{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T04:41:56Z","timestamp":1776314516731,"version":"3.50.1"},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Hydrocephalus is one of the neurological risks occurring in patients with achondroplasia. Ventriculoperitoneal shunt (VPS) insertion is the most common treatment. However, reports of successful endoscopic third ventriculostomy (ETV) suggest that ETV may be a good alternative to VPS insertion in achondroplasia. However, it has been stated that ETV in achondroplasia patients is technically demanding to perform. The current study examined the anatomical variations of the third ventricle and the brainstem in achondroplasia patients and correlated the findings with the difficulty of performing ETV.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A retrospective analysis of 51 patients with achondroplasia and 138 hydrocephalus patients without achondroplasia (48 patients had tumor-related hydrocephalus and 90 patients had hydrocephalus of nontumorous origin) who have visited the authors\u2019 institution since 2012 was performed. Preoperative T2-weighted sagittal MR images were used to measure \u03b1 (steepness of the third ventricle floor), \u03b2 (endoscopic angle of incidence), d1 (vertical distance between the dorsum sellae and basilar bifurcation), and d2 (horizontal distance between the dorsum sellae and basilar artery). Each value was compared using the Tukey multicomparison test.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Achondroplasia patients showed significantly smaller \u03b1 (p &lt; 0.001) and \u03b2 (p &lt; 0.001) angles, while there were no significant differences between the control groups (p = 0.947 for \u03b1, p = 0.836 for \u03b2). The d1 value was significantly larger in achondroplasia patients (p &lt; 0.001), and d2 was smaller (p &lt; 0.001). The control groups showed similar d1 and d2 values (p = 0.415 for d1, p = 0.154 for d2). Smaller \u03b1 and \u03b2 values meant that in achondroplasia patients the third ventricle floor stood more vertically than in other patients with hydrocephalus, and the endoscopic contact angles were small, increasing the risk of ventriculostomy devices slipping down into the infundibular recess. Additionally, a large d1 meant that the basilar artery was shifted upward and a small d2 indicated that the basilar artery was located closer to the dorsum sellae, potentially increasing the risk of basilar artery damage.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Achondroplasia patients\u2019 skull and brain anatomies were significantly different from those of other hydrocephalus patients, with steeper third ventricle floors and basilar arteries closer to the dorsum sellae. Because these anatomical differences lead to difficulties in performing ETVs in achondroplasia patients, such differences should be considered when ETV is planned for the patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.6.peds2472","type":"journal-article","created":{"date-parts":[[2024,8,31]],"date-time":"2024-08-31T02:11:22Z","timestamp":1725070282000},"page":"462-469","source":"Crossref","is-referenced-by-count":2,"title":["Challenges in endoscopic third ventriculostomy for patients with achondroplasia: a focus on third ventricle floor anatomy"],"prefix":"10.3171","volume":"34","author":[{"given":"Ji Yul","family":"Shin","sequence":"first","affiliation":[{"name":"College of Medicine, Seoul National University, Seoul;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. Hyeon","family":"Kim","sequence":"additional","affiliation":[{"name":"College of Medicine, Seoul National University, Seoul;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jung Min","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Seoul National University Children\u2019s Hospital, College of Medicine, Seoul National University, Seoul;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tae-Joon","family":"Cho","sequence":"additional","affiliation":[{"name":"Division of Pediatric Orthopedics, Seoul National University Children\u2019s Hospital, College of Medicine, Seoul National University, Seoul; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seung-Ki","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Seoul National University Children\u2019s Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji Hoon","family":"Phi","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Seoul National University Children\u2019s Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Orphanet J Rare Dis","first-page":"1","article-title":"Achondroplasia: a comprehensive clinical review","volume":"14","author":"Pauli RM","year":"2019","unstructured":"Pauli RM. Achondroplasia: a comprehensive clinical review. Orphanet J Rare Dis. 2019;14(1):1\u201349."},{"issue":"4","key":"b2","series-title":"J Neurosurg Pediatr","first-page":"297","article-title":"Neurosurgical implications of achondroplasia","volume":"4","author":"King JA","year":"2009","unstructured":"King JA, Vachhrajani S, Drake JM, Rutka JT. Neurosurgical implications of achondroplasia. J Neurosurg Pediatr. 2009;4(4):297\u2013306."},{"issue":"8","key":"b3","series-title":"Childs Nerv Syst","first-page":"1295","article-title":"Pathogenesis of hydrocephalus in achondroplastic dwarfs: a review and presentation of a case followed for 22 years","volume":"35","author":"Rekate HL","year":"2019","unstructured":"Rekate HL. Pathogenesis of hydrocephalus in achondroplastic dwarfs: a review and presentation of a case followed for 22 years. Childs Nerv Syst. 2019;35(8):1295\u20131301."},{"issue":"1","key":"b4","series-title":"Orphanet J Rare Dis","first-page":"81","article-title":"Predictors of cervical myelopathy and hydrocephalus in young children with achondroplasia","volume":"16","author":"Shim Y","year":"2021","unstructured":"Shim Y, Ko JM, Cho TJ, Kim SK, Phi JH. Predictors of cervical myelopathy and hydrocephalus in young children with achondroplasia. Orphanet J Rare Dis. 2021;16(1):81."},{"issue":"3 Suppl","key":"b5","series-title":"J Neurosurg","first-page":"260","article-title":"The role of endoscopic third ventriculostomy in the treatment of triventricular hydrocephalus seen in children with achondroplasia","volume":"103","author":"Etus V","year":"2005","unstructured":"Etus V, Ceylan S. The role of endoscopic third ventriculostomy in the treatment of triventricular hydrocephalus seen in children with achondroplasia. J Neurosurg. 2005;103(3 Suppl):260\u2013265."},{"issue":"12","key":"b6","series-title":"Childs Nerv Syst","first-page":"3907","article-title":"Endoscopic third ventriculostomy for hydrocephalus in a patient with achondroplasia: a case report and literature review","volume":"37","author":"Shoda K","year":"2021","unstructured":"Shoda K, Ohe N, Sasai H, Miyai M, Ohnishi H, Iwama T. Endoscopic third ventriculostomy for hydrocephalus in a patient with achondroplasia: a case report and literature review. Childs Nerv Syst. 2021;37(12):3907\u20133911."},{"issue":"1","key":"b7","series-title":"J Neurosurg Pediatr","first-page":"73","article-title":"Endoscopic third ventriculostomy in hydrocephalus associated with achondroplasia","volume":"9","author":"Swift D","year":"2012","unstructured":"Swift D, Nagy L, Robertson B. Endoscopic third ventriculostomy in hydrocephalus associated with achondroplasia. J Neurosurg Pediatr. 2012;9(1):73\u201381."},{"issue":"3","key":"b8","series-title":"J Neurosurg Pediatr","first-page":"268","article-title":"Hydrocephalus in achondroplasia: efficacy of endoscopic third ventriculostomy","volume":"29","author":"Kim J","year":"2021","unstructured":"Kim J, Patel VJ, El Ahmadieh TY, Olson DM, Swift DM. Hydrocephalus in achondroplasia: efficacy of endoscopic third ventriculostomy. J Neurosurg Pediatr. 2021;29(3):268\u2013275."},{"issue":"3","key":"b9","series-title":"Am J Hum Genet","first-page":"732","article-title":"Prospective assessment of risks for cervicomedullary-junction compression in infants with achondroplasia","volume":"56","author":"Pauli RM","year":"1995","unstructured":"Pauli RM, Horton VK, Glinski LP, Reiser CA. Prospective assessment of risks for cervicomedullary-junction compression in infants with achondroplasia. Am J Hum Genet. 1995;56(3):732\u2013744."},{"issue":"1-3","key":"b10","series-title":"Acta Neurochir (Wien)","first-page":"243","article-title":"Basilar impression in an achondroplastic dwarf: causative role in tetraparesis","volume":"41","author":"Luyendijk W","year":"1978","unstructured":"Luyendijk W, Matricali B, Thomeer RT. Basilar impression in an achondroplastic dwarf: causative role in tetraparesis. Acta Neurochir (Wien). 1978;41(1-3):243\u2013253."},{"issue":"2","key":"b11","series-title":"Pediatr Neurosurg","first-page":"78","article-title":"Achondroplasia and cervicomedullary compression: prospective evaluation and surgical treatment","volume":"31","author":"Keiper GL Jr","year":"1999","unstructured":"Keiper GL Jr, Koch B, Crone KR. Achondroplasia and cervicomedullary compression: prospective evaluation and surgical treatment. Pediatr Neurosurg. 1999;31(2):78\u201383."},{"issue":"2","key":"b12","series-title":"Bosn J Basic Med Sci","first-page":"110","article-title":"Craniosynostosis\u2014recognition, clinical characteristics, and treatment","volume":"18","author":"Kajdic N","year":"2018","unstructured":"Kajdic N, Spazzapan P, Velnar T. Craniosynostosis\u2014recognition, clinical characteristics, and treatment. Bosn J Basic Med Sci. 2018;18(2):110\u2013116."},{"issue":"2","key":"b13","series-title":"J Neurosci Rural Pract","first-page":"163","article-title":"Endoscopic third ventriculostomy","volume":"3","author":"Yadav YR","year":"2012","unstructured":"Yadav YR, Parihar V, Pande S, Namdev H, Agarwal M. Endoscopic third ventriculostomy. J Neurosci Rural Pract. 2012;3(2):163\u2013173."},{"issue":"1","key":"b14","series-title":"Pediatr Neurosurg","first-page":"35","article-title":"Basilar artery perforation as a complication of endoscopic third ventriculostomy","volume":"28","author":"Abtin K","year":"1998","unstructured":"Abtin K, Thompson BG, Walker ML. Basilar artery perforation as a complication of endoscopic third ventriculostomy. Pediatr Neurosurg. 1998;28(1):35\u201341."},{"issue":"6","key":"b15","series-title":"Neurosurgery","first-page":"1400","article-title":"Traumatic basilar aneurysm after endoscopic third ventriculostomy: case report","volume":"41","author":"McLaughlin MR","year":"1997","unstructured":"McLaughlin MR, Wahlig JB, Kaufmann AM, Albright AL. Traumatic basilar aneurysm after endoscopic third ventriculostomy: case report. Neurosurgery. 1997;41(6):1400\u20131404."},{"issue":"6","key":"b16","series-title":"Neurosurgery","first-page":"1461","article-title":"Endovascular management of a basilar artery false aneurysm secondary to endoscopic third ventriculostomy: case report","volume":"49","author":"Horowitz M","year":"2001","unstructured":"Horowitz M, Albright AL, Jungreis C, Levy EI, Stevenson K. Endovascular management of a basilar artery false aneurysm secondary to endoscopic third ventriculostomy: case report. Neurosurgery. 2001;49(6):1461\u20131465."},{"issue":"12","key":"b17","series-title":"Pediatr Radiol","first-page":"1669","article-title":"Neuroimaging and calvarial findings in achondroplasia","volume":"50","author":"Sarioglu FC","year":"2020","unstructured":"Sarioglu FC, Sarioglu O, Guleryuz H. Neuroimaging and calvarial findings in achondroplasia. Pediatr Radiol. 2020;50(12):1669\u20131679."},{"issue":"1","key":"b18","series-title":"Childs Nerv Syst","first-page":"129","article-title":"Achondroplasia in children: correlation of ventriculomegaly, size of foramen magnum and jugular foramina, and emissary vein enlargement","volume":"31","author":"Bosemani T","year":"2015","unstructured":"Bosemani T, Orman G, Hergan B, Carson KA, Huisman TA, Poretti A. Achondroplasia in children: correlation of ventriculomegaly, size of foramen magnum and jugular foramina, and emissary vein enlargement. Childs Nerv Syst. 2015;31(1):129\u2013133."},{"key":"b19","series-title":"Interdiscip Neurosurg","first-page":"66","article-title":"Ventriculoperitoneal shunt complications: a review","volume":"13","author":"Paff M","year":"2018","unstructured":"Paff M, Alexandru-Abrams D, Muhonen M, Loudon W. Ventriculoperitoneal shunt complications: a review. Interdiscip Neurosurg. 2018;13:66\u201370."},{"issue":"5","key":"b20","series-title":"J Neurosurg","first-page":"923","article-title":"Endoscopic third ventriculostomy in the management of communicating hydrocephalus: a preliminary study","volume":"109","author":"Hailong F","year":"2008","unstructured":"Hailong F, Guangfu H, Haibin T,  Endoscopic third ventriculostomy in the management of communicating hydrocephalus: a preliminary study. J Neurosurg. 2008;109(5):923\u2013930."}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/34\/5\/article-p462.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/34\/5\/article-p462.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/34\/5\/article-p462.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T13:08:24Z","timestamp":1733490504000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/34\/5\/article-p462.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,1]]},"references-count":20,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2024.6.peds2472","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,1]]}}}