From the Guidelines
Cerebral aqueduct stenosis is typically diagnosed with imaging studies and treated with surgical intervention, such as endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunting.
Diagnosis
- Imaging studies, including MRI or CT scans, are used to diagnose cerebral aqueduct stenosis by visualizing the narrowing of the aqueduct of Sylvius 1.
- The status of the aqueduct on imaging or through ventriculoscopy is a key issue in the classification methods, and many studies reported high numbers of aqueduct stenosis and determined this as congenital aqueduct stenosis 1.
Treatment
- Surgical intervention, such as endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunting, is typically used to treat cerebral aqueduct stenosis 1.
- The choice of treatment depends on the individual case and the underlying cause of the stenosis, and may involve a combination of surgical and medical management.
Important Considerations
- The scarcity of advanced imaging facilities, such as MRI, can hinder proper diagnostics and classification of aetiology, as well as adequate evaluation of treatment 1.
- Infections can cause aqueduct stenosis due to inflammation, and some cases of congenital aqueduct stenosis may in fact have a postinfectious hydrocephalus aetiology 1.
From the Research
Diagnosis of Cerebral Aqueduct Stenosis
- Cerebral aqueduct stenosis is a condition where the flow of cerebrospinal fluid (CSF) is blocked due to a narrowing of the aqueduct of Sylvius, leading to hydrocephalus 2, 3.
- The diagnosis of cerebral aqueduct stenosis can be made using modern neuroradiologic techniques such as MRI, which can help identify the site of obstruction and guide treatment 3.
- Clinical presentation and radiological diagnosis are crucial in identifying patients with late-onset idiopathic aqueductal stenosis (LIAS) 4.
Treatment of Cerebral Aqueduct Stenosis
- Endoscopic third ventriculostomy (ETV) is considered the gold standard treatment for obstructive hydrocephalus due to partial or complete obstruction of CSF ventricular pathways caused by mass lesions 4.
- ETV has become the first-line treatment for aqueductal stenosis, with fewer complications and rare revisions compared to shunt surgery 2, 3.
- However, some patients may require shunt surgery to improve despite a patent ventriculostomy, and there are currently no common criteria for patient selection to either ETV or ventriculo-peritoneal shunt surgery 2.
- Endoscopic aqueductoplasty is an effective alternative to third ventriculostomy for the treatment of hydrocephalus caused by short aqueductal stenosis, but longer follow-up periods are necessary to evaluate long-term aqueductal patency after aqueductoplasty 5.
- The treatment outcome of aqueductal stenosis can be influenced by the age and type of the condition, with different subtypes responding better to ETV or VP-shunting 6.