Stereotaxic reconstruction of the aqueduct of Sylvius

Abstract

A stereotaxic technique was developed to cannulate the cerebral aqueduct in patients with hydrocephalus resulting from occlusion of the aqueduct of Sylvius. Precise placement of a 15-20 mm long radiopaque prosthesis between the 3rd and 4th ventricles can reestablish the normal CSF pathway. Seven patients underwent aqueductal reconstruction. The surgical goal in this series was to manage the hydrocephalus by creating and maintaining a patent aqueductal channel. The follow-up period ranged from 1.5-6.5 yr. In 4 cases, aqueductal reconstruction alone resulted in control of the hydrocephalus, although 2 patients underwent revisions of their prosthesis. Three patients ultimately required shunts, despite initial symptomatic improvement after reconstruction. In these 7 cases (13 stereotaxic procedures), no mortality and no significant operative morbidity were encountered. Although the technique is relatively simple to perform, technical difficulties remain. No clinical or radiographic test adequately discerns the ideal candidate for stereotaxic aqueductal reconstruction. Four patients required stereotaxic revision because of malposition or malfunction of the prosthesis. This approach should be reversed for patients with a short aqueductal occlusion, and normal distal CSF pathways and dynamics. The rationale, technique, problems and results of stereotaxic reconstruction are presented.