Management of Aqueductal Stenosis in Children

Initial Management at Presentation

• ETV preferred by many: During the second half of the 1990s the results of large clinical series validated ETV as an acceptable treatment of aqueductal stenosis (9, 16, 17, 40, 47, 48, 106). It has since become the preferred treatment by many.
• Aqueductoplasty a controversial alternative to ETV: Endoscopic aqueductoplasty has been used as alternative to ETV in cases of membranous occlusion or short stenosis of the aqueduct (94). However aqueductoplasty is generally considered more risky because of the surround delicate midbrain structures, with the risk of neurological deficits such as oculomotor and trochlear palsies, Parinaud’s or aqueduct syndromes.
• Shunting: Although most prefer ETV to shunting for the management of aqueductal stenosis, there is still a 20% or more failure rate with ETV that necessitates the use of a shunt to manage the hydrocephalus.

Adjunctive Therapies

• Surgical resection: In rare cases the removal of a compressive lesion can result in the reopening of the aqueduct with resolution of the hydrocephalus.

Follow-up

• Routine hydrocephalus follow-up: Follow-up recommendations are covered in the chapter titled CSF Circulation and Hydrocephalus in Children.