access to the third ventricular floor) in three patients, and adherent to the floor of the third ventricle in three patients. All four patients had primary absence of the septum pellucidum. Previous reports found associations of IHAs with other congenital, particularly midline, abnormalities. The IHAs in our cohort affected the surgery in three of four cases including misdirecting the ventriculostomy and requiring retraction or division of the IHA. In no case was postoperative pituitary or hypothalamic dysfunction observed.

Conclusions

Although interhypothalamic adhesions are rare, these anomalies must be recognized as they may hinder access to the third ventricular floor. IHAs may be large, multiple, or adherent to adjacent ventricular structures, they can misdirect or occlude the ventriculostomy or impart risk of bleeding and hypothalamic injury. Techniques for management of IHA include aborting the attempt, re-siting the ventriculostomy, or retracting or dividing the IHA, which enabled technically successful ETV in three of four patients in this series.

Keywords

Hypothalamic adhesion Intrahypothalamic adhesion Primary agenesis of the septum pellucidum Third ventricle anatomy 

Notes

Acknowledgments

The authors appreciate Dr. Mark Hamilton’s help with review of this manuscript. The authors also wish to acknowledge Dr. Simon Walling, Dr. Andrew Parrent, and Dr. James Drake for their advice and expertise.

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Neurosurgery, Department of Clinical NeurosciencesUniversity of CalgaryCalgaryCanada
  2. 2.Division of Neurosurgery, Foothills Medical CampusCalgaryCanada
  3. 3.Department of Clinical Neurological SciencesWestern University and London Health Sciences CentreLondonCanada
  4. 4.Division of NeurosurgeryUniversity of British ColumbiaVancouverCanada
  5. 5.Division of NeurosurgeryUniversity of TorontoTorontoCanada
  6. 6.Division of NeurosurgeryUniversity of AlbertaEdmontonCanada

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