Endoscopic aqueductoplasty in the treatment of aqueductal stenosis

Endoscopic aqueductoplasty is an option of treatment of obstructive hydrocephalus caused by aqueductal stenosis. We report on our experience with this endoscopic technique. Eighteen patients with primary or secondary aqueductal stenosis underwent endoscopic aqueductoplasty (EA) with or without stenting between July 2004 and January 2007. EA, EA with a stent, EA with endoscopic third ventriculostomy (ETV), and EA with stenting in addition to ETV were performed in eight, five, three, and two patients, respectively. A repeat endoscopic procedure was done in one patient. EA with a stent was performed in case 1, 8 months after first endoscopic procedure. In four cases, aqueductoplasty with stent was performed through a suboccipital approach. There were no deaths due to the neuroendoscopic procedures. All of the patients showed improvement or resolution of their preoperative symptoms, although in case 1 a new endoscopic procedure was performed: EA with a stent. Cerebral aqueductoplasty is an effective and successful treatment for membranous and/or short-segment stenosis of the sylvian aqueduct. Endoscopic aqueductoplasty candidates must be selected very carefully but longer follow-up periods are necessary to evaluate long-term aqueductal patency after aqueductoplasty.