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Philosophical Transactions of the Royal... Feb 2020The brain ventricles are interconnected, elaborate cavities that traverse the brain. They are filled with cerebrospinal fluid (CSF) that is, to a large part, produced by... (Review)
Review
The brain ventricles are interconnected, elaborate cavities that traverse the brain. They are filled with cerebrospinal fluid (CSF) that is, to a large part, produced by the choroid plexus, a secretory epithelium that reaches into the ventricles. CSF is rich in cytokines, growth factors and extracellular vesicles that glide along the walls of ventricles, powered by bundles of motile cilia that coat the ventricular wall. We review the cellular and biochemical properties of the ventral part of the third ventricle that is surrounded by the hypothalamus. In particular, we consider the recently discovered intricate network of cilia-driven flows that characterize this ventricle and discuss the potential physiological significance of this flow for the directional transport of CSF signals to cellular targets located either within the third ventricle or in the adjacent hypothalamic brain parenchyma. Cilia-driven streams of signalling molecules offer an exciting perspective on how fluid-borne signals are dynamically transmitted in the brain. This article is part of the Theo Murphy meeting issue 'Unity and diversity of cilia in locomotion and transport'.
Topics: Biological Transport; Cilia; Hypothalamus; Third Ventricle
PubMed: 31884922
DOI: 10.1098/rstb.2019.0154 -
Cureus Oct 2018Third ventricle tumors are uncommon and account for 0.6 - 0.9% of all the brain tumors. Tumors of the third ventricle are classified into primary tumors, such as colloid... (Review)
Review
Third ventricle tumors are uncommon and account for 0.6 - 0.9% of all the brain tumors. Tumors of the third ventricle are classified into primary tumors, such as colloid cysts, choroid plexus papillomas, and ependymomas, or secondary tumors, such as craniopharyngiomas, optic nerve gliomas, pineal tumors, and meningiomas. Third ventricular tumors are uncommon, and their treatment involves significant morbidity and mortality. The colloid cyst has a better surgical outcome and many approaches are available to achieve a complete cure. Choroid plexus papilloma is also a common tumor documented with its treatment majorly based on surgical resection. In addition to multiple treatment options for craniopharyngiomas, surgery is the most preferred treatment option. Ependymomas also have few treatment options, with surgical resection adopted as the first line of treatment.
PubMed: 30542631
DOI: 10.7759/cureus.3417 -
Neurology India 2021Endoscopic third ventriculostomy (ETV) has become a proven modality for treating obstructive and selected cases of communicating hydrocephalus. (Review)
Review
BACKGROUND
Endoscopic third ventriculostomy (ETV) has become a proven modality for treating obstructive and selected cases of communicating hydrocephalus.
OBJECTIVE
This review aims to summarize the indications, preoperative workup, surgical technique, results, postoperative care, complications, advantages, and limitations of an ETV.
MATERIALS AND METHODS
A thorough review of PubMed and Google Scholar was performed. This review is based on the relevant articles and authors' experience.
RESULTS
ETV is indicated in obstructive hydrocephalus and selected cases of communicating hydrocephalus. Studying preoperative imaging is critical, and a detailed assessment of interthalamic adhesions, the thickness of floor, arteries or membranes below the third ventricle floor, and prepontine cistern width is essential. Blunt perforation in a thin floor, while bipolar cautery at low settings and water jet dissection are preferred in a thick floor. The appearance of stoma pulsations and intraoperative ventriculostomography reassure stoma and basal cistern patency. The intraoperative decision for shunt, external ventricular drainage, or Ommaya reservoir can be taken. Magnetic resonance ventriculography and cine phase-contrast magnetic resonance imaging can determine stoma patency. Good postoperative care with repeated cerebrospinal fluid drainage enhances outcomes in selected cases. Though the complications mostly occur in an early postoperative phase, delayed lethal ones may happen. Watching live surgeries, assisting expert surgeons, and practicing on cadavers and models can shorten the learning curve.
CONCLUSION
ETV is an excellent technique for managing obstructive and selected cases of communicating hydrocephalus. Good case selection, methodical technique, and proper training under experts are vital.
Topics: Cerebral Ventricles; Humans; Hydrocephalus; Magnetic Resonance Imaging; Third Ventricle; Ventriculostomy
PubMed: 35103009
DOI: 10.4103/0028-3886.332253 -
Frontiers in Oncology 2022
PubMed: 35392218
DOI: 10.3389/fonc.2022.872689 -
Neurology India 2021The global burden of pediatric hydrocephalus is high, causing significant morbidity and mortality among children especially in low- and middle-income countries. It is... (Review)
Review
BACKGROUND
The global burden of pediatric hydrocephalus is high, causing significant morbidity and mortality among children especially in low- and middle-income countries. It is commonly treated with ventriculoperitoneal shunting, but in recent years, the combined use of endoscopic third ventriculostomy (ETV) and choroid plexus coagulation (CPC) has enabled patients to live without a shunt.
OBJECTIVE
We aim to give an overview of ETV+CPC for the treatment of hydrocephalus in infants, focusing on patient selection, perioperative care, and long-term follow-up.
METHODS AND MATERIAL
We summarize observational studies and randomized trials on the efficacy and safety ETV+CPC, mainly from Uganda and North America. The equipment needs and operative steps of ETV+CPC are enumerated. At the end of the article, three illustrative cases of infants who underwent ETV+CPC with differing outcomes are presented.
RESULTS
The likelihood of success following ETV+CPC is the highest among infants older than 1 month, those with noninfectious hydrocephalus (e.g., aqueductal stenosis and myelomeningocele), and those previously without a shunt. Poor outcomes are seen in patients with posthemorrhagic hydrocephalus or evidence of cisternal scarring. Failure of ETV+CPC most commonly occurs within 3-6 months of surgery.
CONCLUSIONS
ETV+CPC is an effective and safe alternative to ventriculoperitoneal shunting in appropriately selected infants with hydrocephalus. Long-term studies on functional and neurocognitive outcomes following ETV+CPC will help guide clinicians in decision making, allowing as many children as possible to attain shunt freedom.
Topics: Cautery; Child; Choroid Plexus; Humans; Infant; Neuroendoscopy; Third Ventricle; Treatment Outcome; Ventriculostomy
PubMed: 35103010
DOI: 10.4103/0028-3886.332270 -
Turkish Neurosurgery 2015Colloid cysts are usually located in third ventricle and are believed to be derived from either primitive neuroepithelium or endoderm. Patients may remain asymptomatic... (Review)
Review
Colloid cysts are usually located in third ventricle and are believed to be derived from either primitive neuroepithelium or endoderm. Patients may remain asymptomatic for long time while some can present with paroxysmal headache, gait disturbance, nausea, vomiting, behavioral changes, weaknesses of lower limbs, impaired memory, new learning disability and sudden death. Computed tomography usually reveals a well-defined round or oval nonenhancing lesion. Although magnetic resonance imaging (MRI) signal intensity of colloid cysts is variable, the most common appearance is hyperintensity in T1-weighted sequences and iso to hypointensity in T2-weighted sequences. Observation, stereotactic aspiration, microscopic or endoscopic approaches and shunt surgery are various management options. Transcallosal and transcortical microscopic (with or without tubular retractor) approaches are mainly useful in normal-sized and dilated ventricles respectively. Endoscopic technique is an effective alternative to microsurgical technique but total resection and long-term recurrence remains a concern. Utilization of two instruments, the bi port technique and tubular retractor can be helpful in selected patients to overcome limitations. Although total excision should be aimed, subtotal excision and coagulation of residual cyst wall usually results in good long-term results without any growth of remnant wall. Conversion to an open procedure may be required in some patients.
Topics: Cerebral Ventricle Neoplasms; Colloid Cysts; Humans; Neurosurgical Procedures; Third Ventricle
PubMed: 26037175
DOI: 10.5137/1019-5149.JTN.11086-14.1