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Collapsing ventricles: an unusual but challenging technical issue in ventricular neuroendoscopy

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Abstract

Background and importance

Ventricular endoscopy represents one of the most important surgical tools in modern neurosurgery. Even though it is a safe and well-tolerated procedure, it is worth remembering that complications and technical pitfalls are still a concern. In this paper, we describe an uncommon technical issue, namely ventricle collapse.

Clinical presentation

Hereby, we present two cases in which endoscopic procedure was burdened by a repeated collapse of the lateral ventricles that significantly limited the procedure. The first case was a 13-year-old girl with left thalamic tumor, while the second one was a 17-year-old girl with left paramedian cerebellar hemorrhage and associated supratentorial hydrocephalus.

Conclusions

Continuous irrigation with calculated, intermittent over-irrigation allowed us to “reopen” the ventricles and carried out the procedures. Alongside the paper, the authors will address the novelty presented in the literature on management, diagnosis and pathogenesis to offer a better understanding of such a heterogeneous pathology.

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Acknowledgements

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Authors and Affiliations

  1. Department of Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Federico Bianchi, Paolo Frassanito, Gianpiero Tamburrini & Luca Massimi

  2. Università Cattolica del Sacro Cuore, Rome, Italy

    Salvatore Marino, Gianpiero Tamburrini & Luca Massimi

Authors
  1. Federico Bianchi
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  2. Salvatore Marino
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  3. Paolo Frassanito
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  4. Gianpiero Tamburrini
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  5. Luca Massimi
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Corresponding author

Correspondence to Federico Bianchi.

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Ethical considerations

Hospital protocols followed.

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Supplementary Information

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Video 1: Through a left frontal burr hole, a 30-degree rigid endoscope was inserted in left lateral ventricle. Once inside, ventricular walls intermittently collapsed on itself during procedure, obstructing endoscopic view. Calculated and intermittent over-irrigation with physiological solution, reopen intraventricular spaces and allowed us to continue procedure for few seconds before the ventricle collapsed again, until tumor samples is obtained. Finally, patency of Monro foramina and third ventricle is verified before endoscope is pulled out. Video Link: https://drive.google.com/file/d/1Vw884HPWAyARIBEDugLfUEgEOr8ieg-K/view?usp=share_link (MP4 22291 KB)

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Bianchi, F., Marino, S., Frassanito, P. et al. Collapsing ventricles: an unusual but challenging technical issue in ventricular neuroendoscopy. J Ped Endosc Surg 5, 123–126 (2023). https://doi.org/10.1007/s42804-023-00191-y

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  • DOI: https://doi.org/10.1007/s42804-023-00191-y

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